Fillable Informed Assent Form printable pdf download

Informed Assent Form

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Complete Informed Assent Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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[YOUR INSTITUTIONAL LETTER HEAD]

Please do not submit assent forms on the WHO letter head

An Informed Assent Form does not replace a consent form signed by parents or guardians. The assent

is in addition to the consent and signals the child's willing cooperation in the study.

[Informed Assent Form for _____________________]

Name the group of individuals for whom this assent is written.

Explanation

Example

[Name of Principle Investigator]

[Name of Organization]

[Name of Sponsor]

[Name of Project and Version]

This Informed Assent Form has two parts:

•

Information Sheet (gives you information about the study)

•

Certificate of Assent (this is where you sign if you agree to participate)

You will be given a copy of the full Informed Assent Form

Part I: Information Sheet

Introduction

This is a brief introduction to ensure the child knows who you are and that this is a research study.

Explanation

Example

Purpose: Why are you doing this research?

Explain the purpose of the research in clear simple terms.

Example

Choice of participants: Why are you asking me?

Children, like adults, like to know why they are being invited to be in the research. It is important to

address any fears they may have about why they were chosen.

Example

Participation is voluntary: Do I have to do this?

State clearly and in child-friendly language that the choice to participate is theirs. If there is a

possibility that their decision not to participate might be over-ridden by parental consent, this should

be stated clearly and simply.

Example

I have checked with the child and they understand that participation is voluntary __(initial)

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Informed Assent Form

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