TPP Replication Study Baseline-Attachment J youth assent 0516

ATTACHMENT J

Youth Assent Form for use in Reducing the Risk and ¡Cuídate! Sites

Participant Agreement

We would like you to be part of an important study. The study will learn about how schools and communities can help young people make smart decisions. It will also look at how to help students avoid risky behavior. Your school or community center may have new classes this year. The study will look at how these classes help young people.

Your parents have said it is okay to ask you to be a part of this study. It is up to you whether you want to be in the study. If you do not want to, you will not be in trouble with your parents, teachers, or other people at your school or community center. If you choose to participate, you can also decide not to answer certain questions or choose to drop out of the study at any time.

What Will Happen?

You will be asked to answer some questions. The first time we ask you to do this will be now. You will then be asked to answer questions six months to a year from now, and again a year and a half to two years from now. The questions will take about 30 minutes to answer and will be given at your school or community center this first time. The next two times you can take the survey on your own on a computer. Each time you take the survey, you will get a gift card.

You will be asked questions about your family, what you know about how to avoid risky behavior, your ideas about teen sex, and about sexual activity. You may skip questions or stop answering questions at any time. Your answers will be kept private. This means that your parents, teachers, and other people at your school or community center will never be able to see your answers.

If you have any questions about the study, you can call the people who are doing the research at (877) 520-6835. This is a free call

Participant Statement

1. I have been told by an adult about the study and what it means to be a part of it.

2. I understand that, if I take the survey, any answers I give will be kept private.

3. I understand that, if I take the survey, I do not have to answer any question. I can skip questions, and I can stop the survey at any time.

	I agree to be a part of the study.
	I do not agree to be a part of the study.

Name (print) Signature Date Home Address Phone Number Email

55 Wheeler Street  Cambridge, Massachusetts USA  02138-1168  617 492-7100 telephone  617 492-5219 facsimile