ࡱ> >@=g =bjbjVV 80r<r<=<X."ttttttO> !!!!!!!$#T&|!ROORR!tt!444R tt!4R!44Vq @5!t қ7@\: !!0." x&&5!&5!d[|4d;!!."RRRR& : AV EAST BAY Assent to Participate in a Research Study Research Title PURPOSE AND BACKGROUND My name is ____. I am a graduate student/professor at AV East Bay and I am conducting a research study about whether high schools prepare students for life in the real world. I am inviting you to take part in the research because you are a high school student. PROCEDURES If you agree to participate in this research study, the following will occur: I will interview you for 45 minutes at a time and place convenient to you about your high school education so far and how it has prepared you for real life experience. I will audiotape the interview to be sure I record your thoughts correctly. RISKS There is a risk of loss of privacy. However, the researcher will not use your name or any other identifying information in any published reports of the research. The research material will be kept in a secure location, and only the researcher will have access to the data. At the conclusion of the study, the researcher will destroy all audiotapes of your interview, will remove all identifying information from the transcripts, and will keep the data in a locked cabinet or office. Add other risks only if they exist, such as There is a risk of discomfort or anxiety due to the nature of the questions asked; however, you can answer only those questions he/she chooses to answer, and can stop participation in the research at any time. Include the final disposition of the data, that is, what you will do with the data when the study is completed. If you keep the data, you may use it in the future only for research purposes consistent with the original purpose of the research stated in this consent document as long as you remove all identifiers. Otherwise, you may say that the data will be destroyed at the end of the study. If you are conducting focus groups, please see the focus group consent for additional protection for subjects. DIRECT BENEFITS There are no direct benefits to you for participating in this research. The Benefits section must mirror the protocol statement of benefits. There is almost never a direct benefit to the types of research that will be done by students, in that a Direct benefit applies to clinical trials in which a subject may get an experimental drug therapy or something that may immediately benefit him/her. Payment is not a 1 of 2 benefit. Any indirect benefits can only be anticipated, since you cant guarantee them since you havent done the research yet. If you talk about anticipated benefits, do so briefly and use the conditional tense, as in Benefits may include..) COSTS There will be no cost to you for participating in this research. If there will be costs such as transportation to the interview site or lunch, mention those costs here. COMPENSATION There will be no compensation for participating in this research. If the researcher will be paying the participants, state the amount or the nature of the compensation here, for instance: Participants will be given $20 or an Old Navy gift certificate for participation. ALTERNATIVES For minimal risk research, the standard wording is The alternative is not to participate in the research. For research involving more than minimal risk, an explanation is required as to whether any compensation and any medical treatments are available if injury occurs and, if so, what they consist of, or where further information may be obtained. QUESTIONS You may speak with (researchers name) about this study and ask any questions now. If you have any further questions about the study, you may contact the researcher by email at _____@csueastbay.edu or you may contact Professor _______, the researchers advisor, at 510-885-department extension or _______@csueastbay.edu. You may also ask questions about your rights as a research participant, or send any comments or complaints about the study, to the Office of research and Sponsored Programs at AV East Bay at 510-885-4212 or irb@csueastbay.edu. Participation in research is voluntary. You do not have to participate, and you may stop participating at any time, or at any point in the project, without any penalty to yourself. CONSENT You have been given a copy of this consent form to keep. I understand the purpose and the procedures of the research as stated above, and agree to participate. Participants Name (print)_________________________________________ Signature _____________________________ Date: _________ Research Participant 2 of 2  $%-3Wefg}~  E  L {nn_M_MM"h-+ohMT56CJOJQJaJhMT56CJOJQJaJh! 5CJOJQJaJhMT5CJOJQJaJh-+ohMT5CJOJQJaJh-+ohMTCJOJQJaJh! hMTCJOJQJaJh-+ohMT5OJQJh&FGhMTOJQJh>hMTOJQJh"$/OJQJhMThMT5OJQJhIhMTOJQJh! 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