Student Letter and Assent Form

Heller Research Associates

Educational Research, Evaluation, Assessment

Joan I. Heller, M.A., Ph.D.

Director

[Insert Date]

Dear Student,

We are asking for your help with a research study about how students think and learn about force and motion. Your participation is voluntary—you do not have to meet with a researcher if you do not want to, and you can stop at any time. Also, your responses are completely confidential. What you do and say will not be shared with your teacher or anyone else other than researchers, and will not affect your grade in your science course.

S incerely,

Joan I. Heller, Ph.D., Director

Heller Research Associates

S TUDENT ASSENT

If you agree to be part of this study, please read and sign below. Thank you!

• I have been asked to help with a study about how students think and learn about force and motion. I will be answering questions and talking aloud as I work on some force and motion problems. My statements will be audio recorded.

• I do not have to take part in this study if I do not want to, and I can stop at any time.

• What I do and say in this study will not be shared with anyone other than the researchers, and my name will never be given out.^ My grade in science will not be affected by my participation in this study.

Please check one box:

 Yes, I agree to participate in this study.

 No, I do not agree to participate in this study.

Printed name

Signature

Date

 Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.

230 Grand Avenue, Suite 303 • Oakland, CA 94610-4559

Phone 510-873-0808 • Fax 510-873-0811 • www.heller-research.org