VASSAR COLLEGE
Department of [Insert name]
Minor Assent Form

(Form 3: omit this label)

Primary Investigator: [Insert the name of the professor/supervisor]
Student Researcher(s):
Title of Project:


I was told by [Insert the name the person asking the questions/conducting the study] of Vassar College about a study:

[In this section, please:
1) overview the nature of the research project;
2) overview the basic procedures/types of questions and the participant’s role;
3) explain how confidentiality will be maintained;
4) describe the approximate duration of participation;
5) provide contact information (e.g., e-mail and phone number of the primary investigator) and state that participants may contact the PI with questions or concerns. ]
6) describe any potential risks and the level of risk;
7) describe any potential benefits/


If you want to stop participating in this project, you are free to do so at any time. You can also choose not to answer questions that you don't want to answer.

If you have any questions or concerns you can always ask me or call [name of PI] __________ at this number: _______.



I understand the project described above. My questions have been answered and I agree to participate in this project. I have received a copy of this form.


Date:_________

_________________________
(Printed name of Participant)

_________________________
(Signature of Participant)