Survey Administration Release Form

Under current law; Chapter 63, SLA 99, school districts are required to obtain written permission for any survey or questionnaire that will be administered during the upcoming school year. Notification and opportunity for review of any survey will occur no less than two weeks prior to administration. The North SlopeBoroughSchool District encourages you to review at that time the survey for content and appropriateness.

At this time, the North Slope Borough School District is planning implementation of the following surveys during the 2014/2015 school year. Notification of any additional survey instruments will be given as soon as possible.

I give my approval to administer surveys to my child this year. I understand that I may review the survey to be given no less than 2 weeks prior to administration, and I may remove my child at that time if I wish.

(Circle Yes or No)

  1. Youth Risk Behavior Survey (grades 7-12)YesNo

2.AASB School Climate Survey (grades 6-12)YesNo

3.Other ______YesNo

Name of Student:______

Grade of Student: ______

Printed name of Parent/legal guardian: ______

Signature: ______

For further information:

Please contact your building Principal

Survey Summaries

Youth Risk Behavior Survey (grades 7-12)

The Youth Risk Behavior Survey is administered every two years and is a joint project of the Centers for Disease Control, the Alaska Department of Health and Social Services, and the Alaska Department of Education and Early Development. The survey is designed to assess students’ self reported behaviors and experiences in six major areas of health that directly lead to morbidity and mortality in both adults and adolescents in our country. Data from the survey is required for many grant applications and it allows the school district and teachers to provide quality instruction and services within our schools.

AASB School Climate and Connectedness Survey (grades 6-12)

The School Climate and Connectedness Survey measures student and staff perceptions of school climate and connectedness. School climate refers to factors that contribute to atmosphere and attitudes in a school, such as feeling safe at school and feeling included by staff. Connectedness refers to students’ school experiences and their perceptions and feelings about school. This includes feeling that they belong and are part of the school and feeling like they are treated fairly by staff.

The Survey Administration Release Forms are to be completed by 9/1/2014

Rev 5/7/2014