Appendix E-4 Classroom Participant Notification Document

Consent to Participate (Classroom Respondent)

[NOTE: A COPY OF THIS PARTICIPANT NOTIFICATION WILL BE PROVIDED TO RESPONDENTS IN AN ADVANCE MAILING AND ITS CONTENTS WILL BE READ ALOUD BY THE INTERVIEWER PRIOR TO BEGINNING THE INTERVIEW.]

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, 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, a sample of school districts, and approximately 1,400 schools throughout the country will be asked to complete questionnaires about their school health programs.

Your participation in this study will involve answering questions asked by an interviewer about your school’s [TOPIC AREA], which will take approximately [TIME].

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 schools in a summary report that does not identify you, your school, or your school district. 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 at ICF Macro at 800-287-1815. State and local school district officials have approved the study. 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 XXXXXX of the CDC at (800) XXX-XXXX.