Parental Permission/Assent Form


University Affiliation:   Clarion University of Pennsylvania Administrative Office
                                                108 Carrier Administration Building
                                                Clarion, PA 16214

Project Title: Research Study on the Impact of COVID-19 on Teen Use of Virtual Library Services

Principle Investigator:   Philip Krogmeier, Senior Library Specialist. Pikes Peak Library District.
                                                1175 Chapel Hills Dr. Colorado Springs, CO 80920. 719-531-6333 x6070

Faculty Advisor:               Xiaofeng Li, Ph.D. Assistant Professor.
                                                Department of Information and Library Science.
                                                Clarion University of Pennsylvania. 840 Wood Street. Clarion, PA 16214.

Your child is invited to participate in a research study being conducted through Clarion University of Pennsylvania. We ask that you and your child read this form and ask any questions you both may have before you decide whether or not you want to give permission for your child to participate in the study. Please feel free to ask researchers any questions you may have. The University requires that you give your signed permission and that your child assent if your child chooses to participate.

Purpose of the Study: The purpose of this survey is to evaluate the impact of the COVID-19 pandemic on the use of virtual library services by teen patrons within Pikes Peak Library District (PPLD). The survey is comprised of ten questions, and is completely voluntary. It should take five to ten minutes to complete. All data is compiled anonymously, and returned survey responses will not be associated with any provided consent information. Data will be used in a research project being conducted by a graduate student in the Library Science program at Clarion University in Pennsylvania.

Procedures: If you agree to give permission for your child to participate in this study, we would ask you to do the following. Assist your child in the completion of the ten question survey.

Risks and Benefits of Being in the Study: There are no risks to participation in the study. Participation in the study will not impact your or your child’s use of Pikes Peak Library District services. There are no benefits to participation in the study.

Compensation: There is no compensation provided for participating in the survey.

Privacy and Confidentiality: Data and identifying information including consent signatures will be kept in a locked file for thirteen months from the completion of the survey. Only the researcher will have access to any identifying information. Identifying information will not be linked to the collected responses to the survey. An exception to confidentiality is information on child abuse and neglect that is obtained during research. The information will be reported to the appropriate local or state agency in accordance with Pennsylvania law.

Right to Refuse or End Participation: I understand that my child may refuse to participate in this study or withdraw at any time. I also understand that my child may be withdrawn from the study at any time by the investigator(s).

Contact Information: If you have concerns or questions about this study, please contact the researcher. Philip Krogmeier (, )

If you have questions or concerns about your rights as a research participant or would like to register a complaint about this study, you may contact the Clarion University of Pennsylvania IRB by calling 814-393-2337, or emailing, or mailing the IRB using the following address: Clarion University of PA Administrative Office, 108 Carrier Administration Building, Clarion, PA 16214.

Question Title

* 1. I certify that I am 18 years of age or older, or that I have parental consent to participate in this survey.