2019 Jeffco Smart Source Survey Approval Form
Utilize this form to indicate person at your school who will be the main contact for the Healthy Schools Smart Source Survey (this will likely be one of your Healthy Schools Liaisons). Complete Smart Source by December 31, 2019.

-This contact person will receive a custom link for your school to complete the survey.

-The principal MUST give approval for the school to complete Healthy Schools Smart Source.

-This survey has been approved by the Jeffco Review of External Research; see approval letter below.

-Each school that completes the survey will receive a $100 for taking the time to complete the survey.

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Dear Principal:

The Jefferson County Public Schools External Research Review Committee has given preliminary approval to Colorado
Education Initiative (CEI), to conduct a research study, Colorado Healthy Schools Smart Source Inventory in Jeffco Schools.

This letter is simply to notify you about the study and provide you with a brief overview. It is not an endorsement of the study nor should it be viewed in any way as either encouraging or discouraging your participation. Your participation in this study is completely voluntary and your decision.

Purpose of study
“Smart Source is a school-level inventory that assesses health policy and practices across nine content areas: general health policies and practices; nutrition; physical education/activity; health education; health services; counseling, psychological, social services; healthy and safe school environment; family, community, and student involvement; and staff wellness.”

Time Commitment
The researcher is asking for any interested administrators from Jeffco schools to complete the online Smart Source tool which takes approximately 1 to 3 hours. The participation consent form from the researcher will be sent to the contact person completing this form.

Financial Incentive
$100 to offset staff time to complete the survey.
Informed Consent

For this study, the researchers must obtain active consent from the participants prior to participation.

Confidentiality
No information identifying individual districts, schools, teachers, or students will ever be released. The committee has reviewed this research proposal and found that the study meets district requirements for research. Note that final approval for this research project comes from the principals in the schools where the study will be conducted, in accordance with district regulation IGB-R:
 The Research Committee will contact principals/program managers in the schools/departments where the study will be
conducted.
 The written description of the project and other supporting materials will be sent by the researcher to the
principal/program manager for review.
 Schools or programs interested in participating in the project will then meet/communicate with the researcher to arrange for implementation of the study. No school or department will be forced to participate in an approved study.
 For research conducted in schools, the principal in consultation with staff and community shall be the final
decision-maker regarding participation.

The researcher will be contacting you about this study. Your school's/department's participation in this research is optional and entirely left to your discretion. Furthermore, participation by district employees in any external research study is always voluntary. There is no penalty for declining to participate or withdrawing from the study at any time. Please email or call me at (303) 982-6601 if you have any questions.

Sincerely,
Holly Jolly
Jeffco Review of External Research
Research and Assessment Design
Jefferson County Public Schools/303-982-6601
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Survey Contact First Name *
This is the person who will be the main contact for the survey. Typically a Healthy Schools Liaison.
Your answer
Survey Contact Last Name *
Your answer
Survey Contact Email Address *
Your answer
Our principal has given approval for our school to participate in Smart Source. *
Schools may ONLY participate once their principal has approved.
Required
School *
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