Consent Form

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Consent Form

Study 2: Flexible Attention to Numbers and Sizes and Math Skills

Email *

Description of Study

If you decide to have your child do this study, you and your child will meet via Zoom with a trained researcher for two sessions to do math games with sizes and numbers and other tasks to learn about their language and thinking skills. Each session will take 15 – 20 minutes to complete and you will need access to a tablet, computer, or smartphone and wifi or hotspot. You will receive a $20 e-gift card to Amazon as a thank you for doing the study.

Adverse Effects and Risks

We do not expect any negative effects from this study. We think that your child will enjoy the math games and other tasks. However, if your child feels concern at any time or wants to stop the game for any reason, the study will end without any penalty or consequences. If your child is part of Preschool Promise, your child’s participation in Preschool Promise will not be affected in any way if you decide to do the study or stop the study.

Duration of Study

Two 15 – 20 minute sessions

Confidentiality of Data

Your name and your child’s name will be kept separate from the data we collect. Your child’s responses to the games and tasks will be recorded on a computer and will be stored on a password-protected computer. We will not record the video or audio of the Zoom sessions. Only the investigator and her research assistants will have access to the responses, and they will be linked to a number and not your child’s name.

Contact Person

Parents or guardians of participants may contact: Mary Fuhs, mfuhs1@udayton.edu, (937) 229-2775. If you have questions about your rights as a research participant you may also contact the chair of University of Dayton’s Institutional Review Board, Candise Powell, J.D., at (937) 229-3515, IRB@udayton.edu.

Please indicate your willingness to participate by checking the boxes below and filling out information about yourself. *

Yes, I have read and understood the consent form. My child and I would like to participate in this study.

I certify that I have access to a phone, tablet, or computer and wifi or hotspot that can be used to access Zoom to complete this study.

Required

Child's Name *

Child's Birthdate *

YYYY

Child's Gender *

Male

Female

Other:

Is your child of Spanish/Hispanic/Latino ethnicity?

Yes, Spanish/Hispanic/Latino

No, not Spanish/Hispanic/Latino

Clear selection

Mark one or more races that you consider your child to be.

White/Caucasian

Black/African American

Hawaiian/ Pacific Islander

American Indian/Alaskan Native

Asian/Asian American

Other:

What is your relationship to this child?

What is your gender?

Male

Female

Other:

Clear selection

What is your occupation?

What is your spouse/partner's occupation? (If applicable)

What is your highest level of education completed?

Did not complete high school

Completed high school or GED

Some college (no degree)

Associate's degree or equivalent 2-yr degree

Bachelor's degree or equivalent 4-yr degree

Some graduate school

Graduate degree

Clear selection

What is your spouse/partner's highest level of education?

Did not complete high school

Completed high school or GED

Some college (no degree)

Associate's degree or equivalent 2-yr degree

Bachelor's degree or equivalent 4-yr degree

Some graduate school

Graduate degree

Not applicable

Clear selection

Which of the following categories best describes your family's annual gross income?

<$25,000

$25,000 - $42,000

$42,001 - $60,000

$60,001 - $72,000

$72,001 +

Clear selection

Parent/Guardian's Primary Phone Number

Please also indicate whether this is a home, cell, or work phone number.

Would you prefer to receive information from us via email or text?

Text

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Employment at UD- please check one *

I have NOT been employed by the University of Dayton during this calendar year.

I am employed by the University of Dayton, but have NOT earned more than $299 in income from the University of Dayton in this calendar year.

I am employed by the University of Dayton, and have earned more than $299 in income from the University of Dayton in this calendar year.

Research Incentives are Taxable Income

If you have earned more than $299 in income from the University of Dayton during this calendar year, you are not eligible to receive the incentive for participating in this study unless the researchers completes a PAF and submits it for processing. You may not receive the incentive directly from the researcher if you have earned more than $299 in income from the University of Dayton during this calendar year. By signing below, I acknowledge that the incentive payment I receive for participating in this research study is taxable and it is my responsibility to report it to the IRS as required by federal law.

UD ID #- if applicable

Parent/Guardian Signature (Please type full name) *

Type the letters that you see below. *

THANK YOU!

Please sign up for the first session via Zoom at the link below. If none of the times work for you, please email us at fuhslab.r15@gmail.com to set up another time. You will receive an email or text reminder from us once you have signed up for a time slot.

https://calendly.com/fuhslab-r15/math-games-study-session-1-signups

A copy of your responses will be emailed to the address you provided.

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