Attachment A - Consent and Assent Forns

ATTACHMENT A: CONSENT AND ASSENT FORMS:
PARENT/GUARDIAN PASSIVE CONSENT TO PARTICIPATE IN
RESEARCH

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Dear Parent:
[Name of School] will be participating in an evaluation of the Poetry Out Loud program that the school
offers to students [specify grade level, if appropriate]. Poetry Out Loud is a national arts program that
encourages high school-aged youth to learn about poetry through memorization and recitation. The
purpose of the study is to understand how reading and performing poetry affects student engagement,
learning, and grades.
All students in the school will be given the opportunity to fill out two short surveys in the Fall and Spring
of this academic year about their experiences with poetry. The survey is anonymous and voluntary. Your
child’s grade does not depend on answering the questions. Your child does not have to fill out any part of
the questionnaire that makes him or her feel uncomfortable or that you think your child should not
answer.
Students who are participating in Poetry Out Loud may be invited to participate in an interview or focus
group with a researcher.
If for any reason you do not wish your son or daughter to participate in the survey, please sign this form
and return it by [date].

_______________________________________________
Student’s Name (please print)

_______________________________________________
Parent signature

Date:_______________

The study is funded by the National Endowment for the Arts and is being conducted by Social Policy
Research Associates. If you have any questions about the study or problems related to the study you can
talk to your principal; the project director at the NEA, [insert appropriate NEA contact], who can be
reached at [phone] or [email]; or the director of the study, Melissa Mack. You can call or email her at
(510) 788-2478 or [email protected]. If you have questions about the study but want to talk to
someone else who is not a part of the study, you can call the Solutions Independent Review Board at
(855) 226-446.

STUDENT ASSENT TO PARTICIPATE IN INTERVIEWS AND FOCUS GROUPS
(This form will be distributed to students who are asked to participate in interviews and focus groups.)
1.

What will happen to me in this study?

Description of the study: This study looks at student experiences with poetry to understand how the
Poetry Out Loud program is working in classrooms like yours across different schools. This study seeks
to understand how reading and performing poetry affects student engagement, learning and grades. As a
participant in this study you may be asked to participate in an interview or focus group. Interviews and
focus groups will last between 30 minutes and one hour. During the interview/focus group, you will be
asked questions about your experiences at your high school and in your classes. With your permission,
the interview will be audio taped and we will selectively transcribe the tapes.
2.

Can anything bad happen to me?

Risks or Discomforts of Participating in the Study: There is very minimal risk for participating in the
study. If you feel uncomfortable with any of the questions you are asked you do not have to answer the
question or continue participating in the interview.
3.

Can anything good happen to me?

Benefits of Participating in the Study: We cannot guarantee any benefits of this study but it might be
enjoyable to talk about your experiences at your high school and what we learn about your experiences in
your school might help other schools and classrooms be better places for students.
4.

Will anyone know who I am in the study?

Confidentiality: Your name will not be used in the study; we will identify you by your grade level.
5.

Who can I talk to about the study?

Contact Information: If you have any questions about the study or problems related to the study you can
talk to your teacher, who can put you in touch with the study directors.
6.

What if I do not want to do this?

Voluntary Participation: You can choose not to participate in the study or you can change your mind and
stop being in the study at any time and you do not have to answer any of the questions asked of you
without getting in trouble and without it affecting your grades in school.

STUDENT ASSENT FORM TO PARTICIPATE IN SURVEYS
(A version of this form will appear on the front page of the electronic survey. Students will indicate their
assent to participate by clicking the “I Agree” button or something similar.)
1.

What will happen to me in this study?

Description of the study: This survey is a part of a study that looks at student experiences with poetry to
understand how the Poetry Out Loud program is working in classrooms like yours across different
schools. This study seeks to understand how reading and performing poetry affects student engagement,
learning and grades. As a participant in this study you will be asked to participate in this survey, which
will take approximately 20-30 minutes to complete. The survey will ask you questions about your
experience in your community, your school and your classes.
2.

Can anything bad happen to me?

Risks or Discomforts of Participating in the Study: There is minimal risk to participating in this survey. If
you feel uncomfortable with any of the questions you are asked you do not have to answer the question or
continue participating in the survey.
3.

Can anything good happen to me?

Benefits of Participating in the Study: We cannot guarantee any benefits of this study but what we learn
about your experiences in your school might help other schools and classrooms be better places for
students.
4.

Will anyone know who I am in the study?

Confidentiality: Your name will not be used in the study; we will identify you by your grade level.
5.

Who can I talk to about the study?

Contact Information: If you have any questions about the study or problems related to the study you can
talk to your teachers, who can put you in touch with the study directors.
6.

What if I do not want to do this?

Voluntary Participation: You can choose not to participate in the study or you can change your mind and
stop being in the study at any time and you do not have to answer any of the questions asked of you
without getting in trouble and without it affecting your grades in school.