ࡱ> .0-%` QbjbjNN 4,,Q2vvvv 2\   $F h  ) ) )    )  )   8Kv3 R , 0\ 4 4 4 8  Y  \ ) ) ) ) 222Dv222v222 Appendix J MODEL FORMS SAMPLES OF WRITTEN CHILD ASSENT FORM (This is to be used when parents have given approval for their children to participate and the researcher is now beginning data collection with the children themselves.) Language must be simplified as appropriate for the age group used as subjects, such as: I have been told that my parents (mom or dad) have given permission (said it's okay) for me to take part in a project about _____________________________. I will be asked to ________(briefly describe the task involved here)__________. I am taking part because I want to. I know that I can stop at any time I want to and it will be okay if I want to stop. ____________________________ ______________________________ Sign Your Name Here Print Your Name Here OR I have been informed that my parent(s) have given permission for me to participate in a study concerning _______________________________________________. I will be asked to ___________(briefly describe the task involved here)_____. My participation in this project is voluntary and I have been told that I may stop my participation in this study at any time. If I choose not to participate, (it will not affect my grade, treatment/care, whichever applies) in any way. _________________________________ ____________________ Signature Printed Name For children unable to understand written assent forms, a verbal script for assent should be submitted in lieu of the above. The researcher should sign the script indicating that he/she has sought assent and that the child agrees to participate.   % 0   PQhY hqS56 hqS>* hqS6 hqS6>*hqS hqS5 hqSCJ   =>A B 1 2 ' (  ``]gdqS ``]gdqS H]gdqS]gdqS$ ]a$gdqS $]a$gdqSQ( 0 1   r A B Y Z PQ$ ``^a$gdqS ``gdqS ``]gdqS ``]gdqS$ `]a$gdqS21h:p2/ =!"#$% H@H qSNormal CJOJPJQJ_HmH sH tH DAD Default Paragraph FontRiR  Table Normal4 l4a (k(No Listp$@p M<Envelope Address!@ &+D/^@ CJOJQJ^JaJQ  =>AB12'(01r  ABYZPSX0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0X0Q( Q Q .=d8S<S?*urn:schemas-microsoft-com:office:smarttags stockticker [VSrS333333SYX{<4)jqS2M<ePS@VQ@UnknownGz Times New Roman5Symbol3& z Arial3z Times"hzfzf` ` !924NN2HX)?X{2 Appendix JLinda CampbellSanta Clara UniversityOh+'0 $ D P \hpx Appendix JLinda CampbellNormal91Ƶ2Microsoft Office Word@@"@"`՜.+,0 hp  91Ƶ N'  Appendix J Title  !"#$&'()*+,/Root Entry F {Z1Data  1TableWordDocument4SummaryInformation(DocumentSummaryInformation8%CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q