Georgia Student Health Survey - Passive Parental Permission Form
The Georgia Student Health Survey is an anonymous, statewide survey instrument that identifies school safety and climate issues that impact student achievement. In order to provide a safe and supportive learning environment for your child, the Georgia Department of Education collects survey information from students during the school year. The survey takes approximately 20 minutes to complete and covers various topics such as school climate and safety, alcohol and drug use and mental health. All student survey data is anonymous and self-reported.

The Protection of Pupil Rights Amendment (PPRA) gives you the right to opt your child out of participating in the survey. If you do not wish for your child to participate in the Georgia Student Health Survey, please submit this form.
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I would prefer that my child NOT participate in the Georgia Student Health Survey.
Student Name
Grade
Parent/Guardian Name
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