Approved Student Assent Form

Appendix G:

Approved Student Assent Form

ASSENT FORM FOR MINOR STUDY SUBJECTS

6 – 17 years of age

NAME OF SPONSOR COMPANY: Institute of Education Sciences, US Department of Education

PROTOCOL NUMBER AND TITLE OF STUDY: REL-SE 4.1.5; “The Impact of Professional Development in Fractions for Fourth Grade Teachers on Student Achievement and Teacher Knowledge in Georgia and South Carolina”

NAME OF PERSON IN CHARGE OF THE

RESEARCH STUDY (INVESTIGATORS): Russell Monroe Gersten, Ph.D.

Madhavi Jayanthi, Ed.D.

TELEPHONE NUMBER(S), DAYTIME: 714-826-9600

You are being asked to be in a research study about how students learn fractions.

Conducting a research study is what social scientists do. We are social scientists interested in improving education. The purpose of this research study is to help teachers teach fractions better.

This letter tells you about the study so you can decide if you want to be in it. Before you decide, you can talk about it with your parents or anyone else you like.

If you agree to be in the study and your parents say it is okay, we will ask you to:

• Take a fractions test (about 30-40 minutes) near the end of this school year.

Place and total time: The test will be done in your classroom and will take about 30-40 minutes.

If you don’t want to be in the study, your teacher will give you a different activity to work on during that time. It will take about the same amount of time as the test.

Any benefits? Being in this study won’t change anything for you. But we hope that what we find out from this research helps kids in the future to learn fractions.

Any discomforts? If for any reason you decide that you don’t want to finish the test, you can stop at any time. Just tell us you want to stop.

Who will know? If we write up a report or give talks about this research, we won't use any real names of people who were in it. We will just talk about what we learned from all the results put together.

Do you have to participate? No, participating in research is something you do only if you want to. Whether you decide to participate or not, it will have no effect on your grades at school or your relationship with your teacher. You can say no and no one will be upset with you. And if you agree now, you can always change your mind later if you don't want to be in the study any more. If you decide to stop after we begin, that's okay too.

Questions?: You can ask questions about this study at any time, now or later. Feel free to contact me, Christopher Tran at 714-826-9600 or [email protected].

STUDENT ASSENT

If you decide to participate, and your parents agree, we will give you a copy of this signed and dated form to keep. That way you can look at it later if you want to.

If you would like to be in this research study, please sign your name on the line below.

________________________________________ _______________

Child's Name/Signature (printed or written by child) Date

________________________________________ _______________

Signature of Investigator/Person Obtaining Assent Date

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