JRC-E
Confidentiality Agreement for Classroom Observation by Non-District Individuals
Ashburnham Westminster Regional School District
11 Oakmont Avenue
Ashburnham, MA 01364
Name:
Agency (If Applicable):
Address:
Student to be Observed:
Date of Observation:
v The parent or designee and principal will discuss the parameters of the observation prior to the observation taking place.
v Observer shall protect the rights to privacy of all students, and therefore, shall not share information about any other students in the classroom orally or in writing.
v Observer shall restrict my observation and comments to the behaviors of the student being observed. The purpose of the observation is not to critique the performance of the teacher or observe other students.
v The observer shall not share criticisms of the teacher(s) with students, parents, or other persons.
v Observer understands that (s) he cannot make educational program or placement decisions (e.g., whether the student needs exceptional student education services or a change in services). Valid concerns about educational placements shall be addressed with the school principal, school ESE specialist, or district supervisor.
v The parent or designee must be a silent observer at all times and not interrupt of disrupt the educational process of the class
v Additional information (i.e., completion of forms, questions specific to the student, etc.) should be obtained outside of classroom observation via e-mail, follow-up conference, or phone with the classroom teacher/school principal, so as to minimize disruptions to the learning environment.
v All materials (e.g., data collection forms, visual supports, etc.) are accessible only with obtained permission by the classroom teacher/school principal.
v If observer is not the parent/guardian, the observer shall provide signed written consent from the parent/guardian authorizing (s)he to observe the student prior to or upon arrival for the observation.
v Observer understands that all classroom observations must be scheduled in advance in accordance with all District policies and with procedures of the individual school.
v If observer has any questions concerning the procedures for classroom observations or compliance with this Agreement, (s) he shall direct them to the principal.
v The observer understands that the District reserves the right to monitor classroom observations and to rescind authority to participate in classroom observations to any individual who misuses such access or otherwise violates this Agreement.
Observer Signature Date ______________________________________________
Observer Printed Name
School Principal Signature Date