2021 KCTC Parent Consent
Rose Hill Middle and High School will again be administering the Kansas Communities That Care Student Survey*. This survey is taken by 6th, 8th, 10th and 12th grade students statewide. We believe this survey is a valuable tool to help us understand how students behave, think and feel about alcohol, marijuana and other drug use, bullying and school safety. The KCTC survey measures teen substance use, delinquency, and related problem behaviors in schools and communities. The survey gives us insight into the problems students face and shows what we can do to help them succeed. The information is important for planning effective prevention programs in our school and community and provides data to assist in applying for grant funding. The survey can be viewed at www.kctcdata.org, scroll to Quick Links.
You may also be interested to know the following:
1. It is completely anonymous. Students will not be asked for their names on the questionnaire, nor will anyone be able to connect any individual student with his/her responses. School staff will not see any one student’s responses, but only summaries of results.

2. Participation is entirely voluntary. Your child may decline to participate in the survey, or may simply skip any particular question they do not wish to answer.

3. Annual participation is important. Even if your child has participated in previous surveys, annual data is extremely helpful in determining the effectiveness of previous efforts and changes in program areas.

We hope you will allow your child to participate. Please check the appropriate box below. Thank you in advance for your cooperation.


Rexanne Tucker
MS Counselor

Casey Tarrant
HS Counselor
Please check one: *
Child's Name: *
Parent Signature: *
*The survey is provided by the Kansas Department for Aging and Disability Services, Behavioral Health Services Commission and administered by Greenbush – The Southeast Kansas Education Service Center, Research and Evaluation Department.
Never submit passwords through Google Forms.
This form was created inside of Rose Hill Schools USD394. Report Abuse