North TIER Course Participation Consent
I will participate and complete a professional development opportunity funded by the North TIER Partnership. I
have read the attached memo and agree to participate in the proposed evaluation study strategies listed below.
1.
Take the LoTI on-line assessment prior to taking any North TIER funded workshop or class.
2.
Complete a pre-training survey for each course, and another some time later.
3.
Provide the University of Virginia with the name of a teacher or colleague who worked with me
directly as a result of the professional development opportunity.
4.
Have that teacher or colleague take the LoTi on-line assessment.
5.
Attend an annual Fall conference hosted by the North TIER. I understand that I may be asked to
participate in a focus group.
Your Name
(printed):
__________________________________________________________________
Division:
___________________________________________________________________
School:
___________________________________________________________________
Signature
___________________________________________________________________
Date:
___________________________________________________________________
Course:
____________________________________________________________________
Please return this consent to your North TIER representative,
North Tier Representatives
Member Divisions
Contact Person(s)
Member Divisions Contact Person(s)
Alexandria
Ms. Elena Collins
Frederick County
Mr. Rod Carnill
Arlington
Dr. Sheryl Asen
Fredericksburg
City
Mr. Robert Young
Clarke
Mr. John Lyttle
Loudoun County
Ms. Lynn McNally
Mr. John O'Connor
Culpeper County
Dr. John Nicolay
Manassas City
Ms. Patti Shaw
Fairfax County
Mr. Derek Kelley
Prince William
Ms. Pat Donahue
Falls Church
Ms. Eileen Backofen
Stafford
Ms. Jan Streich
Fauquier County
Melanie Brown
