2024 YTS permission form |
Dear Parent or Guardian,
Your child's school is taking part in the 2024 Youth Tobacco Survey, conducted by the Tobacco Prevention and Cessation division (TPC) of the Indiana Department of Health (IDOH). The survey is for students in grades 6 – 12. The content of the survey includes questions related to tobacco: lifetime and current use (cigarettes, e-cigarettes, smokeless tobacco, cigars, and more); knowledge and attitudes; cessation; secondhand smoke; media and advertising; youth access to tobacco products; and school curriculum. The survey questions may be viewed here:
The electronic survey has been designed to protect your child’s privacy. Students will not put their names or any other identifying information on the survey, and no school or student will be mentioned by name in any report of the results. Survey responses entered by your student will not be tracked by IP address and cannot be identified by their device (laptop, tablet, or phone).
We would like all selected students to take part in the survey. Because of the importance of this survey, your child's school will receive $500.00 for its participation. The results of this survey will help your child and other Indiana youth in the future. But the survey is voluntary, and no action will be taken against the school, you, or your child, if your child does not participate.
Please read the section below. If you do not want your child to take part in the survey, complete the questions below. If you would like your child to take part in the survey, no further action is needed, and you may close this window.
We would like all selected students to take part in the survey. Because of the importance of this survey, your child's school will receive $500.00 for its participation. The results of this survey will help your child and other Indiana youth in the future. But the survey is voluntary, and no action will be taken against the school, you, or your child, if your child does not participate.
Please read the section below. If you do not want your child to take part in the survey, complete the questions below. If you would like your child to take part in the survey, no further action is needed, and you may close this window.
If you have questions about the survey, you may send an email to YouthTobaccoSurvey@health.in.gov for additional information. Thank you.