YVONNE Ik SCHUYIEK l&OR£ Child Development Research Center U N I V E R S I T Y * 0 # S O U T H C A f t O L l N A

Dear Families, e I am writing to inform you that your child care provide" hafbccn selected to participate in a research project designed to test a web-based version of the Ages & §tages Questionnaire, a child developmental screening tool. The teachers and caregivers at Fort Mill Prepart^ory School will complete the Ages & Stages Questioinnaire periodically throug^nt the school year based on their careful observations of children duringi the typical school day. In addition, teachers will offer families the opportunity to complete the same questiomiaire to validate their observations and facilitate meaningful discussion during family/teacher conferences. - v. ID collaboration with the South Carolina Dep^utment of S o < ^ Services, the State Budget and Control Board OfSce of Research and Statistics, a^d Faculty of the University of South Carolina Child Development "and Research Center a web-based version of Ais questionnaire has been developed. The web-ba^ed version of the questionnaire is designed primarily to ease the burden of questionnaire completion and management through an autoinatcd process of identifying when a child is due for a completed questionnai-e, providing access to the ^>propriate questionnaire to staff and families, ana scoring completed questionnaires. This automation will allow die teachers and caregivers to focus more time on what matters most, using the information to plan Expropriate learning opportunities for the children in their classes. Specifically, your participation will involve completion of tbfc Ages & Stages Questionnaire Online two (2) to three (3) times per year. I estimate that it will takei^>proximately 5 to 10 minutes to complete each questionnaire. Attached to this letter you will find the Authorization to Use and/or Disclose Infonnatiofl form, which wiU serve as informed consent for participation in the use of this website. In a few days you will receive an e-mail invitation to participate that will include your log-in usemame and password (which is randomly generated) and a step-by-step guide for your initial use of the Ages & Stages Online. It is with great enthusiasm that I request your participation in this project. This opportunity wii: significantly lafprm our vyfork t o e s t a b l i s h s y s t e m s to positively impact the quality of care and education provided to young chil(iren in South Carolina, and will provi4e meaningful information that will inform the direct services provided to your child enrolled at the Children's Center. Please contact the directly with any questionsier concerns by ^honc: (803) 777-0934, (803) 318-9566, or e-mail: hkiioof@.sc.edu. -

Early Childhood Education ^ _ ;, Yvonne & Schyler Moore ^I^iild Development Rwearch Caiter ' Um versity of SoUth Carolma, Columbia

South Carolina Ages aiul Stages Qsesdoiiiiafre for Yomig Children AatliorfxatlaB 1^ U w a a d / o r Disclose Informatioii

CMdt's Name DatedfBiitfa Sodai Security Number

Parent/Guardjan Name ^ y

Parsnt/Guanljlao Date of Buth Telephone Number >

Address aiy. State. Zip E-maiJ Address

The University of South Carolina [USC), the Sdnth Caroltaia Department of Sodal Swrlces (DSS), and the Office cf Research and Statistics, Soudi Carolina Budget and Control jBotihf CORS) are woridng together to develop the South Carolina Electronic Record System for Young Children. This system will gather information from femilies diat wfli heir to:

• improve ttie programs developedlof teacbm/caoegivers of yoong childreo to aid in children's development; learning, and 9dbo^ preparedness.

• Increase communlcatton among children's families and ehlldcare providers. • Identify ciuidreo at risk for developmental or learning delays and recommend appropriate eariy

intervention services. • improve ttie overall quality of care and education services that influence the development and sclioos

preparedness of young children enrolled In ceater-based dilldcare prc^rams. Only authorized staif will have access to the Electronic Records System, In addition to the Electronic Records System, all inform*t«M^ shared by you and other families will be combined and presented in report form- Your information is CONFlMNTIAt and NO INFORMATION IDENTIFYING CHILDREN OR FAMILIBS WILL BE RELEASED. By signing this form, you authorize fort MOI Preparatory School to share the results of the Apes & Stages Questionnaires®, and other demographic behavioral, and general Bealtfa informadon, with die SC DSS and the USC College of Education to be used in A e Electronic Records System In an aggregated format that will protect the privacy ofindividuai children and femilies. , I understand that the South qarohna Blectronic Record ^rstem tor Young Children will be maintained by the ORS. Uiat my information may be p.̂ otected under state and Meal law, and that it will not be disclosed wf tfiout my written auUiorizaUon unless otherwise a l lowed by l»w. 1 i m d e r s t u i d that I c a n r e v o k e this c o n s e n t a t any time, except to the

extent that actioa already has been taken. This authorizadon explrtss when I am no longer participating in the Infant and Toddler Electronic Records System, or five y a ^ f r o m this date, whichever comes first I have been given a copy of

this completEd aathorization.

Parent/Guardian Signature Date

Revocadon of Author iza t ion I hereby revOlc^ny authorization:

' r 11 •

Parent/Guardian Signature '[ ; Date