Make-Up List and Instructions

Form Approved

OMB No. 0920-0493

Expiration Date: XX/XX/XXXX

2017 and 2019 National Youth Risk Behavior Survey

Appendix N2

Make-up List and Instructions

MAKE-UP LIST AND INSTRUCTIONS
School Name: ________________________ State:_______			Teacher Name(s):_______________________________ Class: __________________________Period:_______ Grades(s): _____
Dear Teacher: Students who were selected to participate in the (YEAR) Youth Risk Behavior Survey but did NOT complete the survey and are eligible for a make-up are listed below. The list includes students who were coded as: A: Absent; ISS: In-School Suspension; SR: Student Refusal; and NFR: No Form Returned (for schools using active parental permission only). Students coded as NFR must have returned a signed parental permission form, with the “yes” box checked, to be surveyed as part of a make-up session. Students who initially refused to take the survey (SR) but voluntarily changed their mind and decide to participate, also may be surveyed. You are asked to administer a make-up survey with all students who meet the above criteria. An adequate supply of survey booklets, student envelopes, and pencils is enclosed. When administering the survey, please follow the enclosed make-up survey administration script closely. When you have completed the make-ups, please place each student’s sealed envelope containing his/her questionnaire in the white, business reply, pre-paid envelope marked MAKE-UPS along with this form. Please enter your name, school name and address on the envelope prior to mailing. For any student(s) not completing a make-up survey, please note the reason (if known) next to the student’s name below. Please return any unused survey booklets and envelopes. Please do NOT send back pencils. Important: If a student for all practical purposes has ceased to come to class or attend school and you cannot conduct a make-up, mark a capital “D” next to his/her name. Thank you again for your help. If you have any questions, please call us toll-free at 1-800-675-9727. PLEASE PRINT NAMES OR IDENTIFIERS CLEARLY.
Students Needing Make-ups	Code* (See list of codes below)	Students Needing Make-ups		Code* (See list of codes below)

NON-PARTICIPATION CODES*

A = Absent

ISS = In School Suspension

SR = Student Refusal

NFR = No Form Returned (active schools only)