(Must be on Sponsoring Institution's Letterhead)
Date
Dear Parents,
We would like to include your child in a research project on the development of language comprehension skills in children and teenagers. This study will be conducted by researchers from (name of Sponsoring Institution).
Each student will participate in four sessions. All sessions will be held in a room in your child's school during non-instructional hours (e.g. before or after school, lunch, recess, etc.). The four sessions will be held on different days. Each session will last between 25 and 35 minutes. Each session will involve either audio or video taping your child engaged in language development activities.
To help us in our research, we also would like permission to ask your child's teacher for information from your child's school records. This information will consist of scores from standardized cognitive tests, information about possible problems in hearing, vision, and physical mobility, and information about the causes of your child's learning difficulties (e.g., whether these problems are due to Down's syndrome).(1)
It would be helpful if you could complete the brief questionnaire entitled Family Background, which is attached. Completion of this questionnaire is optional. If you would like, you child can participate in the project even if you do not complete the questionnaire.
Only the researchers will have access to the information collected in this project, which will be kept in locked storage at the university for a period of seven years following the completion of the research. Neither your name nor your child's name will appear in any reports of this research. You have a right to review a copy of any survey, questionnaire, checklist, etc. being administered to your child.(2)
Participation in this project is voluntary and involves no unusual risks to you or your child. You may rescind your permission at any time with no negative consequences. Your child can refuse to participate or withdraw from the project at any time with no negative consequences (e.g. their grades, right to receive services, etc.).
Your child's participation in the project will help us develop better methods of identifying and treating language comprehension problems that may hinder a child's academic progress.
If you agree to let your child participate, please indicate this decision on the following page and mail that back to us in the postage-paid envelope provided. A detailed description of the project is attached in case you need more information before deciding. If you complete the Family Background questionnaire, please include it in the postage-paid envelope as well. If you have any questions about this research or would like to review the (survey, questionnaire, checklist, etc.) prior to providing consent, please feel free to contact me at XXX-XXXX or my supervising professor (insert Professor's name here), at XXX-XXXX. If you have questions about your or your child's rights as a research subject, you may contact the (Name of Sponsoring Institution) Institutional Research Board at XXX-XXXX.
Sincerely,
(Researcher's Name)
I give my permission for the items checked "Yes" below: __________________________________________ (Parent/Guardian printed name) __________________________________________ ____________________ (Parent/Guardian signature) Date Yes No ______ ______ My child's participation in this research project. ______ ______ Interviewing my child's teacher. ______ ______ Obtaining information from my child's school records. ______ ______ Videotaping of my child. ______ ______ Audiotaping of my child. Please return this page in the postage paid envelope.
Planning/Research & Evaluation Home Page
Last Updated: August 11, 2006
Author: Kurt Kiefer,
kkiefer@madison.k12.wi.us
HTML Editor: Chris Burch,
cburch@madison.k12.wi.us
HTML Publisher: Joshua Roy,
jroy@madison.k12.wi.us
webmaster@madison.k12.wi.us