Attachment I - Safe Dates Student Assent

Attachment I: Student Assent

Attachment I.

Safe Dates Student Assent

PARENT'S NAME: ______________________________________________

YOUTH'S NAME: _________________________________________

TELEPHONE NUMBER: (___ ___ ___) ___ ___ ___- ___ ___ ___ ___

SCHOOL NAME: ___________________________________________

Safe Dates Student Assent

(for use after parent consent has been obtained)

Hi. I am (FIRST AND LAST NAME OF RTI RECRUITER) from RTI International in North Carolina. Your [MOM/DAD] gave me permission to talk with you about a study that [SCHOOL NAME] is taking part in to learn about preventing youth violence, including violence between teen dating couples. The study is sponsored by the Centers for Disease Control and Prevention (CDC) and will be conducted by RTI International, a not-for-profit research organization in North Carolina. As part of the study, RTI would like to conduct focus groups about students’ experiences with the Safe Dates teen dating violence prevention program and ideas for how to adapt the program for urban schools. A focus group is a group discussion to learn everyone’s opinion. The focus group will take place this summer. You were selected to be in a focus group because you received the Safe Dates Program at school in the ninth grade and because your school said that your opinion would be important.

Your [MOM/DAD] has said it is okay for you to be in a focus group, but I need to make sure you are okay with this, since it’s your choice whether you want to do this. This will involve a 90-minute focus group at [LOCATION, DATE, TIME]. Each teen who participates will receive a $25 gift card.

If you agree to do this, you will be in a focus group with up to 9 other students from your school. We will not ask personal questions during the focus group, just about your opinion about the Safe Dates program. You do not have to have dated to be in the focus group. We are required to audio record the discussion so that we do not miss anything you and the other participants say, but the information you say will be kept private. Only the research team will use these recordings, so we will not share any information about what was said with your school, your parents, or other people who are not in the focus group. If you prefer that we do not record something you want to say, you may choose not to say those things, or you can leave the group at any time.

Do you have any questions or concerns? Does [LOCATION, DATE, TIME] work for you?

IF NOT, SEE WHETHER OTHER DATES/TIMES WORK. IF STUDENT IS OKAY WITH BEING IN THE FOCUS GROUP:

Thank you for talking with me. We will see you on [DAY/TIME at LOCATION], and I’ll probably follow up with a reminder the day before!