I am the parent/guardian of _______________________________ [student’s name]

and I understand that my child is currently enrolled in PSY201, General Psychology, and

that he/she is expected to learn about research in psychology by participating in a series of

empirical studies. Studies typically involve computer tasks, completion of surveys,

response to audio or video presentations, completion of standardized tests, etc. They are

approved by the University’s Institutional Review Board and there will be no disclosure of

individual performance. Each of these studies is required to provide my child with a

Consent Form prior to their participating. However, since my child is not yet 18, he/she

does not have the legal status to consent to participate. I understand that my child may

refuse to participate in any study to which s/he has any objection.

I therefore [check one]:

_____ Delegate authority to my child to sign individual Informed Consent forms

for empirical studies associated with courses in the Department of Psychology.

_____ Retain authority to sign individual Consent Forms for any study in which

my child participates.

_____ Do not want my child to participate in any studies, and therefore would

like him/her to be assigned an alternative activity.

___________________________ ___________________________

Signature Student Signature

___________________________

Printed Name

___________________________

Relationship to Student

___________________________

Date