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Youth Assent/Parent Consent Information

Purpose of the Survey
Muscogee Nation Department of Health/Behavioral Health is asking youth citizens to participate in a survey to learn more about their experiences at home, at school and in the community. The information you share will tell us more about what Muscogee youth citizens experience so that we can create wellness programs and services to better support them.

In order to participate you must:
   -Be 13-17 years old
   -Be a citizen of the Muscogee Nation
   -Have permission from your parent or guardian to participate.

Survey Questions
The survey will ask you questions about your experiences in each of seven important areas of life to promote health and wellbeing for Mvskoke people.  Participation will take approximately 40-55 minutes.

Incentive to Participate 
At the end of the survey you will be given the opportunity to enter into a series of raffle items. To receive any raffle item you must meet the study eligibility. Only one raffle entry is available per person. 

The last page of the survey will ask you to document the time and date you completed the survey. You must then email or call the designated Muscogee Nation staff person listed to enter into the raffle. When taking the survey online youth need to use the name and address of an adult parent or guardian to mail any items that might be won in the raffle drawings. Your personal information for the raffle entry will be collected and stored separately from survey responses.  Only timestamp data will be compared to verify raffle entries. Following the raffle awards, your personal data will be destroyed.

Families, those with disabilities or limited internet access may also request in home support for completing the surveys directly into a mobile kiosk to register for the raffle in person by contacting Tyler Stone by email at or by phone at (918)758-1930.  


Some survey questions may ask about experiences in life that could be sensitive or uncomfortable for you. After this survey, if you feel you need to talk with someone, a list of local and national resources with contact information will be available.
Confidentiality and Anonymity
We do not believe your individual responses will personally identify you in the survey data. We do not ask for names, birthdates, address, etc. in the actual survey questions. We are taking extra precautions to protect your privacy and the anonymity of your responses in the following ways:
  • The IP address function is disabled for the survey and this information is not collected. Therefore, we cannot link your responses to your computer.
  • Survey answers go directly to a contracted evaluator who is outside of or external to the Muscogee Nation. That evaluator will organize and analyze the answers.
  • The answers will be "scrubbed" to remove any information that a youth participant may write in, such as names of people, positions, or other personally identifying information. The answers are a then considered “de-identified”.
  • The survey results are reported as a group and the report will not reveal the answers of any single youth.
  • De-identified responses (electronic data) will be returned to the Muscogee Department of Health/Behavioral Health to be stored on a password protected computer that is only accessible and managed by 2 individuals. These individuals receive ongoing training in protecting confidential information given by citizens participating in this survey.

Question Title

* *Parent Consent: By entering this survey, I agree that

1. My child meets the study participation eligibility,
2. I understand the information above and want to allow my child to volunteer, 
3. I give permission for my child to participate and use my name to enter into a raffle, and 
4. I will be a resource to my child in completing the survey if they ask, but will also work to give them privacy to answer honestly and with anonymity as was intended for the survey participants.

Question Title

* Youth Assent: By entering this survey, you agree that
  1. You meet the study participation eligibility.
  2. You have your parent or guardians’ permission to participate and use their name to enter into the raffle.
  3. You understand the information above and want to volunteer.

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