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Parental Notification/Opt-out – School Climate Survey

The School Climate Survey is a confidential survey used to identify school climate issues within our school.  The survey for elementary school students includes 20 questions and should take no more than six minutes to complete. The survey for secondary school students includes 44 questions and should take less than 10 minutes to complete.

The survey is confidential, but parents/guardians should be given the option to opt out if desired.  The data collected from the survey will be used to identify student perceptions of school climate issues within our school.

School staff use the results to inform our efforts at improving our school climate. Responses are housed securely in an anonymous format with the USBE (Utah State Board of Education). All evaluation research projects are in compliance with the Family Education Rights and Privacy Act, (343 CFR 99.31 (6)) and human subjects regulations (Protection of Human Subjects 45 CFR 46).

Our desire is to involve parents in their children’s education. If you do not wish for your child to participate in this important activity, please sign and return this form to the school by Friday, March 19, 2021.

If you would like to examine the survey questions, please click here. Please note that there is a separate tab for grades K-2, 3-5, and 6-12.  A parent survey will also be administered and questions are available for your review.  You may also come by the school between March 1, 2021 and March 26, 2021 and we will be happy to provide you with a copy for your review.  


Do NOT return this form if your child CAN participate in this survey.

If you do not wish your child to participate in this survey, please sign this form and return it to school by Friday, March 19, 2021

I would prefer that my child NOT participate in the School Climate Survey: Elementary.

School Name ____________________________________________

Student Name Student ____________________________________          Grade __________

Parent Signature _________________________________________           Date ___________

Thank you for your participation.

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