COE - Consent and Release Form

I. Demographic Information

Program/Concentration or Major

II. Components

Please contact Unit Assessment (301.687.7953) or Graduate Services (301.687.4595) if you wish to withdraw any or all consents.

Maryland Assessment Informed Consent
To measure the outcomes of pre-service teachers, an assessment tool is being created that will use anonymous samples of students’ work. Student work may be used to help clarify the rubrics generated during the study, for norming performance, for comparing institutions, or as a benchmark for scoring similar evidence. All documents will be held in confidence to the extent required by law, and student work will be presented anonymously. Your participation in this project is voluntary. You are free to refuse or withdraw consent at any time.
Release of Personally Identifying Information to Specified Personnel at Field Experience Sites
According to the “Family Educational Rights and Privacy Act of 1974”, you must give your consent to our releasing information or data to Principals and Cooperating Teachers who will supervise your site experience(s) or internship.
Consent to Release of Video Recording of Teaching Performance
Identification as a Completer of Frostburg State University Teacher Education Program
The Title II, Higher Education Act requires reports from teacher-preparing states and institutions. This Act intends to measure and report the quality of pre-service (initial certification) teacher preparation programs. The name and social security number of students along with the program that they complete will be sent to the Educational Testing Service (ETS). Reports generated will provide aggregate data about programs at institutions in states. The Maryland State Department of Education (MSDE) requires teacher education programs to identify completers and to supply pertinent information.
National Council for Accreditation of Teacher Education (NCATE) Informed Consent
To achieve and sustain NCATE accreditation, student work is used to demonstrate performance standards; to show scoring, rubrics, norming, and instructional prescription; and to illustrate program processes
Liability Release Statement
In consideration of being permitted to participate in field experiences and internships through Frostburg State University’s Department of Educational Professions (the “University”), I acknowledge and fully understand that I will be engaging in activities that involve risks, including but not limited to the risk of injury or death resulting not only from my actions, inaction, or negligence, but the actions, inaction, or negligence of others. These risks include but are not limited to travel to and from the site, equipment used at the site, conditions that exist on the premises, and other risks that may not be known to me or are not reasonably foreseeable.
I voluntarily assume that all risk of loss, damage, illness, injury or death that I may sustain while participation in said University-sponsored activities. On behalf of myself and my heirs and estate, I agree to release, waive, discharge, and hold harmless the State of Maryland, the University System of Maryland, Frostburg State University, and their respective officers, demands, liabilities, loss, or damages resulting from my participation in the University’s internship program, except as may be due to the gross negligence or willful misconduct of the University or its employees and agents.
The University reserves the right to decline to accept or retain me in the program at any time should my actions or general behavior impede the operation of the program or the rights or welfare of any person. Similarly, if my conduct violates any policy or procedure of the University, I understand that I may be required to leave the program at the sole discretion of the University’s representatives and agents, and may be referred to the appropriate University officials for further disciplinary or other action. In such an event, no refund will be made for any unused portion of the program.
Disclosure Statement