Youth Assent form
The Choosing Your Future Program
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/guardian has agreed that you can be in the program. If you agree to participate in the program, you will participate in the Choosing the Best curriculum.
Benefits of Participation: The benefit to participating in this program is that you will receive medically accurate age-appropriate sexual risk avoidance and relationship education. By participating in the program, you will learn the advantages of delayed sexual activity and be empowered to make healthy choices to improve your life outcomes.
Risks of Participation: The risks to participating in the program are minimal, but you may feel uncomfortable discussing or learning about topics of a personal nature. Program staff will be available to discuss any feelings brought up in the process of participating in the program, and additional counseling and referrals to social service providers will be available outside this project. You may discuss these services with program staff at any time. In addition, if you are completing this consent form 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 will be protected once AZYP downloads the data from the internet and that you are free to decide not to answer any items on this consent form.
Confidentiality: All information gathered while you are receiving services from AZYP is confidential. However, information may be released in case of medical emergency, child abuse or neglect, court order, and where otherwise legally required.
Voluntary Participation/Withdrawal: Participation in the program is voluntary. You have the right to decline or to withdraw from the program at any point. If you do not wish to participate or if you decide to stop participating in the program, it will not affect any other services you are eligible to receive from AZYP.
Mandatory Reporting Requirements: All members of the staff are required by law to report suspected incidents of violence. If you report child abuse, suicidal ideation and suicidal intent, or threaten to harm
others, a report must be filed with an appropriate agency. This may include Department of Child Safety or a similar agency.
Questions: If you have questions about the Choosing Your Future Program, you may contact Christine Barry at AZYP at 520-744-9595.
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, 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 Christine Barry at Arizona Youth Partnership at 520-744-9595 or contact Meg Knight at Civitas Evaluation, LLC at email@example.com.