ASSENT
F O R M , A GE S
7-12
Insert Title of Study
We are asking you to be in a research study. We do research studies to learn more
about how the world works and why people act the way they do. [Researcher should
determine if it is reasonable to have the parent(s) or guardian(s) read through the assent
form with their child.]
I am trying to learn about how [insert topic of study in simple language]. I want to learn more
about [insert research topic] because [Explain research question and purpose in clear, lay
language]. If you would like to, you can be in my study.
You don’t have to be in the study unless you want to. If you decide you want to, we will ask
you to [Describe what the child will do in the study. Be specific, but make sure that your
description is written for the reading comprehension level of the child. You may consider listing
the tasks using bullet points or numbered lists. Include the amount of time that is required for
each task, session, or experiment and where these will take place. For example, “You will answer
some math questions in your classroom and it will take ten minutes.” You must also tell the child
if you will use audio recording, photography, or video recording.]
Being in this study will bring you no harm, but it won’t help you in any way. [If there are risks
involved in the study, describe the risks in age-appropriate language and what you will do to
minimize the risks. Consider explaining the risk using an example that the minor can relate to.
Do not include compensation in an assent form unless payment will be given to the child.]
Other people will not know if you are in my study. Your answers to my questions will be kept
private. I will put information I have about you with information from other people in the
study, so no one can tell what information I got from you. When I tell other people about my
research, I will not use your name, so no one can tell who I am talking about. I keep things
locked up so only I can see them. [Indicate what information will be given to the child’s parent
or guardian, if applicable].
Your parents or guardians have said that it’s okay for you to be in my study. You get to choose
if you want to do it, too. If you don’t want to be in the study, you don’t have to. If you want
to be in the study now and change your mind, that’s okay too. No one will be mad at you. Just
tell me that you don’t want to be in the study anymore, and you don’t have to.
If you have questions about the study, please call me or email me:
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My name is [researcher name] and my telephone number is [researcher’s telephone number].
My email address is [researcher’s email address]. You can call me or email me if you have
questions about the study or if you decide you don’t want to be in the study anymore.
I will give you a copy of this form in case you want to ask questions later.
Agreement
I have decided to be in the study even though I know that I don’t have to do it. The researcher
told me about the study and answered my questions.
__________________________________________________________
Signature of Study Participant
________________
Date
__________________________________________________________
Signature of Researcher
________________
Date
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