CAPISTRANO UNIFIED SCHOOL DISTRICT 33122 VALLE ROAD, SAN JUAN CAPISTRANO CA 92675 TELEPHONE: (949) 234-9200/FAX: 496-7681 www.capousd.org

Dear Parent or Guardian, In mid-January Capistrano Unified School District will be asking your child to be part of our school’s California Healthy Kids Survey (CHKS) sponsored by the California Department of Education. This is a very important survey that will help promote better health and wellbeing among our youth, improve the school learning environment and better equip our schools to combat problems such as drug abuse and violence. We are also asking parents or guardians to complete a parent survey as well. This is your opportunity to share your opinions about your child’s school experience. The District will be providing two Parent Information Presentations at the District office, on January 17 at 9:00am-10:00am and January 18 at 6:00pm-7:00pm. This is for parents who would like more information about the survey and want to understand how the information is being utilized. Survey Content: The surveys gather information on developmental supports provided to youth; school connectedness and barriers to learning; school safety; and health-related concerns such as physical activity and nutritional habits; alcohol, tobacco and other drug use; and risk of depression. The results from these anonymous surveys are compiled into district and county-level CHKS Reports. To view a copy of our district’s report for 2015-16 go to http://chks.wested.org/reports/search and type in Capistrano Unified School District. It is Voluntary: Your child is not required to take the survey. If you do not want your child to complete the survey, you must notify your school. Students that do participate do not have to answer any questions they do not want to answer, and may stop taking the survey at any time. It is Anonymous: No names are recorded or attached to the surveys forms or data. The results will be made available for analysis only under strict confidentiality controls. Administration: The student survey will be administered between January 22 and February 15, 2018. It should take about 45 minutes to complete and will be administered in one of your child’s class periods. To access the Parent Survey go to https://capousd-ca.schoolloop.com/chks and click on your child’s school. A follow up email will be sent to all parents with the Parent Survey link. The link will remain open until February 15 and should take about 20 minutes to complete. Paper copies of the survey are available at your child’s school. For Further Information: The surveys were developed by WestEd, a public, non-profit educational institution. If you have any questions about the surveys, or about your rights, contact Anthony Tran, Director of Assessment, at [email protected]. If you do not want your child to participate, please complete the section below and return it to your child's school by January 19, 2018. ------------------------------------------------------------------------------------------------------------------------------------------------------------------

CHKS Withdrawal Form By turning in this form, I do not give permission for my child to take the California Healthy Kids Survey. (Please Print) My child’s name is: ID: ______

Parent or Guardian Signature:

____________________________ ________ _________

Grade:______

Date:___________