Informed Written Assent Form1
[To be read out in full to potential participant, translated in language in which interview will be conducted]
My name is ___[say interviewer’s name] and I am helping ADRA to conduct this consultation on the situation and treatment of
migrant children in regards to access and participation formal educational system in Serbia. This consultation is with children, but
ADRA will also do similar consultations with other parties involved in education, such as local school staff, cultrual mediators,
local children etc.
I will ask some questions to better understand your experience, views on how the situation is and how it can be improved. It will
cover subjects related to your perception of school, your access to it, your decision to or not to enroll it, relationship with other
children and the services zou were provided in it..
Please keep in mind that we do not pay you in any wayfor answering these questions. Participation is voluntary.
The way you answer the questions will not affect your current situation, services you are receiving or decisions that you are
awaiting from the authorities. You do not have to answer all the questions and I do not need to know why. You can leave the
interview at any time. If you do not feel well, please let me know. I will stop the interview and discuss with you how to help you.
The information you will provide will help identify problems and how you think these problems can be resolved. We will share it
with the authorities in charge.
I will share the information you give me without mentioning your name. Your identity will be kept confidential and will not be
shown to others unless your written agreement is received to do so. Your participation is voluntary and you can choose not to
answer any or all of the questions.
The focus group discussion/individual interview should take approximately 30 minutes.
[After asking each of the following questions, look at the child(ren) and get implicit approval that s/he has understood]
• All the information you give us will remain confidential.
• Your participation in this interview is voluntary.
• You can stop answering questions at any time.
• Do you have any questions? [Note any questions from the child(ren) in the space here]
If you have questions about the interview or the research do not hesitate to ask for clarifications now or later. If you prefer to
consult with a person you trust like a teacher or doctor, please do so.
If you choose to be part of this research, I will also give you a copy of this paper to keep for yourself. You can ask your
caregiver/guardian to look after it if you want.
1
The informed Assent Form will need to be filled by all children (under 18years old) that agreed to take part to the assessment. In addition, the
guardian needs to give his/her consent for the child to participate.
Certificate of Assent
I understand that the interviewis about the situation and treatment received by children who arrive in Europe without family
members– in order to help …understanding how it can be improved.
Statement by the child
I have read this information (or had the information read to me), I have had my questions answered and know that I can ask
questions later if I have them.
I agree to take part in the consultation.
Only if child assents:
Signature of child (may be illegible, not recording name of child): ____________________
Date: ________________
Day/month/year
Statement by the enumerator
I have accurately read out the information sheet to the potential participant, and to the best of my ability made sure that the child
fully understands the consultationand its implications.
I confirm that the child was given an opportunity to ask questions about the interview and consultation, and all the questions
asked by him/her have been answered correctly and to the best of my ability. I confirm that the individual has not been coerced
into giving consent, and the consent has been given freely and voluntarily.
A copy of this assent form has been provided to the participant.
Only if child assents:
Name of the enumerator: ________________________
Signature of the enumerator: _____________________
Name of the translator: ________________________
Signature of the translator: _____________________
Date: ___________________________
Day/month/year
