Certificate of Participation

U.S. Department of Health
and Human Services

Certificate of Participation
The U.S. Department of Health and Human Services and RTI International would like to thank

[Participant’s Signature]

for participating in the National Survey on Drug Use and Health
on
_____________________________
[Date of Interview]

Field Interviewer

Kathleen A. Considine,

FI ID #

Director of Data Collection
RTI International
3040 Cornwallis Road
Research Triangle Park, NC 27709

This document certifies that the above named individual participated in NSDUH, a voluntary survey for the U.S. Department of Health and
Human Services. Across the country, some participants approach their school teachers or other group leaders to ask about possible special
community service credit as they completed this important national survey. The time commitment for participation in this survey is between 1
and 2 hours. A copy of the NSDUH brochure, which explains the study in more detail, should accompany this certificate. If you need further
information, contact the Director of Data Collection, Kathleen Considine, at (800) 848-4079.