Appendix E-1 State Participant Notification Document-revised

Consent to Participate (State Respondent)

[NOTE: A COPY OF THIS PARTICIPANT NOTIFICATION WILL BE PROVIDED TO RESPONDENTS IN AN ADVANCE MAILING. THIS TEXT WILL ALSO BE DISPLAYED ON SCREEN AFTER PARTICIPANTS LOG INTO THE WEB-BASED QUESTIONNAIRE, BEFORE THE FIRST SET OF QUESTIONS IS DISPLAYED.]

You have been invited to take part in the School Health Policies and Practices Study (SHPPS) 2012, a research project sponsored by the Centers for Disease Control and Prevention (CDC). Conducted every six years since 1994, all states have participated in the study each year. The study will measure the characteristics of eight components of school health programs at the elementary, middle, and high school levels: health education, physical education and activity, health services, nutrition services, healthy and safe school environment, mental health and social services, faculty and staff health promotion, and family and community involvement. Personnel in all states and a sample of school districts and schools across the country will be asked to complete questionnaires about their school health programs.

You were identified as the person best able to address questions about state-level programs and practices regarding [TOPIC AREA]. Your participation in this study will involve responding to a web-based questionnaire about [TOPIC AREA], which will take approximately one hour to complete.

Your participation is voluntary and you may stop participating at any time. You have the right to refuse to answer any question. Your participation will be treated in a confidential manner unless otherwise compelled by law and the information you give us will be combined with the responses of staff in other states in a summary report that does not identify you, but will identify your state. There are no risks or benefits to you for participating.

If you have any questions about the study, please call Dr. Nancy Brener of the CDC at 770-488-6184 or Alice Roberts of ICF Macro at 800-287-1815. A review board at CDC has determined this study to be exempt from the human subjects review process. If you have any questions about your rights as a study participant, you can call 1-800-584-8814. Leave a message with your name and phone number, and refer to CDC protocol #4623. Someone will call you back.

You have received this information because your state has agreed to participate in SHPPS 2012. You may access the questionnaire at http://www.WEBSITEADDRESSHERE.com to participate. Please refer to the materials enclosed with this form to obtain further information on how to complete this questionnaire.

Thank you.