University of Nebraska Kearney

 Youth Assent Form 

IRB #110710-3 

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

1. 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 the Department of Communication at the University of Nebraska at Kearney
   
    
2. If you have any questions at any time, please ask.
   
    
3. This research will take you about 30-45 minutes to do.  First, we will train you on a computer task.  They 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.
    
4. Some of the TV show 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.
   
    
5. 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.  
   
    
6. 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. 
   
    
7. 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.  
   
    
8. 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.  You also may contact the University of Nebraska at Kearney Institutional Review Board (IRB), 308-865-8886. 

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. 

_______________________________________                              ______________________________ 

Printed Name of Subject                                                          Date 

_______________________________________                              ______________________________ 

Signature of Subject                                                                 Date 

_______________________________________                              ______________________________ 

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 11/25/10