North Carolina State University

INFORMED CONSENT FORM for RESEARCH

Project Title: Validation for Brothers in Excellence Empowerment Scale (BEES)

Principal Investigator: Marc A. Grimmett, Ph.D.

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We are asking you to allow your child to participate in a research study. The purpose of this study is to establish the validity of the Brothers in Excellence Empowerment Scale (BEES). The BEES is a 105-item form designed to acquire information on identity, social, and career development of African American boys in the 3 rd through 5 th grade. This information can then be used by parents, teachers, counselors, and otherprofessionals who work with African American boys to promote their empowerment. Specifically, information from the BEES can help African American boys to establish a positive identity, develop social skills, and encourage career awareness and exploration.

 

INFORMATION

If you agree for your child to participate in this study, your child will be scheduled by the primary investigator or a research assistant to complete the BEES by either paper-pencil or online-electronic format. The BEES will be administered by the principal investigator, a research assistant, or, if preferred, by you (e.g., if you choose to complete the BEES using the online-electronic format from home). If you choose to administer the BEES to your child, you will be given a detailed set of instructions to follow. Completion of the BEES should take about 20 minutes.

 

RISKS

There are minimal risks associated with participation in this study. Since the BEES is essentially a self-evaluation, some of the items may cause participants to feel uncomfortable as they are asked to make judgments about themselves.

 

BENEFITS

The purpose of this research is to establish the validity of the BEES. Therefore, no direct or indirect benefits are expected for participants at this time.

 

CONFIDENTIALITY

The information in the study records will be kept strictly confidential. Data will be stored securely in locked office in an electronic file using a code to identify each participant as opposed to his name. Names will be removed from individual student report cards and be replaced with an identification code. No reference will be made in oral or written reports which could link participants to the study.

 

CONTACT

If you have questions at any time about the study or the procedures, you may contact the researcher, Marc A. Grimmett, Ph.D., at North Carolina State University, Campus Box 7801, 520 Poe Hall, Raleigh, NC 27695, or (919) 515-6358. If you feel you have not been treated according to the descriptions in this form, or your rights as a participant in research have been violated during the course of this project, you may contact Dr. David Kaber, Chair of the NCSU IRB for the Use of Human Subjects in Research Committee, Box 7514, NCSU Campus (919/515-3086) or Mr. Matthew Ronning, Assistant Vice Chancellor, Research Administration, Box 7514, NCSU Campus (919/513-2148)

 

PARTICIPATION

Your participation in this study is voluntary. You may decline to participate without penalty. If you decide to participate, you may withdraw from the study at any time without penalty and without loss of benefits to which you are otherwise entitled. If you withdraw from the study before data collection is completed your data will be returned to you or destroyed at your request.

 

CONSENT

“I have read and understand the above information. I have received a copy of this form. I agree to participate in this study with the understanding that I may withdraw at any time.”

 

Yes , I do provide consent.

No, I do not provide consent.

Please type you name in the box below as your signature to provide consent.