Sample Assent Form printable pdf download

Sample Assent Form

Name of study:

_____________________________________________________________________________________

I understand that I have been asked to participate in a study about: __________________

________________________________________________________________________

I will be asked to ________________________________________________, which will take about

_______________ minutes. I understand that I do not have to participate. If I do participate, I can quit at any

time. I also understand that I do not have to answer any questions I don't want to answer or do anything I don't

want to do.

My parents, teachers, or anyone else will not know what I have said or done in the study. No one but the

researchers will know.

This study is being done by _____________________________________ (name of

researcher) at Wabash College. His/her phone number is 765-361-____ and his/her e-mail address is

_________________.

If I have any questions or concerns about the study, I can call and ask him/her about them.

When I sign my name, this means that I agree to participate in the study and that all of my questions have

been answered. I have also been given a copy of this form.

Name____________________________

Date______________________

Signature_________________________

Sample Assent Form