Child Assent Form
IRB #061717-4
Title of the Research Study: Assessing the Impact of Speech Rate and Performance in Dysarthric Speakers
Summary
In this study we will try to learn how changing the speed you talk affects the way you talk. You might like to participate because you may learn to speak more clearly, but the study will take about an hour.
You are deciding whether or not to be in this study. Signing this form (or saying “yes”) 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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Printed Name of Witness Date
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Signature of Witness Date
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Signature of Investigator Date
Identification of Investigators
Principal Investigator
Julie K. Robinson, Ph.D. University of Nebraska at Kearney
Office: 865-8888
Secondary Investigator
Samuel Johnson, Ph.D. University of Nebraska at Kearney
Office: 865-9999
Approved 06/28/17