Consent Form: Youth
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 you to complete a questionnaire
at two different times – after you have completed a formal scientific method
write-up using traditional methods and later in the year after you have had a
chance to utilize a web-based tool developed to assist you in completing a
formal scientific method write-up in school.
This tool will also be available over the Internet from home for your
use. It will take you 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 you receive on formal
scientific method write-ups before and after you utilize the web-based
tool. We will ask your teacher for the
grades. In addition to your permission,
we will also ask your parents to consent for you to participate in the study. We will be asking your teacher to complete
a questionnaire before and after your use of the web-based tool.
You
are free to withdraw your permission for participation at any time for any
reason. You do not need to answer any
questions that you don’t want to. Your responses to the questionnaire and
grades will be kept completely confidential.
The staff of the ____________________, except for
______________________, will never see the individual responses you give while
participating in this study. Whether or
not you give permission for yourself to take part in the study will in no way
affect your participation or grade in any science class at
___________________________________.
If
you have any questions, please contact ____________________________, the
research assistant in charge of this project.
I
have read and understand the above, and I voluntarily give consent to
participate in this project.
________________________________________________________________________
Student
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)