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Early Signal Project: Parent/Guardian Consent Form

Purpose: To identify early signs of student mental health and academic risk using secure, privacy-compliant data analytics.


Section 1: Project Overview

What is the Early Signal Project?
The Early Signal Project is a school-supported initiative that uses existing student data (such as attendance, grades, and behavior logs) to help counselors and educators identify students who may benefit from early support—before challenges escalate.

Why is this important?
Early intervention can improve student well-being, academic success, and access to resources. This project helps schools respond proactively and equitably.


Section 2: What Data Will Be Used?

We will use only school-approved data, including:

  • Attendance records
  • Academic performance (grades, test scores)
  • Behavior and discipline reports
  • Counselor referrals or notes (if applicable)
  • Optional student surveys (with separate consent)

All data will be:

  • De-identified before analysis
  • Encrypted and stored securely
  • Accessed only by authorized project staff and school personnel

Section 3: What You’re Agreeing To

By signing this form, you agree that:

  • Your child’s school may share the above data with the Early Signal Project team for analysis.
  • You understand that no data will be sold, shared externally, or used for non-educational purposes.
  • You may withdraw consent at any time by contacting the school or project lead.

Section 4: Your Rights

Under FERPA (Family Educational Rights and Privacy Act), you have the right to:

  • Review your child’s educational records
  • Request corrections to inaccurate data
  • Receive information about how data is used and protected
  • Decline participation without penalty

Student Name: ___________________________________
School Name: ____________________________________
Grade Level: ___________

Parent/Guardian Name: ____________________________
Signature: _______________________________________
Date: _______________

☐ I consent to my child’s participation in the Early Signal Project
☐ I do NOT consent to my child’s participation


Questions?

If you have questions or concerns, please contact:
Project Lead: William Aubrey
Email: william@earlysignalproject.org


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