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C.F.B.CoE ERC 3 Assent Form

1) The document is an assent form for minors to participate in a research project. 2) It explains that the minor's parent/guardian has already consented to their participation and the form is to ensure the minor also understands and agrees. 3) The form outlines what participation involves, that participation is voluntary, and ensures confidentiality of the minor's identity and responses.

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Zarif Haikal
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50 views4 pages

C.F.B.CoE ERC 3 Assent Form

1) The document is an assent form for minors to participate in a research project. 2) It explains that the minor's parent/guardian has already consented to their participation and the form is to ensure the minor also understands and agrees. 3) The form outlines what participation involves, that participation is voluntary, and ensures confidentiality of the minor's identity and responses.

Uploaded by

Zarif Haikal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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C/F/B/CoE ERC3 (2022)

College/Faculty/Branch/Cluster of Centre of Excellence


Universiti Teknologi MARA

ASSENT FORM
Your parent/legally authorized representative (LAR) has given permission for you to be in a
project called (state name of project here). We would like to explain it to you, so that you can
decide if you want to be in it. If you don’t understand, please ask questions. You can choose
to be in the study, or not to be in the study, or to take more time to decide.

What is the project about? (Briefly describe the project)

Why do I need to be in this project? (Briefly describe the purpose of the project)

What should I do in this project? (Briefly explain the minor’s role in the project)

What will happen to me in the project? (Briefly explain the risk)

Do I have to be in the project?


You don’t have to be in the project if you don’t want to. If you are in the project, you can stop
at any time without making anyone upset. If you want to be in the project, please write your
name below. Please make sure that you understand what has been explained to you.

Who can I talk to about this project?


If you want to ask anything, you can call me anytime.
Name of Researcher:
Contact number:

Will anyone know about what I say or do in the project? (Briefly explain the anonymity
and confidentiality of research participation)
Assent Questions:
Instructions to minor: Please circle your answer below.

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C/F/B/CoE ERC3 (2022)

1. Has somebody explained this project to you? Yes/No


2. Do you understand what this project is about? Yes/No
3. Do you have any questions about the project? Yes/No
4. If you have asked a question, do you understand the answer? Yes/No
5. Do you understand it’s ok to stop taking part at any time? Yes/No
6. Are you ok to take part? Yes/No
7. Are you ok for your voice to be recorded? Yes/No
8. Are you ok to be on video? Yes/No
9. Are you ok to have photographs taken? Yes/No

(If the minors are unable to read, thumbprint should be taken, in lieu of signature)

If you want to take part, please write your name and sign, or place your thumb print in the
box.

Name of participant
Signature
Date

Name of consent taker


Signature
Date

(In instances where the minor is unable to read, or where the research covers sensitive
issues, a witness should attest in the section below)

Name of witness
Signature
Date

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C/F/B/CoE ERC3 (2022)

Jawatankuasa Penilaian Etika Kolej Pengajian/Fakulti/Cawangan/


Kluster Entiti Kecemerlangan
Universiti Teknologi MARA

BORANG PERSETUJUAN MENYERTAI PROJEK


Ibu bapa / wakil sah anda (LAR) telah memberi izin untuk anda menyertai projek yang
bertajuk (nyatakan nama projek penyelidikan di sini). Kami ingin memberi penerangan
mengenai projek tersebut, supaya anda boleh membuat keputusan sendiri sama ada ingin
menyertai projek tersebut ataupun tidak. Ada boleh tanya soalan sekiranya tidak faham.
Anda boleh memilih sama ada untuk menyertai projek tersebut, atau tidak. Anda juga boleh
mengambil lebih masa sebelum membuat keputusan.

Projek ini mengenai apa? (Terangkan secara ringkas mengenai projek)

Mengapa saya patut menyertai projek ini? (Terangkan secara ringkas tujuan projek)

Apa yang perlu saya lakukan dalam projek ini? (Terangkan secara ringkas kepada
kanak-kanak ini peranannya dalam projek)

Apa yang akan berlaku kepada saya dalam projek ini? (Terangkan secara ringkas dan
mengenai risiko)

Adakah saya perlu menyertai projek ini?


Anda tidak perlu menyertai projek ini jika anda tidak mahu. Sekiranya anda menyertai projek
ini, anda boleh berhenti pada bila-bila masa tanpa membuat sesiapa marah. Jika anda ingin
menyertai projek ini, sila tulis nama anda di bawah. Sila pastikan bahawa anda faham apa
yang telah dijelaskan kepada anda.

Dengan siapa boleh saya bercakap mengenai projek ini?


Jika anda mempunyai apa-apa soalan, anda boleh menghubungi saya:

Nama Penyelidik:
Nombor Telefon:

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C/F/B/CoE ERC3 (2022)

Adakah orang lain akan tahu tentang apa yang saya katakan atau lakukan dalam
projek ini? Terangkan secara ringkas mengenai kerahsiaan penyertaan penyelidikan

Soalan Persetujuan:
Arahan kepada kanak-kanak: Sila bulatkan jawapan anda di bawah.
1. Sudahkah projek ini dijelaskan kepada anda? Ya/Tidak
2. Adakah anda memahami projek ini? Ya/Tidak
3. Adakah anda mempunyai apa-apa soalan mengenai projek ini? Ya/Tidak
4. Jika anda telah bertanya, adakah anda memahami jawapannya? Ya/Tidak
5. Adakah anda faham bahawa anda boleh berhenti daripada projek ini pada Ya/Tidak
bila-bila masa?
6. Adakah anda selesa untuk mengambil bahagian dalam projek ini? Ya/Tidak
7. Adakah anda selesa sekiranya suara anda direkodkan? Ya/Tidak
8. Adakah anda selesa sekiranya berada dalam video? Ya/Tidak
9. Adakah anda selesa sekiranya gambar anda diambil? Ya/Tidak

(Sekiranya kanak-kanak tersebut tidak dapat membaca, cap ibu jari hendaklah diambil,
sebagai ganti tandatangan)

Jika anda ingin mengambil bahagian, sila tulis nama dan turunkan tandatangan, atau
letakkan cap ibu jari anda di dalam kotak.

Nama peserta
Tandatangan
Tarikh

Nama pengambil
persetujuan
Tandatangan
Tarikh

(Sekiranya peserta projek tidak boleh membaca, atau sekiranya penyelidikan membabitkan
isu-isu sensitif, seorang saksi hendaklah menjadi saksi ketika persetujuan diambil. Saksi
tersebut perlu melengkapkan bahagian di bawah)

Nama saksi
Tandatangan
Tarikh

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