GorhamHigh School

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Maine Integrated Youth Health Survey

Gorham High School

41 Morrill Avenue

Gorham, Maine 04038

(207) 222-1100


January 8, 2023

Dear Parent/Guardian:

Our school is taking part in the 2023 Maine Integrated Youth Health Survey. This survey is sponsored by Maine Department of Health and Human Services and Maine Department of Education. The survey will ask about the health behaviors of 9-12 grade students. The survey will ask about nutrition, physical activity, injuries, tobacco, alcohol, and other drug use. For students in grades 7-12, the survey will also ask about sexual behaviors that could lead to pregnancy and sexually transmitted infections; depression and suicide; and gambling.

Students will be asked to fill out a survey that takes about 45 minutes to complete.

Participating in this survey will cause little or no risk to your child. The only potential risk is that some students might find certain questions to be sensitive. The survey has been designed to protect your child’s privacy. Students will not put their name on the survey. Also, no student will ever be mentioned by name in a report of the results. For the survey results to be accurate, it is important that all students, regardless of whether they have engaged in health-risk behavior, are given an opportunity to participate in the survey, but the survey is voluntary. No action will be taken against the school, you, or your child if your child does not take the survey. Students may skip any questions they do not wish to answer. In addition, students may stop taking the survey at any point without penalty. If you would like to see the types of questions on the survey, the question banks are available at www.maine.gov/miyhs/2023-survey-information

Please read the other side of this form for more facts about the survey. Complete the section below and return it to the school within 2 weeks only if you DO NOT want your child to take part in the survey. If you have additional questions about the survey your child’s teacher or principal cannot answer, please contact:

Korey Pow Haggerty at 207-287-5084 or email [email protected]
Jean Zimmerman at 207-215-6841 or email [email protected]


Please contact the school OR complete this section of the form only if you do not want your child to participate in the survey.

Student name: ______________________________________________ Grade: _________

I have read this form and know what the survey is about. 

NO, my child may not take part in this survey.

Parent signature: _________________________________________ Date: _____________

Maine Integrated Youth Health Survey Fact Sheet

  1. Why is the survey being done?
  2. The Maine Department of Education and the Maine Department of Health and Human Services will use the survey results to help measure the percentage of youth who practice healthy and risky behaviors. The information will be used to create school health programs to help reduce risky behaviors and increase healthy behaviors.

  1. Are sensitive questions asked?
  2. Yes. Tobacco use, alcohol and other drug use, and bullying may be considered sensitive topics. Questions are written in a direct but sensitive way. Students in grades 7-12 are also asked about depression, suicide, and sexual behaviors that may lead to HIV infection and other sexually transmitted infections (STIs) and unintended pregnancy. Sexual intercourse and injected drug use are behaviors that increase the risk of HIV infection. The only way to learn if youth are at risk of becoming infected with HIV or other STIs is to ask questions about these behaviors. 

  1. Will students’ names be used or linked to the surveys?
  2. No. The survey has been designed to protect your child’s privacy. Students do not put their name nor any other identifying information (such as a student ID number) on the survey. 

  1. Do students take the survey more than once to see how their behaviors change?
  2. No. Students who take part one year cannot be tracked because their names are not on the survey.

  1. How was my child picked to be in the survey?
  2. Your child’s school was selected to participate, and all students in their grade are being asked to participate. 

  1. How long does it take to fill out the survey? Does the survey include a physical test?
  2. One class period is needed to fill out the survey. The survey does not include a physical test or exam.

  1. Can I see the questions my student will be asked?
  2. Yes, you can view the questions at www.maine.gov/miyhs/2023-survey-information.

  1. What happens if I opt my child out of the survey?
  2. Your child’s teacher will give them an alternative activity, such as homework or reading, to work on quietly at their desk while their classmates complete the survey.

  1. Who supports this survey?
  2. This survey is supported by many organizations in Maine interested in the health of youth. It is also supported by many national organizations. People from more than 100 state and district health and education agencies and 19 federal agencies helped develop the survey.