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This sample is a template from which a passive parental consent letter can be developed. The language does not have to be repeated verbatim. THE CONSENT LETTER SHOULD BE WRITTEN IN TERMS UNDERSTANDABLE TO THE SUBJECT (avoid or define technical terminology, adjust for educational background and ages, provide translations in other languages when subjects do not understand English). Information provided in italics needs to be filled in and the italics deleted.

IMPORTANT: Investigators who intend to utilize a passive parental consent procedure are advised to review the policy on passive parental consent included in the Investigator's Manual. The policy specifies that passive parental consent letters must be mailed home to parents at least two weeks before the proposed activities are to begin.

Your child is invited to participate in a research study conducted by [name of investigator], from the University of Oregon [departmental affiliation]. I hope to learn [state what the study is designed to discover or establish. If a student, indicate that results will contribute to thesis or dissertation]. Your child was selected as a possible participant in this study because [state why subject was selected].

If your child participates, [describe procedures, including their purpose, how long they will take, their location and frequency. If activities are to be audio or video recorded, indicate this]. [Describe risks, discomforts, inconveniences, and how these will be managed. Describe any alternative procedures or courses of treatment, if applicable. Indicate costs of participating, if any.] [Describe benefits to subjects and humanity expected from the research]. However, I cannot guarantee that you or your child will personally receive any benefits from this research. [If subject will receive compensation, describe amount and when payment is scheduled.]

Any information that is obtained in connection with this study and that can be identified with your child will remain confidential and will be disclosed only with your permission. Your child's identity will be kept confidential by [describe coding procedures and plans to safeguard data]. [If information will be released to any other party for any reason, state the person/agency to whom the information will be furnished, the nature of the information, and the purpose of the disclosure.]

Your child's participation is voluntary. Your decision whether or not to let your child participate will not affect your relationship with [name of agency, school, etc. where subject was recruited]. If you decide to allow your child to participate, you are free to withdraw your consent and discontinue your child's participation at any time without penalty.

If you have any questions, please feel free to contact [provide name, phone number, and department address. If student, also provide advisor name and phone, and identify as your advisor.] If you have questions regarding your child's rights as a research subject, contact the Office for Protection of Human Subjects, University of Oregon, Eugene, OR 97403, (541) 346-2510. This Office oversees the review of the research to protect your rights and is not involved with this study.

If you do not give your consent for your child's participation in this study, please sign the bottom portion of this form and return it to the school principal by [date]

I DO NOT give consent for my child (name)____________________ to participate in this study

Print Parent/Legal Guardian name: _______________________

Parent/Legal Guardian Signature:___________________________ Date_________________________