Parent Informed Consent

Parental Permission

By signing this document, you are agreeing to allow your child to be part of the study entitled A Study of the Impact of the Nation Builders Program on the Self-Perception of African American Male Students in the Fourth and Fifth Grades at Paul Laurence Dunbar Elementary School. Your child’s participation in this study is completely voluntary. If you allow your child to be part of the study, you may change your mind and withdraw your approval at any time. Your child may choose not to be part of the study, even if you agree, and may refuse to complete the self-perception survey or stop participating at any time.

You also understand that the sessions that will be conducted during this study will be recorded by the researcher using the audio and video recording capabilities available in the Zoom videoconferencing platform. These recordings are necessary because the interactions must be transcribed so that the researcher can analyze the information provided during the study. Recordings created during the study will be stored on the password-protected computer of the researcher in an encrypted file format. You also understand that additional copies of the recordings may be saved by Zoom on the company’s servers, beyond the control of the researcher. Recordings stored by the researcher will be kept for one year and destroyed no later than August 30, 2022

You will be given a copy of this document for your records and one copy will be kept with the study records. Be sure that the questions you have asked about the study have been answered and that you understand what your child will be asked to do. You may contact the researcher if you think of a question later.

Typing your child's name and your name signify that you give your child permission to participate in this program.

Video Recording of Study Activities Video recordings of interviews may be generated during the study to help the researcher detect non-verbal communication relevant to the study (e.g., nodding, gestures, facial expressions). You have the right to refuse to have your child recorded. Please indicate your preference below:

Yes

Parent's Name:

Your Child's Name: *

Photography during Study Activities Photographs of study participants may be taken as part of the research. You have the right to refuse to have your child photographed. Please indicate your preference below:

Yes

Parent's Email: *

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Audio Recording of Study Activities Audio recordings of interviews may be generated during the study to help the researcher ensure accuracy when transcribing your child’s responses. You have the right to refuse to have your child recorded. Please indicate your preference below:

Yes