ࡱ> 8:7Y bjbj[[ 49 \9 \9 M8L`tt(wwwdffffff$wwdd0:HvP0Lw0"wwwdwwwwwwwwwwww> : MARQUETTE UNIVERSITY ASSENT FORM FOR RESEARCH PARTICIPANTS (insert title of project) Investigator(s): [List all individuals (name and degree) who will obtain assent from subjects] We are doing a research study. A research study is a special way to find out about something. We want to find out [purpose of study in simple language]. You can be in this study if you want to. If you want to be in this study, you will be asked to [Describe procedures simply.] We want to tell you about some things that might happen to you if you are in this study. [Describe risks e.g., painful procedures, other discomforts, things that take a long time.] If you decide to be in this study, some good things might happen to you. [Describe possible direct benefits, or state There is no direct benefit to you for being in the study.] But we dont know for sure that these things will happen. We might also find out things that will help other children some day. [For medical treatment studies only, please delete if this does not apply to your project:] If you dont want to be in this study, we will tell you about the other things we can do for you. When we are done with the study, we will write a report about what we found out. We wont use your name in the report. All the information you provide will be kept private. No one except the research team will know that you are in the study unless you and your parents decide to tell them. The only time that we would break this rule would be if you tell us information that we think your parents need to know to be able to keep you or other people safe. For example, if you have been having serious thoughts about hurting yourself in some way, we would inform your parents. Even if your parent/guardian agrees to your participation in this study, it is still your decision whether or not to be in the study. You do not have to be in this study if you dont want to. You can say no and nothing bad will happen. If you say yes now, but you want to stop later, thats okay too. If something about the study bothers you, you can stop being in the study. All you have to do is tell the researcher you want to stop. If there is anything you dont like about being in the study, you should tell us and if we can, we will try to change it for you. If you have any questions about the study, you can ask the researcher. We will try to explain everything that is being done and why. Please ask us about anything you want to know. If you want to be in this study, please sign and print your name. I, ____________________________________, want to be in this research study. (write your name here) _____________________________________ _________________ Sign your name here (Date) _____________________________________ _________________ Investigator signature (Date)     Protocol Number: __________ Page  PAGE 1 of  NUMPAGES 2 !;UVij, Q /  > ?   OUYrJds  QReɺۮ۪۪۪۪۪ۮۖۖۖh>o hzCJ hfCJhzhfh^Uh^Uh^U\h^UB*\phf hf5hfB*\phfhfB*phfhf holh>oholh>oB*phf h>oaJholh>oaJ;;UVWU V   R|gdf$a$gd>$$>789;<>?$$f9:<=?@BCEghnopquvhF<mHnHujhCUhCh1Sjh1SUhfhf21h:p>o/ =!"#$% s2&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH @`@ fNormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4@4 >oHeader  !4 @4 >oFooter  !PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  ))LLLOe | .57<GIO!8@0(  B S  ?ѠѠѠ   9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType 9 9 ; < < > ? A B D E g q u <B f k 9 ; < > ? A B D E 3333W>OUYrJds R e } 8 9 9 < < E ` b g q u 8 9 9 ; < < > ? A B D E   ND`"Bs~yf1SjF<Cz^Uf>o9 ; @ @UnknownG*Ax Times New Roman5Symbol3. *Cx ArialA$BCambria Math"1h{'{'  !244 4 3qHP ?f2!xx Project Title:Melissa LauritchKennedy, BenjaminOh+'0 ( H T `lt|Project Title:Melissa LauritchNormalKennedy, Benjamin2Microsoft Office Word@@~J:@~J: ՜.+,0  hp  տƵ4  Project Title: Title  !"#$%&()*+,-.01234569Root Entry F:;Data 1TableWordDocument4SummaryInformation('DocumentSummaryInformation8/CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q