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FA12 MAeP Permission Cohort I-Semester 3

Moving Ahead with ePortfolios Project
VALUE Rubric Assessment

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* 1. I agree to provide samples of my work for the VALUE Rubric Assessment.

I understand that I do not have to participate in this project. My willingness or unwillingness to participate will not affect my relationship with my teacher, nor will it affect any evaluations of my work, that is, it will not affect my grade in anyway.

I may not receive any direct benefit from taking part in this project; however, the project may help to increase knowledge that will help others in the future.

I have read and understood the above information and agree to provide samples of my work. I grant permission to the Moving Ahead Project Staff to use samples of my work.

Yes

No

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* 2. Please fill in the following information:

First Name: *

Last Name: *

Tiger Mail Address:

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* 3. Ethnicity:

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* 4. Gender:

Female

Male

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* 5. My Teacher's Name:

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* 6. My Course and Section (like EN-101DE):