1 CTK Parent Consent Form

OMB Control No: 0970-0401

Expiration date: 10/1/2020

Youth Remote Testing

Parental Permission for Your Child’s Participation

____________________________________________________________________________________Public reporting burden for this collection of information is estimated to average less than 5 minutes per response, including the time for reviewing instructions and providing the information requested. You are not required to respond to any request for information unless it displays a currently valid OMB control number.
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Introduction and purpose:

RTI International is a nonprofit public health organization headquartered in Research Triangle Park, NC. RTI provides health research and technical services to government and commercial clients worldwide. RTI is creating an online community with youth to guide and provide feedback on a project that we’re leading. The purpose of our project is to design a marketing campaign, game, and website for youth ages 10–22 that will empower them to make informed choices to help them avoid risky behaviors. With the research activities on the online community, we hope to understand what types of content, products, and design elements are most appealing to youth and young adults.

We will not collect any personal or family health information from your child. This activity is not considered research with human subjects. Researchers at RTI are conducting this project and activity using public funds. None of the researchers participating in this study stand to gain anything financially or personally.

This form requests your parental permission based on what the project is about and what your child will be asked to do. It also tells you how we will protect your child’s information and who you can call if you have questions. Your child will be provided with an assent form with similar information before participating in online research activities.

Procedures:

If you agree to let your child participate, they will join an online community using the platform CMNTY. They will have the opportunity to participate in activities that we create, such as vote for their favorite designs, respond to a forum question, or complete a short questionnaire. The discussions and activities will focus on their preferences and reactions to various types of media that we're creating to support the campaign, including infographics, quizzes, and videos. Each activity should take no longer than 15 minutes to complete.

Risk/Discomforts:

There are minimal risks to your child for participating in this study. There are no costs associated with taking part in this study.

1. While the discussion questions we ask are not meant to be sensitive, there is always a chance that your child may feel uncomfortable with some of the questions. Your child does not have to answer any question that they don’t want to answer and can stop participating at any time. The activities they choose to complete are up to them.

2. RTI will take several steps to keep your child’s participation confidential and will not share their names with anyone outside of the platform. The information that your child gives us will be anonymized and combined with the responses of other participants to inform our campaign design.

3. Other members in the community will be able to see your child's username (much like social media). If you would prefer that their username not include their real name, that is fine; please provide that guidance to your child.

Benefits:

This study will offer your child $15 in the form of an electronic gift card for movies, music, or food as a token of appreciation for their time and effort. They will receive a $15 gift card when they have completed one hours’ worth of activities.

Right to Refuse or Withdraw:

Your child’s participation in these online research activities is voluntary. Your child can choose not to answer any questions and can stop participating at any time without penalty. You may withdraw your permission and stop your child’s participation at any time. Your child can select which activities he or she would like to complete. They are all completely optional.

Persons to Contact:

If you have questions about the project, you can call the Project Director, Dr. Barri Burrus, at 1-800-334-8571 ext. 25109 (a toll-free number). If you have questions about your child’s rights as a participant, you can call RTI’s Office of Research Protection at 1-866-214-2043 (toll-free number).

STATEMENT OF PARENTAL PERMISSION FOR THE ONLINE RESEARCH PLATFORM

I have read this parental permission form. The above document describing the benefits, risks and procedures for this online research community has been explained to me. I had a chance to ask questions, and my questions were answered. I was given a copy of this parental permission form.

Have Questions?

Check out our FAQs: https://docs.google.com/document/d/1txDu2VnPj3jHfV... If you have additional questions or would like to see the platform before your child joins, email [email protected]

I have read this parental permission form. I agree to let my child participate in the online community.

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Child’s name

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Name of parent or guardian

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Signature of parent or guardian Date