School Survey Coordinator Checklist

The following bullet points list the responsibilities of the survey coordinator in each school and/or school district. Following the steps below will ensure that the PFS Youth Survey will be successfully administered in your school and district.

Please check the following items once you receive your package. If anything is missing or unclear contact Janelle Simpson at (307) 840-0651 or

  • Inventory the survey package. It should include:
    • Survey Packets
      • Instructions
      • Parental Consent Forms
      • Surveys (for classes administering paper surveys)
      • Pencils (for classes administering paper surveys)
    • Example Questionnaire
    • Return UPS Label (for returning paper surveys and parental consent forms)
  • Check the Survey Packets. These packets are usually organized by teacher or class, and should cover all 6th, 7th, 8th,9th, 10th, 11th, and 12th grade students. A Parental Consent Form is included for each student. For classes administering the paper version, this packet will contain a survey for each student. For classes administering online, there will only be a page of instructions with an access code for the entire class.
  • The Example Questionnaire should be available in the main office of the school for parents.
  • Distribute the Parental Consent Forms to students’ parents/guardians at least two week prior to survey administration. These forms are most often sent home with students or included in a school newsletter.
  • Distribute the Survey Packets to the staff that will be administering the survey.
  • Collect and return to WYSAC any Parental Consent Forms that were returned.
  • For classes administering paper surveys: Collect the completed Survey Packets and repackage them in the original box/envelope. Return the package to WYSAC using the pre-paid UPS label.

Please do not return the pencils as they cannot be re-used. Please let your students keep the pencils.

Paper Survey Administration Instructions & Script

Thank you for your assistance with this project. Please read through the following instructions completely. The data collected from the NDPFS YS provides important information used to plan and evaluate alcohol prevention programming for your school, community, and the State of North Dakota.To make the data comparable to previous years and within the state, it is very important that the surveys are filled out correctly based on these instructions. More information about the survey can be found at the survey website:

Materials Needed

  • Classroom Survey Packet containing:
    • A survey booklet for each student in the classroom
    • A sharpened pencil for each student in the classroom
    • Manila envelope or box to return the surveys
    • Survey Administration Instructions (on the reverse side)
  • A list of your students that indicates whether or not they returned a Parental Consent revoking permission to take the survey.

Survey Administration

  1. Verify that all the students in the classroom are either in the 6th, 7th, 8th, 9th, 10th, 11th, or 12th
  2. Open the Survey Packet and distribute the surveys and the pencils to the students. In passive consent school districts, such as this, give the survey to all the students in the class except those students for whom you received a parental consent form withdrawing consent to participate.
  3. Students who do not have permission to participate or students who choose not to participate should be given an alternative non-obtrusive activity, such as independent reading or studying for another class, to do while the remaining students complete the survey.
  4. After distributing the survey booklets and pencils, please read the statement on the back of this page. What you read out-loud is in normal typeface, whereas the actions you need to complete are in bold.
  5. After reading the script, please sit and stay in a location where it is obvious you cannot monitor or see the student’s survey answers and is away from the collection envelope or box. If a student asks, you may help pronounce any unfamiliar words or provide a definition of a word to that student. However, do not try to “interpret” or “explain” the meaning of a question for the student. Simply tell the student to answer the question as best as he or she can.
  6. Five minutes before the end of the class period, inform the students of how much time they have remaining.
  7. At the end of the class period, allow all the students to insert their surveys into the collection envelope or box and then immediately seal it.
  8. Please recycle all unused survey forms.

NDPFS Survey Administration Script

“Good (morning/afternoon). The purpose of the survey is to learn how students feel about their community, peers, and school. The survey also asks about health behaviors. The results from this survey will be used to evaluate prevention services, make policy decisions, and justify the need for future funding. Your participation and honesty on this survey may help decide what services you and your fellow students receive in the future. It may also be used to evaluate whether the services are successful. The answers you give are very important because only you can tell us about yourself. Please read each question carefully and answer it openly and honestly based on what you really think, believe, or do. This is not a test. There are no right or wrong answers.”

“Filling out this survey is voluntary and nothing negative will happen if you choose not to participate. Choosing not to participate will not affect your grades or class standing. If you do not have permission from your parents or guardians, or if you choose not to participate, please work on something else quietly while the other students complete the survey.” [If necessary explain what other activities the students who are not to participating in the survey can do, such as silent reading or studying.]

“Your answers will be completely private. Please do not put your name anywhere on the survey. After you are done, place your completed surveys in this envelope (or box) [Hold up envelope or box and set it back down on a table where all students can have easy access]. After the whole class has finished, the envelope (or box) will be sealed and sent off for analysis. No one will be able to tell your survey from any of the other surveys. During the analysis and reporting of the survey results, your answers cannot and will never be singled out. Instead, the results will be presented across groups of students.”

“Do you have any questions?” [Pause and answer any questions that are asked.]

“We are now ready to begin. Please read the instructions for the survey, which are located in this box [Hold up a copy of the survey and point to the instructions on the first page]. After you have finished reading the instructions please begin answering the questions right here [Hold up a copy of the survey and point to the first survey question]. Please answer all of the questions on the survey by completely filling in one of the answer spaces. If you do not find an answer that exactly fits, use the one that comes the closest. If any question does not apply to you, or you are not sure what it means, just leave it blank. You can skip any questions you do not wish to answer. You may also stop at any time. Overall, completing the survey should not be any more work than finishing your usual schoolwork.”

“After you have finished answering the questions on the first page, please turn the page and continue to answer the other survey questions on the remaining page. You will have the rest of the class period to complete the survey. Please work as quickly as you can, so you can finish in time.”

“Please raise your hand at any time if you have any questions and remember to put your survey booklet in the collection envelope (or box) after you are done. Thank you for participating in this survey.”