Student Consent Form (Page 2 of 3) in pdf

Student Consent Form Page 2

Mayerson A cademy

Page 2 o f 3

This study will take place at Bethlehem Middle School.

WHAT WILL MY PARTICIPATION INVOLVE?

If you decide to take part in this study, you will be asked to answer multiple-

choice survey questions 3 separate times between now and 7/30/15. The survey

will take about 15-20 minutes to complete each time you take it. The survey is

not a test. There are no right or wrong answers; you will not be graded. The

survey includes questions about what you see as your strengths and talents.

You may also be asked to take part in a group discussion (also called a focus

group). The questions will ask for your feedback about the middle school’s focus

on character strengths. Discussion groups will include 5-10 students and are

completely voluntary.

HOW WILL MY PRIVACYBE PROTECTED?

While there may be articles in books or magazines that tell about this study, your

name (or other identifiable information) will not be known to the people who are

writing about this study. .

You can stop doing the surveys or doing the group discussions at any time for

any reason. No one will be angry or upset.

Are there benefits to taking part in the research?

You may not benefit directly from taking part in the study. But you may increase

your awareness of your own character strengths.

Will what I say be kept private?

What you tell the people who are doing the study may be written down. What is

written down about you will be seen by the people who are doing the study.

People who make sure that the study is being done the right way may also see it.

If the information about the study is sent anywhere else, it will not have your

name on it.

Will I be paid for my participation in this research?

No.

What if I don’t want to be in this research study?

If you do not want to be in this study, you do not have to take part.

Mark Linkins

Chesapeake IRB Approved Version 11 Feb 2014

Student Consent Form Page 2