(ii) Informed Consent Form(s)
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School
California State University, Long Beach *
*We aren’t endorsed by this school
Course
130
Subject
Communications
Date
Apr 3, 2024
Type
docx
Pages
6
Uploaded by AmbassadorAardvarkPerson480
Version: 10 Nov 2023
Page 1 of 6
California State University Long Beach
Project Title: Afrocentric Values, Positive Youth Development, and Black Youth
Investigator(s): Isaiah Ringo
Project Contact: 818-482-0810
Faculty Advisor(s): Dr. M. Keith Claybrook Jr.
Faculty Advisor(s) Contact: M.Keith.Claybrook@csulb.edu
California State University, Long Beach (CSULB)
College of Liberal Arts, CSULB: 1250 Bellflower Blvd., Long Beach, CA 90840
PARENT/GUARDIAN PERMISSION FORM – SOCIAL-BEHAVIORAL
Afrocentric Values, Positive Youth Development, and Black Youth
Introduction
Hello, my name is Isaiah Ringo. I am a student in the College of Liberal Arts at CSULB. I am working with my Faculty Advisor (FA), Professor Dr. Claybrook, on a research study. With your permission I would like to invite your child to participate in this study.
Before you and your child decide whether he/she will be part of this study, it’s important for both of you to understand why we’re doing the research and what’s involved. Please read this form carefully. (Your child will receive his/her own assent form.) I encourage you to discuss the study with your child. If you or your child has questions about the research, feel free to ask me.
Purpose
I am inviting your child to participate because they are a part of the BSU program at Aspire Public Schools
. Whether or not your child participates in the study will have no effect on his or her grades if a
school-related study or on his or her relationship with the organization engaged with the research.
Procedures
If you give your permission and your child/youth decides to participate, I will ask him/her to:
Be
interviewed
I will ask your child to participate in an interview with me
.
If your child agrees to be interviewed, I will meet with him/her. This will be at a place that is convenient for your child on the school site of Aspire Public Schools.
I will ask your child questions about the way he/she studies and learns. I will take notes on our discussion. With your permission and your child's assent, I will also audiotape the interview. The taping is to accurately record the information he/she provides. If your child chooses not to be audiotaped, I will only take notes. If he/she agrees to being audiotaped but feels uncomfortable at any time during the interview, I can turn off the tape recorder, or stop the interview at his/her request at any time.
The interview will take about 15-30 minutes.
Version: 10 Nov 2023
Page 2 of 6
Be
surveyed
I will ask your child to participate in an survey. Participants can agree to both the survey and the
interview,
disagree
to
both,
or
choose
to
participate
in
either
the
survey
or
the
interview. If
your
child
agrees
to
the
survey, I
will
meet
with
him/her.
This
will
be
at
a
place
that
is
convenient
for
your
child
on the school site of Aspire Public Schools.
I will ask your child to take about 10 minutes to complete the survey. The survey will consist of
questions
concerning
how
Black
Student
Union
has
affected
their
sense
of
community
and
created
friendships.
Total
time
: The questionnaire will take about 10 minutes of your child's time. If your child also has an interview, the whole study will take about 4
0
5-50
minutes
.
Benefits
The possible direct benefits to the participants would be the opportunities to share their experiences of being Black individuals and opportunities to reflect on positive aspects of their racial identity. This research will allow for opportunities in educational leadership practice, education policies, and future research in Africana studies.
Risks/Discomforts
Your child might get bored or tired and decide that he or she does not want to complete the study
activities. If so, your child can tell me that he or she wishes to stop.
Your child may feel coerced to participate. Your child can choose to skip any of the interview and/
or survey questions or withdraw from the study. Also,
you
or
a
staff
member
can
be
present
during the interview if desired.
Breach of Confidentiality: A possible risk for any research is that confidentiality could be compromised, that is, people outside the study might get hold of confidential study information. I
will do everything I can to minimize this risk.
Confidentiality
I will keep your child's study data as confidential as possible. If I publish or present the results of this study, I will not use individual names or other personally identifiable information.
To help protect confidentiality, I will keep all information in a password protected laptop that only I can access.
I plan to keep this information for 2 years should I need to use it later for other studies. I will follow the same steps to keep it as confidential as possible. Participants are able to have access to their
transcriptions. If requested, I will send the guardian/parent and the participant via email.
Compensation/Payment
Your child will receive a $30 Amazon Gift Card as a thank-you for the time and effort to take part in this study. Compensation will be received through email after the completion of the participants partaking in the survey or
and
interview questions.
Rights
Version: 10 Nov 2023
Page 3 of 6
Your child’s participation in this study is voluntary
. You have the right to refuse to allow your child to participate or to withdraw your child at any point in the study without any penalty or loss of benefits
to which you or your child are otherwise entitled. Your child has the same rights to decline to participate or withdraw from the study at any time.
Questions
You and your child can ask questions about this study at any time, now or later. You can talk to me, Isaiah Ringo at any time during the study. You can contact me, Isaiah Ringo, at 8184820810 or isaiahringo@gmail.com
.
If you have any questions or concerns about your child/youth's rights as a research participant, you may contact the CSULB Institutional Review Board (IRB) at 562-985-8147 or IRB@csulb.edu
. An IRB is a committee that reviews research to ensure that the rights and welfare of research participants are protected.
