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GVWP Teacher Consultant
STUDENT RELEASE FORM
(to be completed either by the parents/legal guardians of minor students involved in this project, or by students who are more than 18 years of age
that are involved in this project)
Dear Parent/Guardian:
I am a classroom teacher consultant (TC) for the Great Valley Writing Project (GVWP). Reflecting on student work
helps me examine and improve my teaching practice. As a TC, I often share my classroom practices (including
samples of student work) with other teachers of writing. The primary purpose of this type of professional
development is to enhance student learning and encourage excellence in teaching.
On occasion GVWP uses reproductions of student work and photographs of teaching demonstrations as evidence of
teaching practice. The samples focus on the teacher's instruction, not on the students in the class. In the course of
this academic year I will select classroom photographs and representative writing samples, which may include some
of your child's work.
No student's last name will appear on any materials that are shared. The form below will be used to document your
permission for these activities.
Sincerely,
(Consultant Signature)
PERMISSION SLIP
Student Name: School/Teacher:
Your Address:
I am the parent/legal guardian of the child named above. I have received and read your letter regarding your work with colleagues
and the Great Valley Writing Project, and agree to the following:
(Please check the appropriate
boxes below.)
I DO give permission to you to include my child’s classroom work.
I DO give permission to you to include my child’s image as he or she participates in a class or
demonstration.
I DO NOT give permission to you to include my child’s classroom work.
I DO NOT give permission to you to include my child’s image as he or she participates in a class or
demonstration.
Signature of Parent or Guardian: Date:
I am the student named above and am more than 18 years of age. I have read and understand the information given above. I
understand that my performance is not being evaluated by GVWP and that my last name will not appear on any samples that may
be shared.
I DO give permission to you to include my image and/or to reproduce samples that I may produce as part of classroom
activities.
I DO NOT give permission to you to include my image and/or to reproduce samples that I may produce as part of
classroom activities.
Signature of Student:
Date:
Date of Birth: / /