URBAN MEASUREMENT OF AEROSOL AND ASTHMA PROJECT

Date: __________

Dear Parent or Guardian,

Our school: _____________________________, is facilitating a student research project called Urban Measurement of Aerosols and Asthma Project (UrbanMAAP). The study seeks to randomly administer a short survey in your son's/daughter's school concerning the incidence of asthma among young people in our city. We have received approval from our school to administer this survey.

The survey asks such questions as student age, whether they have asthma, the impact this health problem has on them and what time of year it occurs. The survey will be given during a class period and should take about 5 minutes to answer the questions. All questions only require students to place a check mark by a response category (e.g., Yes or No) or fill in a number.

Students are not asked to indicate their name on the survey. Thus, all information about an individual child is confidential, and it will be integrated with other data collected to calculate statistics for a report being prepared. We expect to share survey results among all participating schools. In addition, students and researchers collaborating on UrbanMAAP hope to use the survey statistics in papers that contribute to relevant science questions facing our community, as well as to educate the public about their research.

Please complete the form below if you do not agree to your (son/daughter) participating in this UrbanMAAP research, and return it to your (son's/daughter's) teacher.

If you have any questions, please call _____________ at ____________. Also, if you are interested in the results of this project, you can write to me at the address above and I will send you a copy of our report.

Sincerely,

Name of School Faculty Advisor

_______ I do not give my permission for my (son/daughter/child) to participate in the UrbanMAAP Asthma Survey.

Your signature: _________________________________________
Date: ____________________