Attach-5_School_Requirement-Letter_-Participation_Form

Attachment 5

School Recruitment Letter and School Participation Agreement Form

DATE, 2014

<Chief School Administrator>

<ABC School>

<Street Address>

<City>, NJ <ZIP>

SUBJECT: Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation Study

Dear <Chief School Administrator>:

<ABC School> has been selected to participate in the Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation Study being conducted by the Bloustein Center for Survey Research (BCSR), at Rutgers University. Your support is essential to the success of this National Institutes of Health-funded research [NIH funding number HHSN271201100016C] which aims to validate a questionnaire that was developed in order to measure behavioral characteristics in teens and young adults that are found to be associated with future substance use problems. These findings will help doctors and other health professionals with efforts to identify at-risk youths for the purposes of early intervention.

The Bloustein Center will conduct the survey during the 2014-2015 academic year and our experienced school survey team will provide extensive administrative support in order to minimize the burden on school staff. We also will provide each school with a check for $500 upon completion of participation in this study. Your office will be contacted in the coming weeks by BCSR to schedule the survey and provide any additional information you may require.

The Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation Study will be administered online to between 130 and 160 students in a total of about four to ten classes selected by random sampling. This survey has approximately 170 brief items and should not take more than 40 minutes to administer. Student participation will be anonymous and school participation will not be reported in any study documents. BCSR will work with you to ensure that your school follows all applicable state and local statutes, regulations, and requirements, if any, for parental consent with regard to student survey participation.

The research design and sampling method require high participation rates to ensure usable data, so your participation is essential to the success of this project. The number of sampled schools has been kept as small as possible in order to minimize demand on schools. Through your commitment to this effort, we will be able to obtain critical information about students’ at-risk behaviors and together take action to address youth substance use disorder.

Enclosed is a copy of the Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation questionnaire, a timeline of the process, and a fact sheet. Also enclosed is a form for your signature that indicates an agreement to participate. Please FAX this form to Dr. Chris Bruzios, The Bloustein Center for Survey Research at 732-932-1881. If you have questions concerning the study, please direct them to Siobhan Foley at 848-932-2782 or to the Rutgers University, Office of Research and Sponsored Programs, Institutional Review Board, Sponsored Programs Administrator at 848-932-0150.

Thank you very much for your assistance and cooperation in this important endeavor.

S incerely yours,

Chris Bruzios, Ph.D., Director

Bloustein School for Public Policy

Rutgers, the State University of New Jersey

School Agreement

Participation in the Evaluation of Transmissible Risk for Substance Use

Disorder in Youth Validation Study

The ________________________________________ (school name) agrees to participate in the Evaluation of Transmissible Risk for Substance Use Disorder in Youth Validation Study during the 2014-2015 academic year. We understand that this agreement to participate entails the following commitment of resources from the Bloustein Center for Survey Research (BCSR), at Rutgers University and the school’s agreement to cooperate in the following ways, so that the survey is representative of the nation’s students and meets commitments to students in terms of their voluntary and anonymous participation.

BCSR:

1. Will provide $500 to the school as unrestricted funds.

2. Will provide information and forms to teachers of selected classes.

3. Will administer the survey online, supplying the URL for a web interface including unique passcodes for all schools to have access to the site, on a day of the school’s choosing.

4. Will assure that survey administration procedures support student voluntary and anonymous participation.

School and its Staff:

1. Will provide a list of classes (such as all second or third period classes) with the number of enrolled students in each class so that a random sample of about four to eight classes can be selected.

2. Will provide the name and contact information for the teacher of each class selected to participate.

3. Will designate a person within the school to serve as liaison for the survey.

4. Will select a date for survey administration through May 2015.

5. Will maintain a copy of the survey questionnaire in the principal’s office and make it available for review by parents or guardians on request.

6. Will provide telephone numbers or e-mail addresses of teachers of selected classes to permit follow-up.

7. Will follow all applicable state and local statutes, regulations, and requirements, if any, for parental consent with regard to student survey participation.

Sincerely,

____________________________ ___________________________ __________

Name Title Date