Appendix C: Confidentiality Pledge for Survey Proctors (sample)

I hereby certify that I have carefully read and will cooperate fully with the EDSCLS procedures on confidentiality. I will keep completely confidential all information arising from surveys concerning individual respondents to which I may gain access. I will not discuss, disclose, disseminate, or provide access to survey data and identifiers. I give my personal pledge that I shall abide by this assurance of confidentiality.

My signature below indicates I have read and agree to the Pledge of Confidentiality

Signature:______________________________________    Date: _______________________

Printed Name: __________________________________

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