Dear Parent/Guardian:

Our school is participating in the Student Health Survey (SHS), a survey sponsored by the Oregon Health Authority Public Health Division and the Oregon Department of Education. The survey asks about health risk behaviors of students in grades 6, 8 and 11. The survey will be conducted online in the classroom and includes questions about student health and safety, mental and behavioral health, school climate and culture, and risk and protective factors.

Taking the Student Health Survey poses minimal risk to your child, who may feel embarrassed or uncomfortable answering some of the questions. Survey procedures have been designed to protect your child's privacy and allow for anonymous participation. If your child is not comfortable answering a question, he or she can leave it blank. While we encourage all students to participate, the decision to participate is voluntary. You may opt to send a refusal for your child’s participation. Your child will have the chance to refuse at the time of the survey. There will be no action against you or your child if your child does not participate.

If you do not wish your child to take this survey, return this form to the principal’s office before the survey date of December 9th. You only need to return this form if you do not wish your child to participate.

Please see the other side of this form for more information. You can review the survey document at the principal's office before the survey date. The survey is also available on the Oregon Health Authority (OHA) Public Health Student Health Survey website for you to review before the survey date.

If you have other questions about the survey, please contact the building principal.