Child Assent From

Exhibit H. Child Assent Form

^The Pennsylvania State University

FORM FOR CHILD ASSENT

Title of Project: The Effect of Connected Mathematics 2 (CM2) on the Math Achievement of Middle School Students in Selected Schools in the Mid-Atlantic Region: A Randomized Controlled Trial

Principal Investigators: Taylor Martin, Ph.D., Assistant Professor of Mathematics Education, University of Texas at Austin, 512.232.9686, taylormartin@mail.utexas.edu; Kelli Millwood, Ph.D., Research Associate, Regional Educational Lab: Mid-Atlantic, 310.945.5157, kmillwood@relmid-atlantic.org.

This is to certify that I, _____________________, have been given the following information about my participation as a volunteer in a study directed by Dr. Martin & Dr. Millwood.

1. Purpose of the study: Math is an important part of science, technology, and many other parts of modern life; from things you use everyday to the modeling of complex systems. The purpose of this study is to see whether students in 6th grade have better math skills when their teacher uses the Connected Mathematics program. Your teacher may use the Connected Mathematics program, or your teacher might not use it, either way you will be part of this study. The study will be part of your regular 6^th grade math class.

2. Procedures to be followed: Each school that is in this study will be randomly picked for one of two groups. One group will have their usual 6^th grade math class as developed by your teacher or school, and the other group will use the Connected Mathematics program. Both groups will take a test and a survey before and after the program. These tests are not part of your school grade, and your teacher will not see what you write, we just want to learn what you know about math and how you like it.

3. Discomforts and risks: There are no physical or psychological risks by being in this study. All of the research activities are part of your regular math class. You will not experience discomfort from this study.

4.a. Benefits to you: You may learn many things about math.

2. Potential benefits to society: This program can help people improve their math skills.

5. Time of the study: The main part of the study will last through your 6^th grade year.

6. Statement of privacy: No one will use your name in reports about this study, so your personal information will be confidential and secure. 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.

7. Right to ask questions: If you have any questions about this project you should ask your parents and your math teacher. If needed, questions can also be asked to Dr. Taylor Martin, 512.471.8460 taylormartin@mail.utexas.edu or Dr. Kelli Millwood, 310.945.5157, kmillwood@relmid-atlantic.org.

8. Compensation: There is no payment to you for participating in this project.

9. Voluntary participation: I understand that being part of this study is my choice (voluntary), and that I can not be part of it or can stop being in this study at any time by talking with my math teacher.

Only students whose parents said they could participate are being offered a chance to be in this study, but no student has to participate if they do not want to. This is to certify that I agree to participate as a volunteer in this program. I have read this form, and understand it.

______________________________________________

Child's Signature Date

I, the undersigned, have defined and explained the study to the above child.

______________________________________________

Investigator Date

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.  The valid OMB control number for this information collection is xxxx-xxxx.  The time required to complete this information collection is estimated to 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.  If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:  U.S. Department of Education, Washington, D.C. 20202-4651.  If you have comments or concerns regarding the status of your individual submission of this form, write directly to:  [insert program sponsor/office], U.S. Department of Education, 600 Independence Avenue, S.W., [insert building/room number], Washington, D.C. 20202-xxxx.  

Page 2 of 2