Student Focus Group - Assent

Empowering students to be fit for life.

Founding Partners

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

Presidential Youth Fitness Program (PYFP) Evaluation

Student Focus Group Assent

ICF International is working with the Presidential Youth Fitness Program, the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation to learn more about the Presidential Youth Fitness Program. This project will tell us more about student physical activity and fitness attitudes and habits.

We are conducting this project at your school because your school has been participating in the Presidential Youth Fitness Program. You have been picked to participate in the student focus groups because you were interested and your parent gave permission. This is called a focus group but what that means is that we will be asking questions and would like you to share your thoughts or opinions. The questions will be about physical education, physical activity and fitness. There are no right or wrong answers. You do not have to respond to all questions, you can skip any question you do not want to answer.

The focus group will take no more than one hour.

You will receive a non-monetary prize equivalent to $15 at the end of the focus group as a thank you for participating.

The answers that you give will be kept private. No one will know how you answered.

About 60 6^th graders just like you will be asked to do a focus group. We will visit about 6 schools across the country over the next two years. You do not have to take part in the focus group if you don’t want to; it is voluntary. Whether or not you participate will not affect your grade in this class. You do not have to answer a question if you do not want to. You can stop at any point without penalty.

You will get no benefit right away from taking part in the survey. But the results of this focus group will help the PYFP program and other children in the future.

Are you willing to participate in the focus group?

YES, you will participate.

NO, you will not participate.

Write your name on this line Date

Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

If you or your parents have any further questions you can call Isabela Lucas, Project Manager for the PYFP Evaluation, at ICF International at 404-592-2155 with any questions or comments. If you or your parents have any questions about your rights as a participant in this program evaluation, you may contact {ENTER IRB CONTACT} at [NUMBER] or [EMAIL].