This convening focuses on the administration of surveys to youth in schools across Kansas. We would like to ask you a few quick questions to help plan for the event. To register for this event, please answer the following questions:

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First Name *
Last Name *
Suffix (e.g.: Jr., Sr., M.P.H., Ph.D., etc.)
Email *
In what role are you attending this convening? *
- Select a Value - Academia/Researcher Community Organizations Educator/School Staff Elected Official Medical or Allied Health Professional Parent or Legal Guardian State Agency/Local Health Department Other
Other
Organization
Title

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• Are you familiar with surveys that are given to students in school?
  Yes No, I am not familiar with any surveys
• Please provide survey names or describe type of survey (select all that apply).
  Youth Risk Behavior Surveillance Survey (YRBS) Kansas Communities That Care (KCTC)
• Other survey (please specify)
• What concerns, if any, do you have about surveys administered to students in school? Please check all that apply or provide additional concerns if not listed.
  Privacy Data security and confidentiality Survey fatigue for students Potential for stigmatization Impact on curriculum or policies Data validity and community impact Survey content I do not have any concerns.
• Other concerns (please specify)
• What benefits, if any, do you see in collecting information from students in school? Please check all that apply and describe any specific examples or applications.
  Grants and funding opportunities Reflecting on the current state of student well-being and needs Program planning Program performance and evaluation Build coalition priorities Inform policy decision Identifying trends I do not see any benefits.
• Other benefits (please specify)

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• What question(s) do you have going into the convening?
• What are you most interested in learning from this convening?

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Residence County *
- Select a Value - Outside of Kansas Allen Anderson Atchison Barber Barton Bourbon Brown Butler Chase Chautaqua Cherokee Cheyenne Clark Clay Cloud Coffey Comanche Cowley Crawford Decatur Dickinson Doniphan Douglas Edwards Elk Ellis Ellsworth Finney Ford Franklin Geary Gove Graham Grant Gray Greeley Greenwood Hamilton Harper Harvey Haskell Hodgeman Jackson Jefferson Jewell Johnson Kearny Kingman Kiowa Labette Lane Leavenworth Lincoln Linn Logan Lyon McPherson Marion Marshall Meade Miami Mitchell Montgomery Morris Morton Nemaha Neosho Ness Norton Osage Osborne Ottawa Pawnee Phillips Pottawatomie Pratt Rawlins Reno Republic Rice Riley Rooks Rush Russell Saline Scott Sedgwick Seward Shawnee Sheridan Sherman Smith Stafford Stanton Stevens Sumner Thomas Trego Wabaunsee Wallace Washington Wichita Wilson Woodson Wyandotte
Residence State *
- Select a State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Islands
Age Range *
Under 18 18-24 25-44 45-64 65 and over Prefer not to answer
Gender *
Female Male Nonbinary Other Prefer not to answer
Ethnicity: Are you Hispanic, Latino/a or of Spanish origin? *
No Yes Prefer not to answer
Race (select all that apply) *
American Indian/Alaska Native Asian Black/African American Hawaiian/Pacific Islander White Other Prefer not to answer

• By registering to attend this educational event, you agree to receive emails from the Kansas Health Institute.

PLEASE NOTE: a confirmation email with more information should arrive shortly. The email may take up to 20 minutes to reach you, so if you do not receive it within that timeframe, please let us know.

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