******************************************
Parent Permission Only – The Child/Youth Assent is Obtained on Separate Form after the Parent/Guardian has given Permission.
If you decide that your child may participate in this study, please sign and date below
. By signing this
form, you are indicating that you have had your questions answered and you are giving permission for
your child to participate in this research.
Child/Youth Participant Name (
please print
)
[If
photos,
audio/video
recording
are
optional
include
the
parent/guardian
choices
below.]
I give permission for taking photos of my child for this research:
Yes ☐
No ☐
I give permission for audio-recording of my child for this research:
Yes ☐
No ☐
I
give permission for
video-recording of my
child
for
this research:
Yes
☐
No
☐
Parent/Guardian's Name (
please print
)
Date
Parent/Guardian's Signature
Date
******************************************
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Version: 10 Nov 2023
Page 4 of 6
California
State
University,
Long
Beach
(CSULB)
Assent
to
be
in
a
Research
Study
for
Children
7-12
Years
of Age
AFROCENTRIC
VALUES,
POSITIVE
YOUTH
DEVELOPMENT,
AND
BLACK
YOUTH
Hello,
I
am
Isaiah
Ringo,
a
student
who
is
doing
research
representing
CSULB
.
Why
do
you think I am meeting and talking with you?
I want to tell you about a research study I am doing. A research study is when a person called an
investigator collects information to learn more about something. An example of a research study is
collecting
information
about how
often
teachers
catch
colds.
I
am
doing
a
research study
to
learn
more
about kids who are Black students in elementary school and how Afrocentric teachings positively
affect
their
growth.
After I
tell
you
about
it,
I
will
ask
if
you’d
like
to
be
in this
study.
I
am
writing
this
after your parents and the school gave me permission for you to participate in the study.
Why
am
I
doing
this
study?
I
am
doing
this
study
as
I
want
to
find
out
about
Black
students
and
their
growth
after
being
introduced
to Afrocentric school lessons, so I am getting information from lots of kids like you who are Black
elementary students. Altogether, there will be about 15 kids in the study.
What
will
happen
to
you
if
you
are
in
this
study?
If
you
say
yes
to
be
in
the
study,
these
activities
will
happen:
You
will
be
interviewed
for
about
15
minutes at school, take a survey on Afrocentric teachings, and be audio recorded for notes that I
have to write for research.
You
will
be
asked to
do
an interview,
which
will take
about
15-30 minutes.
You
will be
asked to
participate in
a
survey,
which
will take
about
10 minutes.
If
you
agree
to
participate
in
the
interview,
you
will
be
asked
for
permission
to
audio
record
the
interview so I can write down notes for my project.
You
can
participate
in
the
survey,
the
interview,
both
the
survey
and
the
interview,
or
none
at
all.
Version: 10 Nov 2023
Page 5 of 6
Will
anything
good
happen
for
me
by
being
in
the
study?
You
will
get
the
opportunity
to
share
your
experience
of
being
a
Black
individual
and
look
at
positive
areas of identifying as Black.
Will
you
get
anything
for
being
in
the
study?
If
you finish
the study,
you can
get
a
$30
Amazon
gift card.
Do
you
have
any
questions?
You
can
ask
me
questions
any
time
during
the
study.
You
can
ask
now.
You
can
ask
me
later.
You
can
talk to me, or you can talk to someone else working on the study.
Do
you
have
to
be
in
this
study?
No, you don’t have to be in the study. No one will be mad at you if you don’t want to do this. If you
start
the
study
and
you
want
to
stop,
just
tell
me
or
your
parent/guardian. If
you
say
yes
or
you
say
no
to being in the study, it won’t affect your grades. You can stop at any time and go back to class.
Do
you
have
any
more
questions
about
the
study?
Do
you
want
to
be
in
this
study?
If
you
don’t
want
to
be
in
this
study,
just
tell
me
no.
Can
anything
bad
happen
if
I
participate
in
this
study?
There are questions in the interview about your experience as an African-American person. There
might
be
some
questions
that
trigger
past
racial
problems.
If
you
do
not
want
to
answer
the
questions,
I
can skip the questions or stop the interview.
Version: 10 Nov 2023
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SIGNATURE
OF PERSON CONDUCTING ASSENT DISCUSSION
I have explained the study to
(print name of child here) in language he or she can understand, and the child has agreed to be in the study.
Is it okay for Isaiah to take pictures of you for this study?
Yes ☐
No
☐
Is it okay for Isaiah to audio-record you for this study?
Yes ☐
No ☐
Is
it
okay
for
Isaiah
to
video-record
you
for
this study?
Yes
☐
No
☐
Obtaining
the
child’s
signature,
printed
name
or
mark
is
optional.
Name
of Child
Signature
or
mark
of Child
(age
7
to
12
years)
Date
By
signing
this
form,
you
are agreeing
that
your
questions
about
the
study
have
been
answered
and
you
agree take part in this study.
OR
I have explained the study to
(print name of child here) in language he or
she can understand, and the child has DECLINED to be in the study.
Print
Name
of Person
Conducting
Assent Discussion
Signature of Person Conducting Assent Discussion
Date
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