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May 31, 2001, via grade 7 science classes
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A annual voluntary and anonymous substance use survey is administered to grade 7 students whose parents give express written permission to partcipate. A letter and permission form similar to the following will go home at least a week prior to the adminstration of the survey.
Substance Use Survey Parent Permission Form
To view the form, you need Acrobat Reader 4.0, which is a free download.
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Dear Parents:
Our school district is participating in a District survey to assess alcohol, illicit drug and tobacco use by students in grades 7, 9, and 11. The questionnaire used in the survey has been administered under sponsorship of the Office of The Attorney General of California as a part of an effort to increase the effectiveness of drug, alcohol and tobacco use prevention and law enforcement programs.
The following is further information about the survey:
(1) It is anonymous. The survey has been designed to protect your child's privacy. Participating students will not put their names or any other identifying information on the questionnaire.
(2) Participation in the survey is voluntary. Your son or daughter may decline to participate without giving a reason.
(3) Results of the survey will be published for the District as a whole in the same manner as for public opinion polls. No student will ever be mentioned by name in a report of the results.
(4) The results of this survey will help in planning ways to assist students in the future.
Please read the section below. Sign and return this form to give permission for your child to take the survey. If we do not receive this signed form, your child will not be permitted to take this survey.
Child's name: _______________School: Grade:______
Teacher:______________
_____I give my permission for my child to complete the survey related to alcohol, elicit drug and tobacco use.
Parent's signature:_______________________Date:_______________
The survey will be conducted in the class where this form was given to your child.
Please return this signed permission form to your student's science teacher. |
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