Opt in/Out Form

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Opt in/Out Form

Please complete for EACH student in USD 353

This will be consent for the MySAEBRS assessment to be given during the 2022 Fall semester.

Student Last Name *

Student First Name *

School *

Grade Level *

Below is a sample of the MySAEBRS questions.

Parent Name (your electronic signature provides validation for answers on this document) *

The SAEBRS (Social, Academic, and Emotional Behavior Risk Screener) is a brief, norm-referenced tool for screening all students to identify those who are at risk for social-emotional behavior (SEB) problems. USD 353 uses this assessment each year. This year, the Kansas Department of Education requires that parents opt in or opt out of this assessment for their child.

Yes, I do want my child to take the SAEBRS assessment.

No, I do not want my child to take the SAEBRS assessment.

Required

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