Date
Dear Parents,
The Iowa Department of Education is working with Florida State Universityon a professional development framework call the Distance Mentoring Model (DMM) and is funded by Early ACCESS, IDEA Part C. DMM has two parts. The first part is to help your child’s service providers learn how to use coaching to support your child’s learning and development. The second part is to work with early intervention programs to produce educational videos that can be used to help other providers learn new skills.
Children and families benefit greatly when providers have the best skills possible for teaching young children. One of the most effective ways to help providers learn new skills is by using video. Videos and photos help providers learn skills by showing them effective techniques. Families also benefit from videos as they can learn the same skills as the providers and can hear from other parents. Video is a wonderful tool that can help improve early childhood services.
The videos and photos that we produce will be used for the purposes of service provider education and public awareness of effective coaching techniques. Children who appear in the videos will not be identified by their last names.
We hope that you will help us in our educational efforts by giving permission for you and your child to appear in these videos and photos. Attached is a standard consent form. Please read it over, and if you agree, sign it and return it to your service provider or service coordinator.
If you have any questions, please feel free to talk with your child’s service provider or coordinator.
Sincerely,
Video/Photo Consent
I voluntarily grant my permission toIowa’sArea Education Agencies and their agents, employees, and licensees, to photograph, video tape, and/or audio tape myself and/or the child named below for whom I am the child’s parent or legal guardian.
I understand that the use of the video, photographic, and audio files covered by this consent will help to advance the field of early childhood care and education.
I understand that all rights, title, and interest in these video, photographic, and audio recordings belong exclusively to the Iowa Department of Education. The Iowa Department of Education and Area Education Agencies reserve the right to edit the images. I understand that these materials may be used by these organizations and by other collaborating organizations, in printed or electronic form for professional development, public awareness, and/or project reports. In the event consideration is paid or received for use of the images, I shall in no way be entitled to any part of such consideration.
I acknowledge that I fully understand the contents of this consent and am under no disability, duress, or undue influence at the time of the signing of this document.
For a child:
Child’s Name in Full (Please Print):
Name of parent or legal guardian (Please Print):
Address:
City, State, Zip:
Phone:
Parent/Guardian Signature: Date:
For an adult:
Name (Please Print):
Address:
City, State, Zip:
Phone:
Signature: Date:
Distance Mentoring Model – A professional development framework for Early ACCESS
Funded by Iowa Department of Education, IDEA Part C
dmm.cci.fsu.edu/IADMM/index.html