Principal’s Consent Form

Attachment 3 –

Principals Consent Form

SCHOOL CONSENT FORM

I hereby give my consent to the National Institute on Drug Abuse (NIDA) to participate in a

web-based survey of students and teachers. The survey will be conducted by NIDA's contractor,

. The survey asks opinions of students and teachers, on the PEERx videos on the NIDA website (http://teens.drugabuse.gov), a government resource for students on drug abuse and addiction. The purpose of the study is to collect information that the National Institute on Drug Abuse can use to improve the message of the videos.

I understand and agree that the results from the survey will become the property of the National Institute on Drug Abuse but will be anonymous. I understand that my name or any other identifying information will not be used in the study analysis and results, or in any other way, and the National Institute on Drug Abuse will not have access to my name or other identifying information, or my students' names or other identifying information, or my teacher's names or other identifying information.

School Name City, State

Principal Name Date Signed