Form Teacher Script for Teacher Script for Teacher Script for Youth Survey

Attachment I: Teacher Script for Youth Survey

Dear Teachers,

Thank you for helping administer the youth survey as part of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) underage drinking prevention initiative. The survey administration should take approximately 10 minutes to complete. Below, we have included a brief script for you to read to your class prior to administering this survey. We encourage you to adhere to the script in an effort to ensure that all important information is communicated to students in a similar way across all administrators. Thank you!

To read/speak aloud to students:

“Shortly, I will be passing out a brief survey. This survey is part of a larger initiative to address underage drinking prevention. The questions are confidential, so please do not put your name on this survey. Your participation is voluntary. Therefore, if for any reason, before, during, or upon survey completion, you choose to withdraw from the study, your answers will not be included. If you have any questions or concerns about the survey or find that the survey topic triggers feelings or concerns, please let me know and I will connect you with appropriate supports.

“First, I will lead you through how to create a unique ID for yourself.”

Note to Teachers: Review the following example on how students can build their unique IDs, and lead them through the exercise. Write the example out on the blackboard, if necessary.

Student Unique ID Builder Exercise

The first letter of your student’s legal first name __________

The last letter of your student’s legal first name __________

The last letter of your student’s legal last name __________

The two-digit month your student was born __________

The two-digit DAY your student was born __________

Example: This is the code that would result if your student was commonly referred to as “Bill,” but his legal name was William Garcia-Lopez, born May 9.

MONTH and DAY of your student’s BIRTHDAY (i.e., if your student was born on May 9, you would enter “05” for the month and “09” for the day).

The FIRST and LAST letters of your student’s legal FIRST NAME (i.e., if your student goes by “Bill,” but his legal name is “William,” you would enter the letters “W” and “M”).

W M Z 05 09

LAST letter of your student’s legal LAST NAME (i.e., if your student’s legal last name is “Garcia-Lopez,” you would enter the letter “Z”).

To read/speak aloud to students:

“Now that you have created your unique ID, please continue answering the remaining questions. Remember: No one will have the ability to link up your answers with your identity, so please be as honest as possible.”

Note to Teachers: Please collect all surveys upon completion and place in the envelope provided.