College Application Study

Parental Informed Consent Agreement

Typing your name and submitting this form will allow your child to participate in the College Application Study. As part of their participation, your child will be sent a questionnaire. In addition, the researchers may call and/or email your child in order to request participation and/or remind him or her to complete each questionnaire.

Please read the Parent Consent Information before completing this form.

I agree to allow my child to participate in the study.

Your Name:
Date:
ID #:	(see the top of your letter)
Child's Name:

To assist us in contacting your child, we would appreciate if you would provide us with the following information about them:

Child's Primary Telephone #:	Cell Home Other
Alternate Telephone #:	Cell Home Other
Child's Email:

Other comments or contact information

Center for Survey Research
University of Virginia
2400 Old Ivy Road, Suite 224
P.O. Box 400767
Charlottesville, VA 22903-4827

surveys@virginia.edu
TEL: 434-243-5232
TDD: 434-982-HEAR
FAX: 434- 982-5524

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