Youth Assent Form

Youth Assent Form
For subjects under the age of 19, you must obtain their permission along with their parents to participate in your study. Include and number all of the elements in this sample assent form.

Youth Assent Form

IRB #110717-3

Title of the Research Study: The Impact of Television Viewing and Program Genres on Adolescent Decision-Making

Summary
This study will examine how TV programs affect the way teenagers do things. You might like to participate because you get to watch different TV shows and do computer tasks, and you may learn about part-time jobs. You might not want to participate because it will take about 30-45 minutes and some of the TV shows might be boring or make you feel uncomfortable.

We are inviting you to participate in this study because you are a teenager, and we are interested in how different kinds of TV programs affect the way teenagers do things. The study is conducted by professors and students in the Department of Communication at the University of Nebraska at Kearney.

If you have any questions at any time, please ask.

This research will take you about 30-45 minutes to do. First, we will train you on a computer task. Then you will watch a short television program. This may be a comedy show, or an instructional program, or a documentary program. Then you will do a task on the computer. The computer task involves choosing between one of four part-time or summer jobs.

Some of the TV shows you watch for the study may be a little boring, or they may make you feel a little uncomfortable, just as watching tragic news events makes some viewers feel uncomfortable. Being in the study will not have direct benefits to you, but it may help researchers and teachers understand how teenagers make choices. You also may learn something about how to choose a part-time job. However, if you agree to participate in this study you will not receive a gift or money.

Your decision to be in this study is voluntary. You do not have to participate if you do not want to. If you agree to participate in this study, you can stop at any time without any consequences to you.

Your responses will be strictly confidential. There will be no way for us to know which responses belong to you or to someone else. We may publish a summary of everybody’s responses or present a summary at a scientific meeting, but the information will not identify you or your responses.

We will also ask your parents for their permission for you to be in this study. Please talk this over with them before you decide whether or not to participate.

If you have questions or concerns about this study, contact Dr. Sally McIntire, principal investigator, 306 Mitchell Center, University of Nebraska at Kearney, Kearney, NE 68849, 308-865-9992. If you have questions about your rights as a research participant, please contact the University of Nebraska at Kearney Institutional Review Board (IRB), (308) 865-8496.

Signing this form means that you have decided to participate and that all your questions about the study have been answered. You and your parents will be given a copy of this form to keep.

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Printed Name of Subject Date

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Signature of Subject Date

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Signature of Investigator Date

Identification of Investigators

Principal Investigator

Sally S. McIntire, Ph.D. University of Nebraska at Kearney
Office: 865-9992

Secondary Investigator

Bobbie Sanchez, Ph.D. University of Nebraska at Kearney
Office: 865-3349

Approved 11/25/17