Shubert @ UNIVERSITY OF CALGARY Name of Researcher, Faculty, Department, Telephone & Email EDPS 674 ~ Interventions to Promote Socio-E) tational and Behavioural Well-being This consent form, a copy of which has been given to you, is only part of the process of informed consent, If you want more details about something mentioned here, or information not included here, you should feel free to ask. Please take the time to read this carefully and to understand any accompanying information. The University of Calgary Conjoint Faculties Research Ethics Board has approved this research study. Purpose of the Study ‘This is an assignment as part of a course in Educational Psychology, Werklund School of Education entitled, “EDP'S 674 Interventions to Promote Socio-Emotional and Behavit -being". Graduate MEd School and Applied Child Psychology students are required to conduct a functional behavioural analysis (FBA) with a child, youth, or adult in their community. The purpose is for the graduate student to get a better understanding of how to help individuals change behaviours, What Will | Be Asked To Do? Depending on the behavior, participants will be asked to talk about a specific behavior, allow the student to interview individuals familiar with the behaviour, and/or observe the participant engaging in the behaviour. The student will develop {an intervention plan for the behavior. The pa o view the plan upon request but the student will not be implementing the plan afterward. icipant will be allowed What Type of Personal Information Will Be Collected? No personal identifying information will be collected in this study, and all participants shall remain anonymous. The student will eecord information from interviews and observations as part of the assignment. Participation will take one to two hours of your time. Participation is completely voluntary, anonymous and confidential you are free to discontinue participation at any time during the study. If participation is withdrawn, any information collected up to that point will be destroyed. Are there Risks or Benefits if I Participate? our will be cause stress or risk will be targeted by the graduate student, The idenified beh ie participant will find the i Only behaviours course instructor before the FBA takeWhat Happens to the Information I Provide? The student will share the information with fellow classmates and the instructor. No identifying information will be shared during any class discussions or in written work (e.g., name, place of work, relation to the student). In all discussion and writing, you will be referred to with a pseudonym. The anonymous data will be stored until the end of term on a memory stick, at which time, it will be permanently erased. Signatures ‘Your signature on this form indicates that 1) you understand to your satisfaction the information provided to you about your participation in this research project, and 2) you agree to participate in the research project. In no way does this waive your legal rights nor release the investigators, sponsors, ot involved institutions from their legal and professional responsibilities. You are free to withdraw from this research project at any time, You should feel free to ask for clarification or new information throughout your participation. Student Participant’s Name: (pl Participant's Signature Researcher's Name: (pl Researcher's Signature: zfyror. Daecta Date: feb 5//S Questions/Concerns ions or want clarification re If you have any further qu please contact arding this research and/or your participation, If you have any concerns about the way you've been treated as a participant jontact an Ethies Resource Officer, Research Services Office, University of Calgary at (403) email A copy of this consent form has been given to you to keep for your records and reference, The investigator has kept a copy of the consent formParert @ UNIVERSITY OF CALGARY Name of Researcher, Faculty, Department, Telephone & Em: Dr. Pd Supervisor: Je of Project: = Interventions to Promote Socio-Emotional and Behavioural Well-being This consent form, a copy of which has been given to you, is only part of the process of informed consent. If you want more details about something mentioned here, o information not included here, you should feel free to ask. Please take the time to read this carefully and to understand any ‘accompanying information. The University of Calgary Conjoint Faculties Research Ethics Board has approved this research study Purpose of the Study This isan assignment as part of a course in Edueational Psychology, Werklund School of Education emtitled, “EDPS 67 Interventions to Promote Socio-Emotional and Behavioural Well-being”. Graduate MEd School and Applied Child Psychology students are required to conduct a functional behavioural analysis (FBA) with a child, youth, or adult in their ‘community. The purpose is for the graduate student to get better understanding of how to help individuals change behaviours, What Will I Be Asked To Do? Ik about a specific behavior, allow the student to interview Vor observe the participant engaging in the behaviour. The student will develop san upon request but the student will Depending on the beh wrticipants will be asked 10 behaviour, a ‘an intervention plan forthe behavior. The individuals familiar w st vicipan will be all be implementing the plan afierward | Inform: ion Will Be Collected? What Type of Pers No personal idemifving infor ed in this study, and all participants shall remain anon ill record information fr vations as part of the assignment, Participation will take one to two ee 10 discontinue participation at any time il be destroyed. is completely voluntary, anonymous and confidential you a during the study. If participation is withdrawn, any information coiled On ida student. The i approved by the course insirwetor hefare the PBA takes place. is possible thatthe hy the student 5s or risk will be targeted by the g or nent some of the strategiesWhat Happens to the Information I Provide? The student will share the information with fellow classmates and the instructor. No identifying information will be shared during any class discussions or in written work (@.g., name, place of work, relation to the student). In all discussion and writing, you will be referred to with a pseudonym. The anonymous data will be stored until the end of {erm on a memory stick, at which time, it will be permanently erased. Signatures ‘Your signature on this form indicates that 1) you understand to your satisfaction the information provided to you about your participation in this research project, and 2) you agree to participate in the research project. In no way does this waive your legal rights nor release th institutions from their legal and professional responsibilities. You are free to withdraw from this research project at any time. You should feel free to ask for clarification or new information throughout your participation, investigators, sponsors, or involved Child’s Name: (please p} ParentGuardian’s Name Parent/Guardian’ Signa} int) Mefisse. Mart: Researcher's Name: (pl Researcher's Signature: Yiuzhine_ _Llaxda Date: 72h. 2c AA15 Questions/Concerns If you have any further questions or want clarification regarding this research and/or your participation, please contact: If you have any concerns about the way you've been treated as a participa ntact an Ethics Resource Officer, Research Services Office, University of Calgary at (403) ail A copy of this consent form has been given to you to keep for your records and reference. The investigator has kept a copy of the consent form