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20-21 NASA & U.S. Department of Education 21st Century Community Learning Centers Collaboration Phase 4: NASA Engineering Design Challenges
Active Parental Consent for Student Data Evaluation
Active Consent Notice
Student Data and Evaluation Consent
In order to understand how well the program improves students’ interest in Science, Technology, Engineering and Mathematics, students will be asked to complete one survey while in the program. The survey will take place at at the end of the program. This survey should take no more than 20 minutes to complete. What we learn from your child’s experience in the program will help us improve this program’s learning opportunities for future students.
Your child will not be able to be identified, in any way, from the surveys. Participating in the completion of the surveys will not affect your child in school, or in any other way. Your name or your child’s name will not be used in any report. When the evaluation is over, all records will be destroyed. Participation in completing the surveys is completely voluntary. Your child can participate in the program without completing the survey. Your child may stop completing the survey at any time without affecting her/his participation in the program.
By signing below, I am giving my permission for my child(ren) to participate in the evaluation of the program.
Privacy Notice: This is an official NASA application hosted on Surveymonkey.com. This is not a government application, the application is controlled and operated by a third party. NASA’s Web
Privacy Policy does not apply to this application. NASA will not maintain, use, or share Personally Identifiable Information (PII) that becomes available through the use of this third-party application unless expressly stated and consent is obtained from the user. For additional information on NASA’s Third-Party Privacy Notice please go to http://www.nasa.gov/about/highlights/HP_Privacy.html.
Paperwork Reduction Act Statement: This information collection meets the requirements of 44 U.S.C. §3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 2700-0182 and expires 11/30/2023. We estimate that it will take 15 minutes to read the instructions and answer the questions. Send only comments relating to this time estimate to: richard.l.gilmore@nasa.gov.