ࡱ> LNK bjbj\@\@ ?(>* k>* kW d~~$$$8\4$$(&1(3(3(3(3(3(3(*j-3("3(H(~"~"~"R1(~"1(~"~"V%@ &`w& ^% (^(0(% . 6. & &&.1&~"3(3(!(.~X : SAINT ELIZABETH UNIVERSITY INSTITUTIONAL REVIEW BOARD (IRB) PARENT/GUARDIAN PERMISSION FORM FOR FOCUS GROUPS Complete this form and submit it with your Submission Form. Indicate whether you will use letterhead or letterhead from the host site. TITLE OF RESEARCH: Insert title of research here. RESEACHER: Insert your name; indicate whether you are a student, faculty or staff member of the College; state if the study is a course/degree requirement. The following permission is required by . This study has been approved by Universitys Institutional Review Board. Insert description of the research here. Be specific e.g. Ms. Jones is studying the Language Arts Program at Hillcrest School. She will conduct a focus group of third grade students about the language arts program for about 30 minutes. I understand that: My child's participation in this study is voluntary and may be discontinued at any time he or she wishes to withdraw and my child may skip any questions. Similarly, I may withdraw my child from the study at any time. If either of us decides to withdraw, my child will not incur any penalty. My childs confidentiality will be protected. It is expected that my child will not discuss what was said at the meeting outside the group. By signing this agreement, I understand that the researchers do not expect any foreseeable risks to my child. There is no plan to reimburse for any costs I might incur as a result of participating in this study. I hereby give my consent for my child/ward to be a participant in your research. You have given me an explanation of the procedures to be followed in the project and you will be willing to answer any inquiries I may have. I also give my consent for my child to be audio (or video) recorded. (Include this statement as applicable and ask the parent/guardian to initial this line.) _______________________________________ Parents /Guardians Signature _______________________________________ Print Name and Date _______________________________________ Child's Name and Birth Date THIS INFORMATION MUST BE PROVIDED TO THE PARENT/GUARDIAN 1. TITLE OF RESEARCH: Insert title of research here. 2. For answers to any questions you may have about this research, contact: RESEARCHER: Insert contact information for Researcher(s) here. Use your or business email; do not use a personal email. 3. 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