<p>IRB-NS Form No. 3.2 Assent Form for children aged 7-12 year</p><p>This study aims to….. (Describe the objectives with language accessible to children.), which expects the benefits: (benefit for children, or society) ………………………………………………………………..………….. I invite you to participate in this project because (Indicate characteristics relevant to the Research study such as “you are teen who ……”., “you are a teen who are risk to the disease of …..) ……………………………………… If you are willing to join in the study, you will receive the following steps. (Describe the procedures step by step using lay language. Instances are as follows.) - Have to take medicine, or receive treatments, or other else - Answer the questions about …… items, take …….minutes. </p><p>Taking part in the study, you might feel…………..(define what would happen eg, boresome, tired). You can tell me, then I will take care of you and will let you ….(tell the process of primary care, eg, “take a rest until you feel good, and I will ask you if you are prompt to continue answer the questions. If you are still not good, or don’t want to continue, you can stop and withdraw from the study”). If there is any ……(define the unwanted side effect from the research projects), you will receive ……(eg “I will take you to see your teachers/ or nurses”, “I will give you the beverage”) If you have any questions about this study, or hurt from taking part in the study, you can ask ……………………….. Telephone: …………………………………. I will keep your private information in secret. Do you understand the details?  yes  no After reading and understand the details of the study,  you are willing to join in the study  you are not will to join in the study</p><p> signature...... (...... ) Date ...... </p><p>Version 5 February 3, 2016 </p>