Idaho State University
Human Subjects Committee
Youth Assent Form (Ages 13-17) Child Assent Form (Ages 7-12)
[Insert the lay title of the research study.]
1. My name is [identify yourself to the potential participant.]
2. We are asking you to take part in a research study because we are trying to learn more
[outline the purpose of the study in language that is appropriate to the youth’s age and maturity
3. If you agree to be in this study [describe chronologically all the tasks in which the subject will
participate in language that is appropriate to the child’s age and maturity level.]
4. [Describe any risks to the research subject that may result from participation in the research.]
5. [Describe any direct benefits to the subject from participating in the research.]
6. [Describe any benefits to society or science from participating in the research. Use language
that is appropriate to the age and maturity level of the subject.]
7. We have already received permission from your parent(s) for you to participate in this
research. Even though your parent(s) have given permission, you still can decide for yourself if
you want to participate.
8. If you don’t want to be in this study, you don’t have to participate. Remember, being in this
study is up to you and no one will be upset if you don’t want to participate or even if you change
your mind later and want to stop.
9. You can ask any questions that you have about the study. If you have a question later that you
didn’t think of now, you can ask me later.
10. Signing your name at the bottom means that you agree to be in the study. You and your
parents will be given a copy of this form after you have signed it.
Name of Subject
Signature of Subject Date
Signature of Witness (if appropriate) Date
(Child assent must be witnessed when the research involves medical procedures and research of
more than minimal risk. The witness must be someone not related to the research project.)