Consent Form: Parent / Guardian Permission
Our goal at the ____________________________ is for every child to have a successful and enjoyable experience that helps to prepare him or her for the future. To help every child to meet this goal, we want to survey and interview the children who participate in our programs designed to improve education.
We
want to ask all children enrolled at ______________________________ about their
experience in our junior high science programs. With your permission, we will ask your child to complete a
questionnaire at two different times – after your child has completed a formal
scientific method write-up using traditional methods and later in the year
after your child has had a chance to utilize a web-based tool developed to
assist them in completing a formal scientific method write-up in school. This tool will also be available over the
Internet from home for your student’s use and for you to review. It will take your child about 15-30 minutes
to do the questionnaire each time. The
questionnaires are available for you to look at. (Please contact ___________________________ if you would like to
review them.)
In
addition, we ask your permission to compare the grades your child receives on
formal scientific method write-ups before and after they utilize the web-based
tool. We will ask your child’s teacher
for the grades. In addition to your
permission, we will also ask your child to consent to participate in the
study. We will be asking your child’s
teacher to complete a questionnaire before and after their students’ use of the
web-based tool.
You
are free to withdraw your permission for your child’s participation at any time
for any reason. Your child’s responses
to the questionnaire and grades will be kept completely confidential. The staff of the ______________________,
except for ___________________, will never see the individual responses of any
children participating in this study.
Whether or not you give permission for your child to take part in the
study will in no way affect your child’s participation or grade in any science
class at __________________________________.
If
you have any questions, please call _______________________________, the
research assistant in charge of this project.
I
have read and understand the above, and I voluntarily give permission for my
child,
_____________________________________
to participate in this study. I
understand that I may keep a copy of this form.
________________________________________________________________________
Parent
or Guardian Signature Date
The
Executive Secretary of the UIUC Institutional Review Board can answer any
questions about the general rights of research subjects (417 Swanlund Bldg.,
217-333-2670)