Choosing Your Future Youth Assent Form

Choosing Your Future is an Arizona Youth Partnership (AZYP) program that helps students learn about peer pressure, media pressure, assertiveness skills and the risks of early sexual involvement.  It also helps youth learn how to make healthy decisions, set boundaries, and increase communication with trusted adults. Your parent or guardian has agreed that you can be in the program and participate in the program evaluation.

What is the program evaluation about?

AZYP has hired Civitas Evaluation, a Tucson-based consulting firm to evaluate the Choosing Your Future program. The purpose of the program evaluation is to determine if AZYP is meeting its goals, suggest areas for improvement, and help plan future programs. The program evaluation will gather information about the characteristics of youth who participate in the program and their experiences, attitudes, and perceptions. You were chosen because you are participating in the Choosing Your Future program. Your parent/guardian has agreed that you can be in the program evaluation.

If you participate in the Choosing Your Future program evaluation, you will be asked to:

  • Complete a survey in class before the program begins and fill out the same survey in class after the program ends. The surveys will not include any youth names. The surveys will ask youth questions about whether they think the program affected their decisions related to substance use; decision making; goal setting; healthy relationships; dating violence and sexual coercion; and overall experience in the program. Youth will also be asked whether they think the program affected their decisions to delay having sex.

Even though your parent/guardian agreed that you can be in the program evaluation, you can decide not to complete any or all parts of the surveys.

Your Answers Will Be Kept Private

No survey answers will be linked with your name. Only the Choosing Your Future staff who teach the program and staff who evaluate the program will be able to see the surveys. The surveys will not be shared with the school. Answers you provide will be combined with those from other youth in the evaluation. That way, the evaluator can say things like, “75% of youth surveyed felt the program helped them understand what makes a healthy relationship.”

Risks from Participating in the Program Evaluation

It is possible that your answers could be seen by another student or somehow revealed. If answers are revealed, you might be embarrassed. However, it is very unlikely that your answers will be revealed, and we will make every effort to keep all answers private. You should not write your name on the surveys. It is also possible some of the topics in the surveys might make you uncomfortable or upset. You may skip any questions that make you feel this way. Choosing Your Future staff will be available to talk to you, answer questions, and provide you a list of people you can talk to, including a school counselor, if you would like to do so. In addition, if you are completing this form or surveys online, there is always a possibility of hacking or other security breaches that could threaten the confidentiality of your responses. Please know that the confidentiality of your responses to this form or surveys will be protected once the data is downloaded from the internet by AZYP or its evaluator and that you are free to decide not to answer any items on this form or on surveys.

Benefits from Participating in the Program Evaluation

The information received from youth will improve the Choosing Your Future program and may help inform the development of future programs in your community.

Your Participation is Voluntary

We hope that you will want to be in the program evaluation, but you do not have to participate. As mentioned previously, even though your parent/guardian consented to your participation in the program evaluation, you may skip any survey questions that make you feel uncomfortable. If you do not participate in the program evaluation, you will still be able to participate in the Choosing Your Future program, and your decision will not affect your grades or school services.

If you have any questions, you may call Dominique Cruz at Arizona Youth Partnership at 520-744-9595 or contact Meg Knight at Civitas Evaluation, LLC at

I have read the above information and have received answers to all of my questions. I agree to participate in the following:

  • Arizona Youth Partnership (AZYP) has permission to use my name and any photographs, videos, slides, etc. of me and/or my children in stories about AZYP for the media, funding sources, and AZYP materials.
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  • This field is for validation purposes and should be left unchanged.

Note: A signed copy of this consent form will be kept on file with AZYP. You may request to receive a copy of this form to keep.