SHARP Survey Consent Form - English
Dear Parent:
The Department of Health and Human Services is conducting the Student Health And Risk Prevention (SHARP) Survey. Your child’s class may be selected to participate in this survey. Students whose classes have been selected will be asked to complete ONE of the following two questionnaires: the Prevention Needs Assessment (PNA) Survey or the Youth Risk Behavior Survey (YRBS) during February, March, or April 2023. The two questionnaires are described below.
Prevention Needs Assessment (PNA) Survey. The PNA survey measures alcohol, tobacco, and drug use; the factors that place students at risk for problem behaviors; the factors that protect students from problem behaviors; and basic demographics. Information gained from the survey will allow your school district and the State of Utah to continue to provide comprehensive prevention programs for our schools and children.
Youth Risk Behavior Survey (YRBS). The YRBS survey measures alcohol, tobacco, and drug use; antisocial behaviors; health behaviors; school safety; and basic demographics. This survey is only administered to students in grades 9 through 12. Sixth through 8th graders are not eligible for the YRBS.
According to Utah law, students’ parents must give their permission before the student can participate in the survey. You need to be aware that:
(1) Your child’s participation is completely voluntary and confidential.
(2) If your child does not participate, they will not be penalized or lose any school benefits to which they are otherwise entitled.
(3) Your child may discontinue the survey or skip any or all questions on the survey without penalty or loss of any school benefits to which he or she is otherwise entitled.
The surveys are being administered by your school district during one class period and will take about 45 minutes to complete. All responses will be completely anonymous and confidential. Results will be reported for groups of students; because the survey is anonymous, responses cannot be linked to any individual student. Additionally, the anonymous survey data may be shared with respected researchers in the United States to aid in prevention planning.
If you have any questions or would like to review copies of the surveys, please ask a school official at your child’s school or visit the following web address: A copy of each survey is available for your review in the school office, or an electronic copy can be emailed, mailed, or faxed to you (see contact information following).  For additional information about the survey, contact SHARP Contact Mary Johnstun at Bach Harrison LL (801-842-2682 / or Ryan Carrier (801-889-8710/ at the Utah Department of Human Services, Division of Substance Abuse and Mental Health.
For the survey results to be accurate, it is important that all students are given an opportunity to participate in the survey, whether or not they have ever used tobacco, alcohol, or other drugs or engaged in problem behavior. Please indicate whether or not you want your child to participate in the survey. Thank you very much for your help on this important project.

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Student First, Middle and Last Name *
School that the student attends *
Grade *
Teacher Name
Class Period for that teacher
I GIVE PERMISSION for my child to complete either the PNA or the YRBS. (NOTE: the YRBS is only offered to a small sample of 9th-12th graders in the state).
I DO NOT GIVE PERMISSION for my child to complete the PNA or YRBS (NOTE: the YRBS is only offered to a small sample of 9th-12th graders in the state).
Typing your name in the space below serves as the equivalent to signing this form *
Date *
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