ࡱ> a 7xbjbjrr L\L\^XXXXXlll8Xl<< \!(!!!''';;;;;;;$?>@<]X'V'V'|''<XX!!_<)))'FX!X!;)';)) 78!Nǿ(R7;u<0<7}Aj(*}A(88h}AX9'')'''''<<)'''<''''}A'''''''''> :  IRBF010b/c RESEARCH WITH MINORS CHILD ASSENT (For Minors UNDER 12 years) General Information Use this form for child assent when enrolling minors who are less than 12 years old. Use the parental consent form provided in the IRB forms page (IRBF010a). This template is suitable for studies that qualify for exemption and those which are reviewed by the expedited or full review mechanisms. Alterations and waiver of this template are strongly discouraged. Child assent must not be administered online. Instructions This form contains two sections: Child Assent section signed by the researcher and given to the child The signature section signed by the participating minor (if 7-12 years) This section will be retained by the researcher Barring the actual signatures, the text boxes in two sections must be properly completed before submitting for IRB approval. Related IRB Forms: Form IDDescriptionIRB CommentAppendix BThis form has to be completed to specifically describe the interventions when researching with minorsMandatory when enrolling minorsIRBF010aParental consent for enrolling minors within the age 0 to 12 Use either IRBF010b or IRBF010c as child assentMust be obtained before administering child assentIRBF010bChild assent for children less than 7 yearsNo signature is necessaryIRBF010cChild Assent for minors 7-12 yearsSignature may be waivedIRBF0101dCombined parental consent child assent forms for minors 12+ yearsMandatory signaturesIRBF010eParental Consent for minors 12+ yearsIn most cases signature is required before enrolling the childIRBF010fChild Assent for minors 12+ yearsChildren must sign or give oral consent  CHILD ASSENT (To be retained by the participating child who is less than 12 years of age) Primary Investigator(s) FORMTEXT       Student  FORMCHECKBOX Contact information  FORMTEXT MTSU Office (If applicable), Telephone and Email IDDepartment Institution FORMTEXT      Faculty Advisor FORMTEXT      Department FORMTEXT      Study Title FORMTEXT      IRB IDNOT APPROVEDExpirationNOT APPROVED Child s Name (Age <12) (type or print)  FORMTEXT        (The PI or his/her IRB-approved representative must read the following disclosures to the child) This information is provided to you because your parents/guardians have enrolled you to participate in a research study. Please read this carefully and feel free to ask any questions before you agree to enroll. The person who is speaking to you now must all of your questions before you participate. He/she must also give you a signed copy of this sheet. Your participation in this research study is absolutely voluntary. You can decline anytime and no one will inform your parents. You can withdraw at any time. Please visit  HYPERLINK "http://www.mtsu.edu/irb/FAQ/WorkinWithMinors.php" http://www.mtsu.edu/irb/FAQ/WorkinWithMinors.php or email  HYPERLINK "mailto:irb_information@mtsu.edu" irb_information@mtsu.edu for more information. (The PI or his/her IRB-approved representative must read the following disclosures to the child) Why are you doing this research?  FORMTEXT Provide Detailed Information here - DO NOT LEAVE BLANK What will the researcher do and how long will it take?  FORMTEXT Provide Detailed Information here - DO NOT LEAVE BLANK Do I have to be in this research study and can I stop if I want to?  FORMTEXT Provide Detailed Information here - DO NOT LEAVE BLANK Will anyone know that I am in this research study? We will not tell anyone unless we believe that you or someone may be in danger or we are required by law. How will this research help me or/and other people?  FORMTEXT Provide Detailed Information here - DO NOT LEAVE BLANK Can I do something else instead of this research?  FORMTEXT Provide Detailed Information here - DO NOT LEAVE BLANK Who do I talk to if I have questions?  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