TEMPLATE ASSENT FORM (7–12 Year Olds) - SOCIAL-BEHAVIORAL

Sep 2, 2026

Upload by Eliana

School-based assent form for children aged 7–12 explaining a research study in clear, age-appropriate language. It covers the study’s purpose, why the child is being invited, what participation involves (computer questionnaire and game, optional interview, and possible classroom videotaping), approximate time commitments, and where activities take place. The form also addresses alternatives if the child declines, potential benefits for future learning, and possible discomforts, while outlining confidentiality and who will know about participation.

LanguageEnglish

CategoryForms

FormatDOCX

Pages3

Reading Time1 min

AccessFree to download

INFORMATION ABOUT A RESEARCH STUDY

Why are we doing this study?

Why are we talking to you about this study?

What will happen if you are in this study?

If you don’t want to be in the study, what can you do instead?

Will good things happen from being in this study?

Are there things you might not like about being in the study?

Who will know that you are in the study?

TEMPLATE ASSENT FORM (7–12 Year Olds) – SOCIAL-BEHAVIORAL (For School-Based Research) INFORMATION ABOUT A RESEARCH STUDY Title of Study [If applicable, designate sub-group after study title, e.g., "7–12 Year Olds"] My name is __________. I am a [student/professor] in the Department [or School] of __________ at the University of California, Berkeley. I am doing a research study [or if student: I am working with my teacher, Professor __________, on a research study], and I want to ask if you will be part of it. What is a research study? A research study is when people like me collect a lot of information about a certain thing to find out more about it. This letter tells you about my study so you can decide if you want to be in it. Before you decide, you can talk about it with your parents or anyone else you like. If you have any questions about the research, just ask me. Why are we doing this study? [Explain study purpose in brief, simple terms. Note that it is different from school work.] I [and the other researchers on my team] am [are] doing this study to find out more about [e.g., how kids learn when they do math on a computer.] This study is not part of your school work, and you won't get grades on it. Why are we talking to you about this study? [Give brief explanation of why the child is being asked to participate in study.] We're asking a lot of children your age if they would like to help. We’re inviting you to take part because [e.g., you go to a school where we’re doing the study]. What will happen if you are in this study? [List all study procedures/activities in chronological order, using bulleted format. Indicate location where procedures will take place and amount of time needed for each procedure. Also note total amount of time required for study participation. See examples below.] If you agree to be in the study and your parents say it’s okay, we will ask you to: Read and answer questions on a computer First, you will sit at a computer and read words and look at cartoons about math on the screen. You will make choices about the words or pictures by clicking on Yes or No. This part will take about ___ [minutes/hours]. You can take a short break before the next part if you want to. Play a computer game Then we’ll load a computer game for you to play. The game has some math problems to think about and answer. This part will take about ___ [minutes/hours]. Have an interview (maybe) We will choose a random sample (not everyone) of the students who agree to be in the study. (A random sample is like pulling numbers out of a hat or flipping a coin to decide.) We will ask these students to also participate in an interview with me or one of our researchers. If you are chosen and want to be interviewed, one of the researchers will meet with you [after school]. This will be at a place that you and your parents decide is convenient (such as a private room at school or at your home). We will ask you questions about the way you study and learn, and audiotape (record what we're saying) if you give me permission. The interview will take about ___ [minutes/hours]. Let us videotape you in your math class If you agree, we will videotape during your regular math class once or twice a week for 3 weeks. We won't interrupt the class. Total time: The questionnaire and computer game will take about ___ [minutes/hours] of your time. If you have an interview, the whole study will take about ___ [minutes/hours]. The videotaping will be done during your regular math class, so it won't take any extra time. [Study place: Note where study procedures will take place if not already specified above.] If you don’t want to be in the study, what can you do instead? [Include this section if research intervention occurs during regular school hours. In such cases, an alternate, supervised activity (taking the same amount of time and approximate effort) must be available for children who do not wish to participate in the study, or when

FAQs

What is the purpose of the research study described in the form?

The study aims to learn more about how kids learn when they do math on a computer. It is separate from school work and will not affect grades.

What activities will a child do if they agree to participate?

A child will read and answer questions on a computer, play a computer game with math problems, and may be selected for an optional interview. If permission is given, the study may include videotaping during regular math class once or twice a week for 3 weeks.

What can a child do instead if they do not want to participate?

The teacher will provide a different supervised activity with about the same time requirement. The alternate activity should be arranged in advance.

Who will know about the child’s participation, and how is confidentiality handled?

Only the child, parents, and researchers will know the participation details. Reports or talks will not use real names, though recognizing the child is possible if recordings are permitted for later use.

Sep 2, 2026

Upload by Eliana