ࡱ> 8;7u bjbjxnxn 4"xjxj ?  KKK___8_*#( """""""D%'l"K " ""!!! 8"! "!!3!٪q)!v!""0*#!f(!Ff(!f(K! ! ""! *# f(  : Assent Script/Form for Participation in Դɼ (Title of Study) Instructions: Standard language appears in black font and should be included in your form; however, it may need to be modified to fit your study. Replace italicized sample language/guidance (in this red font) with the appropriate information about your research protocol. Delete sections that do not apply. Use lay language (avoid technical jargon), at an appropriate age/grade reading level or as is appropriate for the participant population. For instance, it would be appropriate to provide more detailed information to participants who are 14-17 years old and less information for those who are 6-8 years old. In some instances, if a childs developmental/cognitive abilities are so limited that they cannot reasonably be consulted, it may be appropriate not to utilize a formal assent process or document (e.g. for children who are under 4 years old or children with profound developmental disabilities). Information must be consistent with IRB protocol. We are doing a research study to find out how children like you learn how to read and write in a second language. We are asking you to be in the study because you are in a class that is learning a second language. If you agree to be in the study, you will [Describe the research procedures; only those activities that are done solely for research purposes.] allow us to work with you on your reading and writing for four months. You will talk to us about your reading and writing. You will allow us to watch you and take notes while you are reading, writing, or playing. [Describe potential benefits associated with participation/the study.] Being in the study may improve your ability to read and write in the second language. We also hope to learn something about reading and writing that will help other children in the future. You do not have to say yes if you dont want to. No one, including your parents, will be mad at you if you say no now or if you change your mind later. We have also asked your parents permission to do this. Even if your parent says yes, you can still say no. Remember, you can ask us to stop at any time. Your grades in school will not be affected whether you say yes or no. [Explain how you will use the information/data you obtain from the participants and if this is used or showed to others outside the research team in a way that the participant can be identified and/or linked to the information/data.] We will not use your name on any papers that we write about this project. We will only use a number so other people cannot tell who you are. You can ask any questions that you have about this study. If you have a question later that you didnt think of now, you can [Provide contact information, if applicable] ask us next time. Name of Child: _____________________________ Parental Permission on File: ( Yes ( No** **(If No, do not proceed with assent or research procedures.) (For Written Assent) Signing here means that you have read this paper or had it read to you and that you are willing to be in this study. If you dont want to be in the study, dont sign. 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