Lourdes University Institutional Review Board
6832 Convent Blvd.
Sylvania, OH 43560
FWA 00018892
ORAL SCRIPT FOR CHILD/MINOR ASSENT
Hi, my name is
I am a
at Lourdes University and I am doing school work to learn how to
I would like to ask you for your help so I can do my school work. Let me tell you about what you will be doing.
Explain in very simple language the activities the child will do keeping it short.
If you say “yes” you can still stop at any time by telling me “I want to stop.” You will not get in any trouble for stopping.
Your parent(s) know that I am asking you to do these things. Would you like to help me with my work?
Requires hard signature:
As Principal Investigator, my signature below assures that I have reviewed the above assent form with the minor and the
minor has agreed to participate in the research study.
Yes
☐
(Principal Investigator Print)
No
☐
(Principal Investigator Signature)
Date
1