Child Assent for Participation in Research Study

This is a project that Jane Doe and John Doe are doing with first grade students to learn more about words and sentences and what they mean. You can help with this project if you would like to. You do not have to help if you do not want to.

In the project you will be shown some pictures that tell a story and then you will answer questions about the story. Also, you will get to read a story out loud. You will do this one time by yourself for about 15 minutes with Jane or John or one of their helpers. You will also do some of the same things for about 30 minutes with a group of students and Jane or John or one of their helpers. This will happen four different times. Each time you are with Jane or John or their helpers the things you say will be tape recorded.

Your name will not be put on any papers written about this project. Your name will not be put on the tape recordings and they will be erased after the study is done.

If you decide to help with this project but then change your mind you can stop helping at any time.

If you do not understand what Jane and John would like you to do, please ask them questions.

If you want to help with this project, please write your name on the line at the bottom of this page.


Student's Name ____________________________________________________


Student's Signature __________________________________________________

Witness in lieu of signature: In my judgment, the student understands the information in this consent form and agrees to be in the study.

Witness Signature ___________________________________ Date ___________

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