Online Teacher Landing Page - Class Enrollment Forms

NATIONAL YOUTH TOBACCO SURVEY (NYTS) – TEACHER LANDING PAGE
We appreciate your class participating in the National Youth Tobacco Survey (NYTS), sponsored by the Centers for Disease
Control and Prevention (CDC), Office on Smoking and Health. CDC is conducting this survey to assess the prevalence of
tobacco product use among middle and high school students and to monitor if these behaviors increase, decrease, or remain the
same over time.

For pre-survey teacher instructions, please watch this video as soon as you receive your survey materials. This video is
approximately 2 minutes.
PRE-SURVEY VIDEO
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On the day you administer the survey to your class, please watch this video for important instructions and reminders before
students log in. Your students should complete the survey on the pre-planned date recorded on the Summary of School
Arrangements form sent to you with your survey materials.
This video is approximately 2 minutes.
DAY OF SURVEY VIDEO
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Please click on START below to report your class enrollment information. Accurate class enrollment information is critical in
determining how many eligible students actively participated. This form should take less than 3 minutes to complete.
CLASS ENROLLMENT FORM
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If you would like to see a copy of the questionnaire, one is available with your school’s contact person, who is listed on the
Summary of School Arrangements form.
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Please DO NOT log into the survey website in order to view the questionnaire students will be completing.
o Information you enter will be counted as a student’s response.
Please DO NOT talk to students about the survey except to encourage their participation. We do not want to bias their
responses before taking the survey.

If students have any questions about topics raised on the questionnaire, please refer them to the school contact person, a school
nurse, a school guidance counselor, or another appropriate resource.

NATIONAL YOUTH TOBACCO SURVEY
CLASS ENROLLMENT FORM
Please enter the enrollment information for the class specified below.
If any students enrolled in your class are not able to participate, help us understand why. Provide the number of nonparticipating students that fall into each of the categories listed below.
Complete all fields. If the value is zero, enter “0”.
[TEACHER NAME]
[CLASS NAME], [CLASS PERIOD]
Survey Administration Date: _______________________
Number of Students Officially Enrolled in [CLASS NAME], Period [CLASS PERIOD]: _________
As you’re completing the following fields, please make sure each student is counted only one time.
How many students did you give survey access information to on the planned survey administration date? ________
Number of Absent Students: _________
Number of Students Officially Enrolled who:
 Cannot Complete Independently: __________
(This might be a non-English speaker or someone who typically requires supplemental assistance while
at school.)
 Dropped Class/School: __________
 Expelled/Suspended: __________
 Extended Absence: __________
(In your counts of the three categories above, note that these will include students who are officially
enrolled in your class but for all intents and purposes are non-functioning enrollees. That is, they
appear on your roster but are not typically “present.”)
Number of Parent Refusals: __________________
For schools using an Active permission form ONLY:
Number of Students with No Permission Form Returned: _________
Optional: Enrollment comments (Please do not include any student names.)
_______________________________________
Thank you so much! For any students who are absent and did not receive information about how to access the survey, please
provide them with this information when they return to class and encourage them to complete it.
If your school is using an Active permission forms: Students who return an active permission form marked YES after the
planned survey date should be given survey access information and asked to complete it as soon as possible.