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Informed Consent Form

This informed consent form describes a study being conducted by students in an Introduction to Science Research class to determine if there is a relationship between taking selfies and self-esteem in teenagers. The form provides details about the study, including its purpose, procedures, duration, risks/benefits to participants, confidentiality, reimbursement, rights to ask questions, and voluntary participation. It requests the printed names, signatures and dates of both the teenage participant and their parent/guardian to provide consent for the student to participate in the anonymous survey being administered as part of the class.

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38 views1 page

Informed Consent Form

This informed consent form describes a study being conducted by students in an Introduction to Science Research class to determine if there is a relationship between taking selfies and self-esteem in teenagers. The form provides details about the study, including its purpose, procedures, duration, risks/benefits to participants, confidentiality, reimbursement, rights to ask questions, and voluntary participation. It requests the printed names, signatures and dates of both the teenage participant and their parent/guardian to provide consent for the student to participate in the anonymous survey being administered as part of the class.

Uploaded by

api-292934675
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INFORMEDCONSENTFORM

DearParent/Guardian,
CurrentlyinourIntroduction to ScienceResearch class, we arestudying surveydesignandanalysis.Wehavedesigneda
survey to determineif there is arelationship between selfies andselfesteem.In orderfor your child toparticipate, please
read the information below and completethenecessaryinformationatthebottomofthisform.Failure toreturntheformwill
preventyourchildfromparticipatinginthestudy.

TitleofProject:
HowDoSelfiesAffectTeenSelfEsteem
?
PrincipalInvestigators:

TenstudentsinMs.ShallosIntroductiontoScienceResearchclass
Advisor:
Ms.JenniferShallo

1.
Purpose oftheStudy:
The purpose ofthisstudyistodiscoverifthereisacorrelationbetweenselfiesandselfesteem
inteenagers.

2.
Procedurestobefollowed:
Students
w
illbeaskedtoanswerquestionsregardingtheirexperiencetakingselfies.

3.
Duration/Time:
ItwillbeadministeredduringtheirIntroductiontoScienceResearchclass.

4.
Risksand/orDiscomforts
:Thissurveyprovidesminimaltonodiscomfortsorrisks.

5.
Benefits
:TheresultsofthisinvestigationwillbeusedtohelpstudentsinMs.ShallosIntroductiontoScienceResearch
classandanalyzesurveydata.

6.
Statement ofConfidentiality:
Datawillbecollectedsecurely andonlyshowntothosewhoparticipatedinthe makingof
thesurvey.Allanswersareanonymous.

7.
Payment/Reimbursement
:Participantsinthissurveywillnotreceiveanypaymentorreimbursementfortheirtimeand
answers.

8.
Rightto AskQuestions: Ifthere are any questionsabout this surveypleasecontactMs.Shalloat(914)9373600Ext.
3195orjshallo@blindbrook.org.

9.
Participation: Participatingis this surveyisoptionalandverymuchappreciated.Participantsdonothavetoanswerany
questionstheydonotfeelcomfortableanswering.

Ihavereadandunderstandtheaboveinformation,andagreetoparticipateinthisstudy.

_____________________________________________
_____________________
PrintedNameofResearchParticipant
Date

_____________________________________________
_____________________
SignatureofParticipant

Date

_____________________________________________
_____________________
PrintedNameofParent/LegalGuardian
Date

_____________________________________________
_____________________
Parent/LegalGuardianSignature
Date

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