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I agree to allow my child to take part in a National Science Foundation research project titled “The Georgia STEM Accessibility Alliance (BreakThru)” conducted by Noel Gregg, Ph.D. University of Georgia (706-254-2334) and Robert Todd, GaTech (404-894-9865). I do not have to allow my child to take part in this program if I do not want to. My child can refuse to participate or stop taking part at any time without giving any reason, and without penalty or loss of benefits to which she/he is otherwise entitled. If my child decides to withdraw from the study, the information that can be identified as my child’s will be kept as part of the study and may continue to be analyzed, unless I make a written request to remove, return, or destroy the information.
My child will receive $75 per semester for taking part in the BreakThru project. In order to receive the financial incentive, my child will need to provide his/her name, social security number, citizenship, and address on the incentive form. Payment will be mailed to my child at the end of each semester. The identifiable information that is provided will be kept confidential. It will be separate from other BreakThru materials. The information will be used only for the purpose of payment. It will be only seen by the BreakThru account manager and the University of Georgia Business Office.
By checking the box below and submitting this form on-line you are giving permission for your child to participate in the above-described research project. Please print a copy of this form for your records.