ࡱ> EGD bjbj 4(rr. &H H 8>$b,V'pL L L &&&&&&&$(x+|&!* * "!!&p'%%%!R8&%!&%%%&rK!^%&&'0V'%+L"+&&&+-&L 0| "%  L L L &&#L L L V'!!!!+L L L L L L L L L H h:  Template for minors aged 10-17: Minors Assent for Being in a Research Study ؿ Title: [Include a simplified version of the research title] Why am I here? We are asking you to take part in a research study because we are trying to learn more about [briefly outline the purpose of the study in language that is both appropriate to the minors maturity and age]. We are inviting you to be in the study because [state why the minor is being asked to participate]. Why are you doing this study? [Outline what the study is about in language that is both appropriate to the minors maturity and age] What will happen to me? [Describe what will take place from the minors point of view in language that is both appropriate to the minors maturity and age] Will the study hurt? [Describe any risks to the minor that may result from participation in the research] Will the study help me? [Describe any benefits to the minor from participation in the research] What if I have any questions? You can ask any questions that you have about the study. If you have a question later that you didnt think of now, you can call me [insert investigators telephone number] or ask me next time. Do my parents [guardians] know about this? This study was explained to your parents [guardians] and they said that you could be in it. You can talk this over with them before you decide. Do I have to be in the study? You do not have to be in the study. No one will be upset if you dont want to do this. If you dont want to be in this study, you just have to tell me. You can say yes now and change your mind later. It's up to you. Writing your name on this page means that that you agree to be in the study, and know what will happen to you. If you decide to quit the study all you have to do is tell me or the person in charge. _________________________________________ Name of Minor (printed) _________________________________________ ___________________ Signature of Minor Date _________________________________________ ___________________ Signature of Researcher Date      Page  PAGE 1 The ؿ IRB Expiration Date_________________________ Date Approved _________________________ Chair/Admin ___________________________ T & ' . = ? H Q W 4 f n t u 7 8 ! " # 혲}wqkqgh~. h.'CJ h~.CJ hQS4CJ hPE1hPE1'hzh[>0J56B*CJaJph2jhzh[>56B*CJUaJph,jhzh[>56B*CJUaJph#hzhEp56B*CJaJph#hzhPE156B*CJaJph#hzh[>56B*CJaJph( " # _ ` o )*B & p@ P !dh,$ Gp@ P !$`'0*-/2p5@8;=@dha$gdPE1$a$gd[># ( + ] _ o p # + ; n | '*BCjr03KMjo9@N_x5S012ĭh.' hQS4CJ hQS4>*CJh.'6CJ] h~.5CJ h~.>*CJ hQS46] hA>*hQS46CJ]h~.6CJ] h~.CJ h~.6]h~. h~.>*@B23Kwx45S0) Gp@ P !$`'0*-/2p5@8;=@dh` & p@ P !dh & p@ P !dh^01'DE-r.$ Gp@ P !$`'0*-/2p5@8;=@xa$gdA)$ Gp@ P !$`'0*-/2p5@8;=@a$,$ Gp@ P !$`'0*-/2p5@8;=@a$gd% !$ 2 &/4CDE./124578:<>?EFLMNOQRSTrμ{mhzCJOJQJ^JaJ'hrRhz5@CJOJQJ^JaJ h CJhzCJaJmHnHujh0Mh CJUaJh0Mh CJaJ"jhzCJUaJmHnHuh h 0Jh@5jh@5Uh~.hQS4hAh% hACJ h~.CJ$-.0134679:=>P<gdz<gdz$a$$a$gdA$ a$,$ Gp@ P !$`'0*-/2p5@8;=@a$gd0Mh~.h@5hz#hhhz5CJOJQJ^JaJhzCJOJQJ^JaJ hhhzCJOJQJ^JaJ,$ Gp@ P !$`'0*-/2p5@8;=@a$gd0M21F:pz/ =!"#$0%@ DyK yK http://www.umt.edu/research/complianceinfo/IRB/Docs/childsubjects.pdfyX;H,]ą'c^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`< NormalCJ_HmH sH tH N@N  Heading 1$$ @&a$5CJDA`D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 4B@4 Body Text$a$<P@< Body Text 2dhCJb>@b Title9$ & p@ P !]a$54@"4 Header  !4 @24 Footer  !.)@A. Page NumberQ@R Body Text 3X$ Gp@ P !$`'0*-/2p5@8;=@dha$CJJ@b SubtitleX$ Gp@ P !$`'0*-/2p5@8;=@dha$ 5CJ\H@rH _ Balloon TextCJOJQJ^JaJjj 0M Table Grid7:V06U`6 [> Hyperlink >*B*phPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  5( %%%(# 2 B0- 7 X (!@ @ l(  4  L?"Text Box 2S"Æ?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK! +drs/e2oDoc.xmlSn0 }81ri8EÀFcaIJGilo P"utxHoQ|6r&F}Ϳ?ݿ,D h27Uu#=#ռUED' :i٢7E'tr:]=y2|VmLלż^lP=N OPw (1`'Mm9P6Ū.=K@ 5*Ah |bMy}U ⹊ V8RCHtd9ҌE,=NaQc,tRa:>}Vۛa ";P2SOd ;K˚Cl ,PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-! +.drs/e2oDoc.xmlPK-!EΏwdrs/downrev.xmlPK} 0(  B S  ?(n&t>(p?(p@(p   !! 9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceType>*urn:schemas-microsoft-com:office:smarttags PostalCode . 0 1 3 4 6 7 9 : S T . 0 1 3 4 6 7 9 : S T 3TWWdd"'.?HQWj/4fntu & & C C - . 0 1 3 4 6 7 9 < < > E O S TWWdd"'.?HQWj/4fntu & & C C - . . 0 1 1 3 4 6 7 9 : > ? S T T e |88^8`o(.ex\~d-~8 E y#.'~.PE1jE4QS4[>zA0MlTn=e}[~AkAEp0E%=8z@5 5$<cH CV"|_. 0 @ @UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA. Arial Narrow5. .[`)TahomaA$BCambria Math"h:*G:*G ] ] !24( ( 3qHX?cH2!xx Child Assent Form Zeev Kain MD Baker, Paula Oh+'0  8 D P \hpxChild Assent FormZeev Kain MDNormalBaker, Paula5Microsoft Office Word@e@NaK@KDnk@nK] ՜.+,D՜.+,H hp  Yale University(  Child Assent Form Title  8@ _PID_HLINKSARFhttp://www.umt.edu/research/complianceinfo/IRB/Docs/childsubjects.pdf  !"#$%&'()*+,-./012356789:;=>?@ABCFRoot Entry FKHData 1Table,WordDocument4(SummaryInformation(4DocumentSummaryInformation8<CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q