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: PERMISSION DOCUMENT
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INSERT PROJECT TITLE HERE
Dear Parent or Legal Guardian:
We are asking permission for your child, or the child in your legal care, to be in a research about using computers in the classroom. This research study will include roughly X number of participants Participation in this study is voluntary and it is anticipated that your child would be involved for X amount of time. We are asking because your child is a ninth-grade student at X school. Your child will also be asked whether he/she wants to participate and his/her wishes will be followed. Please read this form and ask any questions that you have before choosing whether your child can be in the study.
Amy Smith, a graduate student in Educational Studies, is conducting this research in collaboration with the faculty advisor and Principal Investigator Jane Doe, a professor at ԪB.
Why this Study is Being Done (Purpose(s)
We are doing this study to look at what children think about using computers in the classroom.
What You Will Have to Do (Procedures)
If you allow your child to be in the study, here is what will happen: (list in paragraph or bullet format):
First, the researcher will talk with your child about the study and ask if he/she wants to be in it. This will happen during your childs free period.
Next, if your child agrees, they will be asked to answer some questions about using computers in the classroom. This will also happen during free period. This should take about 20 minutes.
Risks/Discomforts
The main risk of being in this study is
Benefits of Being in the Study
Participating in this study will not benefit your child directly.
Appropriate Alternative Procedures (if any) (this is relevant to intervention studies in particular. Examples include: alternative drugs, treatment, study site, other trials).
You Will Be Paid
Your child will receive X to thank him/her for being in the study.
Deciding Whether To Be in the Study
Participating in this study is up to you and your child. Your child will be asked separately whether he or she wants to participate, and his/her wishes will be followed. Both you and your child can choose not to be in the study, and that is fine. You or your child can change your mind and stop the study at any time, and you do not have to give a reason. If you decide to quit later, that will be fine and acceptable.
How Your Information Will be Protected
Because this is a research study, results will be summarized across all participants and shared in reports that we publish and presentations that we give. Your childs name will not be used in any reports. We will protect your childs information so that he/she cannot be identified. Instead of using your childs name, the information will be given a code number. The information will be kept in a locked office file, and seen only by myself and other researchers who work with me. The only time I would have to share information from the study is if it is subpoenaed by a court, or if we think your child is being harmed by others then I would have to report it to the appropriate authorities. Also, if there are problems with the study, the records may be viewed by the ԪB review board responsible for protecting the rights and safety of people who participate in research. The information will be kept for a minimum of three years after the study is over, after which it will be destroyed.
Who to Contact
You can ask any questions you have now. If you have any questions later, you can contact (Insert name(s) at (Insert email, phone number).
If you or your child think you were treated badly in this study, have complaints, or would like to talk to someone other than the researcher about your rights or safety as a research participant, please contact the IRB Chair at HYPERLINK "mailto:IRB@ric.edu"IRB@ric.edu.
You will be given a copy of this form to keep.
Permission Statement
By signing below I/we are stating that I/we understand the information and give permission for my/our child to be in this study. Both parents/guardians must give their permission unless one parent is deceased, unknown, incompetent, or not reasonably available, or when only one parent has legal responsibility for the care and custody of the child. I/we are over 18 years of age, and either the parent or legal guardian of the child named below.
Childs name: __________________________________________________________
I ___Do ___Do Not give permission for my child to be photographed during this study
I ___Do ___Do Not give permission for my child to be video recorded during this study
I ___Do ___Do Not give permission for my child to be audio recorded during this study
_______________________________________________________________________________
Print name Signature Date
______________________________________________________________________________
Print name Signature Date
Name of researcher obtaining permission: ____________________________________________________
ԪB Institutional Review Board
Approval #: ________
Expiration date: ______
Participants Initials: ____________
Document version: _________
Page PAGE \* Arabic \* MERGEFORMAT 2 of NUMPAGES \* Arabic \* MERGEFORMAT 2
Make sure to state how many participants you expect to have
Clearly state that this is a research study, that participation is voluntary and identify the expected time duration.
Use non-technical language throughout and at 7-8th grade reading level. Check reading level at
https://support.office.com/en-us/article/Test-your-document-s-readability-85b4969e-e80a-4777-8dd3-f7fc3c8b3fd2
For student projects, include faculty advisor.
Provide a brief description of the studys purpose, in clear, easily understood language.
In non-technical language, describe all procedures that participants will be asked to participate in. Must include a time frame for each identified procedure. If the intent is to audio-tape, video-tape, or take photographs, include that here.
Explain reasonable risks. If the study is minimal risk, dont say that there are no risks, but you could say that The risks are minimal, meaning that they are about the same as what you would experience during your typical daily activities. If there are risks state what they are and state ways those risks will be minimized.
Add if there are any identified, appropriate alternatives that might be advantageous Disclose any approved or generally recognized therapy or standard treatment that will be withheld from the subject as a result of participation in this study. Any risks to the subject in withholding the standard treatment must be disclosed in the section on Potential Risks and Discomforts.Omit this section if not relevant.
If there is no compensation, simply say, You will not be paid for this study. If compensation is pro-rated, you need to explain how it will be paid.
If student research, include both student and faculty advisors contact information.
If any audio, videotaping, or photography is taking place, you will need separate statements for each. Otherwise delete these check-off items):
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