YOUNG PERSON ASSENT TEMPLATE
Middle School Age

Although regulations are deliberately flexible with respect to the age and method of seeking the assent of children to participate as research subjects, it is a commonly accepted practice endorsed by the American Academy of Pediatrics that "assent should usually be obtained from any child with an intellectual age of 7 years or more." 

The child assent information may be provided in written form or orally at a reading level that is appropriate for the age of the child. In the event an investigator is working with a significantly diverse age group, the script should be written or explained in terms understandable to the youngest participants.   

To check the reading grade level 

MS Word 97-2003:  
Enable readability statistics: 1) go to Tools; 2) click on Options; 3) click Spelling and Grammar; 4) check the boxes Check Grammar with spelling and Show readability statistics; 5) click OK.

Check readability level: Run Spell check.  The readability statistics will come up after the spell check is complete.  

MSWord 2010: 
Enable readability statistics: 1) click the File tab; 2) click Options (in left menu);  3) click Proofing; 4) under When correcting spelling and grammar in Word, make sure Check grammar with spelling is selected; 5) select Show readability statistics; 6) click OK.
  
Check readability level: 1) Click on Review tab; 2) Click on Spelling and Grammar.  When Word finishes checking the spelling and grammar, it displays information about the reading level of the document.
	
OR use an Internet Readability Checker.

The title does not have to be read to the child unless it is easily understood.

Assent Form

My name is ______________, and I am __________.  [briefly explain who you are in a way that the young person will understand]

We are asking you to take part in a research study to learn more about __________________.  We hope this research will _____________.  [brief description of the anticipated benefits of the research, both to the participant (if appropriate) or to the other young people, or to society in general.  If appropriate, include a sentence(s) that indicates if the young person can expect any direct benefit at the end of participation.]

We are asking you to help because ____________________. [brief explanation why the participant is being selected for this research]

We will ask you to _________________. [brief explanation of what will take place from their point of view. If appropriate, include a sentence about whether or not the procedure will involve any risks & what they are or whether any procedures will be painful and/or the level of discomfort anticipated.]

It will take ________________ [Estimate the length of time.]

Your parent(s) [guardian] have given their permission for you to take part in this research study, but you may choose not to participate.   If you say yes now and change your mind later, please tell__________.

Do you have any questions?  If you think of a question later, you may ask _________________.

____________________________________	________________
Signature (if appropriate)	Date

_____________________________________
Printed name

_____________________________________
Signature of Researcher