Directions for Assent Form Completion: You may modify this template as needed. This can be read aloud,
read by the minor, or both. Delete this header and all red text before submitting to the IRB. Be sure to gear
language to subjects’ comprehension-level.
University of Central Oklahoma
[Name of Research Project here]
Assent Form
My name is [your name]. I am here to talk to you about a research project we are doing. The
purpose of this research project is to understand [explain generally what the research is about, in ageappropriate language, e.g., what you know or how you feel.]
If you agree to participate in the project, you will [explain briefly what will happen if they participate,
including how much time is involved e.g., fill out a survey of your opinions that will take about 30
minutes.]. If you choose not to participate [explain what will happen if they decline to participate, e.g.,
you will do the same things as other class members but we just won’t keep track of what you say].
At the conclusion, we will be presenting or publishing the results of the study but the data will be
reported as a group which means that no names or other personal information will be used. At the
conclusion of the study, we will destroy all of the data.
There are no risks of participation and there are no direct benefits to you. However the information
we learn from the study will help to understand [explain the benefits to society/area].
Your parent or guardian must also give permission for you to participate but no information will be
shared with anyone outside of the study. [Explain if this will or will not affect their grade if done in a
classroom setting.] You have the right to refuse to answer any questions or to withdraw from the study
at any time without penalty.
My telephone number is [researcher’s telephone number]. You can call me if you have questions
about the project or if you decide you don’t want to continue in the study any more. If you have any
questions regarding your rights as a participant, you may contact the UCO Institutional Review Board
at irb@uco.edu or 405-974-5497.
Do you have any questions?
Your signature below will indicate your understanding of this form and agreement to participate. You
will be given a copy of this consent form to keep for future reference. If you do not wish to participate
[explain what they should do, e.g., hand in the form unsigned].
Signature of minor _____________________________________________ Date__________
Print name of minor ____________________________________________
Signature of person obtaining consent ______________________________ Date __________
Print name of person obtaining consent _____________________________________________