Parent Permission Distribution Script

Form Approved

OMB No. 0920-0493

Expiration Date: XX/XX/XXXX

2017 and 2019 National Youth Risk Behavior Survey

Appendix H5

Parental Permission Form Distribution Script

Instructions to be Read

When Distributing Permission Forms

Dear Teacher:

You may wish to read this as you distribute the parental permission forms to encourage student participation in the {Year} national Youth Risk Behavior Survey.

Thank you.

Our class has been selected to participate in the {Year} national Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention. This survey is designed to focus on health-risk behaviors, such as smoking or alcohol and drug use, that cause problems during both youth and adulthood. Your participation in the survey is very important as you represent thousands of students around the country. Each of you will receive a parental permission form to take home for a parent or guardian to sign and check “yes” or “no.” Please bring this form back within three days. You must return this form to take part in the survey.

IF YOU DO NOT HAVE A SIGNED PARENTAL PERMISSION FORM, YOU MAY NOT TAKE THE SURVEY.