Teen Survey Assent

National Adolescent Health Survey parent consent & teen assent via NORC’s AmeriSpeak panel

Parent consent

We are asking you for permission to have [name] take part in this survey on how teens feel about a series of topics, including their mental health, sexual and reproductive health, social support systems, and school environment. This will take [name] about 20 minutes to finish, depending on their answers.

Important things you should know are:

• The National Adolescent Health Survey is being conducted by NORC on behalf of the U.S. Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health.

• All questions are voluntary and they can skip questions if they wish.

• We would encourage your teen to take the survey at any time when they will have privacy.

• Your teen will be compensated for their time via cash-equivalent of $20 for completing the survey.

If you say yes, we will ask you to provide a way to contact them (phone, email, or mailing address).

If you have any questions or concerns about your teen’s participation in this study, you can contact AmeriSpeak Support at [email protected] or call (888) 326-9424.

Would you be willing to have [name] complete this survey?

1. Yes

2. No

Teen intro/assent

Screen 1

Welcome to today’s Amerispeak survey! Your parent/caregiver has invited you to participate in a survey about your mental health, sexual and reproductive health, social support systems, and school environment!

A few things...

This survey is voluntary. We're excited to hear what you think and hope you will answer as many questions as you can, but it is OK to leave a question blank if you choose not to answer it.

Your answers will be kept private. Your answers will be combined with answers from teens across the country. NO ONE will be told how you answered any of your questions.

There are NO wrong answers. We want you to answer truthfully and as best you can, but this is a chance for you to have a voice: tell us what YOU think!

Screen 2

We are asking you to take part in this survey on how teens like you feel about your mental health, sexual and reproductive health, social support systems, and school environment. This will take about 20 minutes to finish, depending on your answers.

Important things you should know are:

• The National Adolescent Health Survey is being conducted by NORC on behalf of the U.S. Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health.

• The survey is voluntary; you can choose whether or not to take it, and you can stop taking the survey at any time.

• We would encourage you to take the survey at any time when you will have privacy.

• You will be compensated for you time via cash-equivalent of $20 for completing the survey.

If you have any questions or concerns about your participation in this study, you can contact AmeriSpeak Support at [email protected] or call (888) 326-9424.

Are you willing to complete this survey?

1. Yes

2. No

Teen intro/consent

Screen 1

Welcome to today’s Amerispeak survey! We are asking you to take part in a survey about your mental health, sexual and reproductive health, social support systems, and school environment!

A few things...

This survey is voluntary. We're excited to hear what you think and hope you will answer as many questions as you can, but it is OK to leave a question blank if you choose not to answer it.

Your answers will be kept private. Your answers will be combined with answers from young adults across the country. NO ONE will be told how you answered any of your questions.

There are NO wrong answers. We want you to answer truthfully and as best you can, but this is a chance for you to have a voice: tell us what YOU think!

Screen 2

We are asking you to take part in this survey on how young adults like you feel about your mental health, sexual and reproductive health, social support systems, and school environment. This will take about 20 minutes to finish, depending on your answers.

Important things you should know are:

• The National Adolescent Health Survey is being conducted by NORC on behalf of the U.S. Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health.

• The survey is voluntary; you can choose whether or not to take it, and you can stop taking the survey at any time.

• We would encourage you to take the survey at any time when you will have privacy.

• You will be compensated for you time via cash-equivalent of $20 for completing the survey.

If you have any questions or concerns about your participation in this study, you can contact AmeriSpeak Support at [email protected] or call (888) 326-9424.

Are you willing to complete this survey?

1. Yes

2. No