Illinois Youth Survey 2015-2016
Parent Notification Letter
Your child’s school district is working with Center for Prevention Research and Development at the University of Illinois to conduct a survey of Illinois middle and high school students. The purpose of the Illinois Youth Survey is to better understand Illinois youth risk and protective behaviors as they related to student problems and academic success.
If your child participates, he/she will be asked to complete a survey (with no names or identification numbers) that will be confidentially administered by a classroom teacher, counselor, or community member who has received training on survey administration. The survey is completely voluntary and privacy will be strictly protected. Students will be given either a paper and pencil survey in a regular classroom or an electronic survey via the Internet, and it will last about between 45-50
minutes. If there are any questions your child does not wish to answer, he/she is free to skip questions and they may stop taking survey
at any time they choose. Students who do not wish to participate in the survey or
stop participating or whose parents choose to deny permission for their participation will be provided with an appropriate alternative activity (e.g. reading in the school library or quiet reading) while the surveys are being administered. The staff handing out surveys will remind students of these rights before the survey begins.
This questionnaire asks about:
use of alcohol and other drugs, perception of risks, where accessed, consequences of use, approval or disapproval of use
feelings about their school experience
• family and personal characteristics
• family communication about substance use
• feeling about
self and moods
• student health behaviors – food intake, exercise, height and weight
While the survey asks personal questions about illegal behavior, several steps are taken to protect privacy of students participating in the survey. Students can skip any or all questions if they
feel uncomfortable, survey administrators will make efforts to insure privacy during the survey completion process. Collecting information from Illinois students has many benefits to youth in your community and throughout the state. Information on students in your school is provided back
to your school to help determine what programs may be needed to keep students safe and healthy. If you wish to look over the
survey questionnaire, it is available for review in your child’s school office. Obtaining full participation is very important
to the ability of your child’s school and community to continue
to improve the programs and strategies to prevent youth problem behaviors and enhance youth development. Thus we would greatly appreciate
you allowing your child to participate.
The surveys will be administered in Illinois schools during the 2015-2016 academic school year. If you DO NOT want your child to participate in the survey, please complete the attached form, sign it, and return it to the school within 2 weeks. Your decision to deny permission will not in any way influence your future relationship with your child’s school, and you may also withdraw your child during the survey by
notifying the school office.
If you have any questions about the survey, please contact the school office. If you have any questions regarding
the project and wish to contact a staff person at the University of Illinois, please contact Peter Mulhall at (888) 333-5612 (Illinois toll free) or email him at email@example.com . If you have any questions about your son or daughter’s rights as a participant in this
study, please contact the University of Illinois Institutional Review Board at 217-333-2670 (collect calls will be accepted if you identify yourself as a research participant) or via email at firstname.lastname@example.org.
Thank you for your prompt
attention to this request.
ILLINOIS YOUTH SURVEY PARENT PERMISSION DENIAL FORM
you are not willing to allow your child to complete the survey, please return this form with your signature to your child’s
homeroom teacher (if applicable).
______ I do not want my child to participate in the Illinois Youth Survey.
Student’s Name: __________________________________________
Homeroom Teacher (if applicable): _______________________________________
UNIVERSITY OF ILLINOIS
AUG - 102016