INFORMED CONSENT STATEMENT

Using Scripted Roleplay To Improve Year 5 Pupils Speaking Skill

I am inviting your child, as part of the Year 5 Amanah class at Sekolah Kebangsaan Permatang Pauh,
to participate in a research study. The purpose of this research study is to examine how Year 5 pupils
can be improved by using scripted roleplay. This action research study is being conducted as part of my
Degree

requirements

in

Primary

School

at

Tuanku

Bainun

Teacher

Training

Institute.

_________________________________________________________________________________.
INFORMATION
If, after reviewing this form and the attached survey, you agree to allow your child to participate please
sign below and then ask your child to review the materials and decide if they want to participate.
If you both agree, please have your child complete the attached survey. Listed in the survey are
statements pertaining to student motivation. The researchers are asking how your child feels about
these statements in terms of how effective are they in motivating them to increase their performance in
the classroom. We would ask your child to respond as honestly as they are able in regard to the
statements, using the scale provided. We are inviting all 6 members out of 32 pupils of the Year 5
Amanah class at Sekolah Permatang Pauh to participate in this study. .
Results from the study will be shared with the English Department and those in attendance of English
Viva presentation in September 2016.
To be included in our study completed surveys should be returned, along with this signed consent,
sealed in the enclosed envelope to the school office by _________________. There will be a locked
box placed on the counter marked with the title of this study to collect the envelopes.
RISKS
I do not anticipate any risk associated with the study.
BENEFITS
Although there is no direct benefit to your child for completing the survey, we hope to add to the body of
knowledge about speaking skill in the 9th grade classroom.
CONFIDENTIALITY

We are not collecting any identifiable information on the surveys and we are asking that subjects not
put their names on the surveys. When the surveys are turned in, the consent forms will be separated
from them immediately. All information from the survey will be kept confidential. The information will be
kept in a locked filing cabinet accessible only to the researcher.
CONTACT
If you have questions at any time about the study or the procedures you may contact the researcher,
Nur Insyirah binti Zulkofli by email at annasusie93@gmail.com.
Parent/Guardian Initials_____________
Student Initials____________________
If you feel you have not been treated according to the descriptions in this form, or your rights as a
participant in research have been violated during the course of this project, you may contact the Tuanku
Bainun Teacher Training Institute for the Protection of Human Research Subjects, Instititut Pendidikan
Guru Kampus Tuanku Bainun, 14000 Mengkuang, Bukit Mertajam Pulau Pinang, by e-mail at
office@ipgktb.edu.my
PARTICIPATION
Participation in this study is completely voluntary. If you do not want your child to participate simply
discard this packet. If your child does not want to participate they can simply not return the packet to
the school. Participation will not affect their grades or status at Sekolah Kebangsaan Permatang Pauh
since no one will know if they participated. Your child can leave questions blank or turn in a completely
blank survey. Since the surveys do not contain identifiers, once they are submitted you will not be able
to withdraw from the study.
CONSENT
I have read this form and received a copy. I have had all my questions answered to my satisfaction. I
agree to permit my child to participate in this study.
Parent and/or Legal Guardian Signature________________________

Date _________________

I have read this form and received a copy. I have had all my questions answered to my satisfaction. I
agree to participate in this study
Students signature______________________________________

Date_________________