FUNDING OPPORTUNITY FOR CALIFORNIA HEALTHY KIDS SURVEY (CHKS) CHKS administration includes the companion school staff survey at no additional cost.

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1 CALIFORNIA SUR V E Y Deipar1ment of Health Care Services - California Deporlm..nl of EDUCATION FUNDING OPPORTUNITY FOR CALIFORNIA HEALTHY KIDS SURVEY (CHKS) Schools in your district have been randomly selected to participate in the Biennial Statewide California Healthy Kids Survey (CHKS). Participation only involves the addition of a short module on substance use at these schools as part of your regular district CHKS administration. In exchange, your district will receive the following benefits:.chks Fee Waiver. The $.30 per-student fee will be waived district-wide for up to 900 students per survey grade level..survey Coordination Compensation. $300 gift card per high school/$200 per middle and continuation school. Copies of Instruments. For districts that do not administer the CHKS online, printed instrument booklets will be provided that can be used throughout the district. School Report. Each sample school will receive a free school level CHKS report, valued at $50. Even if you are not planning a district CHKS in the next two years, the selected school(s) can still participate and receive these benefits. The Biennial Survey is sponsored by the Department of Health Care Services and the California Department of Education. WestEd provides technical assistance. Data from this representative state survey provides the norms for comparison with district CHKS results and have contributed to a better understanding of how to address the state s needs in regard to school climate and safety, pupil engagement, academic performance, and overall student well-being. IMPORTANT REMINDERS:.The Biennial Survey involves no additional burden on the schools if done as part of the regular district administration. The selected schools may participate in the survey, and receive the benefits, even if the district does not participate. The CHKS is available for online administration. CHKS administration includes the companion school staff survey at no additional cost. These surveys are valuable resources for data to guide Local Control and Accountability Plan efforts. If you have any questions, please contact David Gilmore, WestEd Survey Coordinator at / dgilmor@wested.org Please fax back the attached authorization form to: (562)

2 Alameda Alameda High / Bay Farm Alameda Hayward Brenkwitz High, Hayward High / Winton Middle Newark Newark Memorial High / Newark Junior High Oakland Oakland Technical High / Edna Brewer Middle Colusa Colusa Colusa High / George T. Egling Middle Antioch Antioch High / Black Diamond Middle Contra San Ramon Valley Costa California High / Iron Horse Middle El Dorado Buckeye Union Rolling Hills Middle El Dorado Union High Union Mine High Bakersfield City Sequoia Middle Kern High Independence High Kern McFarland McFarland High / McFarland Middle Mojave Mojave Jr.-Sr. High / California City Middle Compton Harriet Tubman High, Compton High / Willowbrook Middle Downey Downey High / Doty Middle Academies of Education & Empowerment at Carson High / John Burroughs Middle Arleta High / San Fernando Institute of Applied Media Augustus F. Hawkins High B Community Health Advocates / Utah Street Elem Carson Senior High / Mt. Gleason Middle Contreras Learning Center-School of Social Justice / Orchard Academies 2C Los Angeles Dr. Maya Angelou Community High / Ellen Ochoa Learning Center Jack London Continuation Los Angeles Senior High / Caroldale Learning Community Los Angeles Metropolitan Continuation Robert H. Lewis Continuation Thomas Jefferson Senior High / Robert Fulton College Preparatory Zane Grey Continuation Lynwood Marco Antonio Firebaugh High / Cesar Chavez Middle Montebello Montebello High / Montebello Intermediate Norwalk-La Mirada Norwalk High / Nettie L. Waite Middle Ganesha High / Palomares Academy of Health Pomona Science Garey High / Lorbeer Middle Rowland Torrance Nogales High / Giano Intermediate South High / Philip Magruder Middle

3 Marin Monterey Orange Riverside Sacramento San Bernardino San Diego San Luis Obispo Dixie San Rafael City High Monterey Peninsula Fullerton Fullerton Joint Union High Newport-Mesa Coachella Valley Lake Elsinore Moreno Valley Menifee Union Perris Union High Riverside Val Verde Elk Grove Natomas Miller Creek Middle Terra Linda High Central Coast High, Seaside High / Seaside Middle Beechwood Fullerton Union High Corona del Mar High / Horace Ensign Intermediate Desert Mirage High / Cahuilla Desert Academy Junior High Temescal Canyon High / Terra Cotta Middle Canyon Springs High / Palm Middle Hans Christensen Middle Paloma Valley High Martin Luther King, Jr. High / Matthew Gage Middle Rancho Verde High / March Middle Florin High / Katherine L. Albiani Middle, Daylor (William) High (Continuation) Inderkum High / Heron San Juan Mesa Verde High / Starr King K-8 Apple Valley Granite Hills High / Mariana Academy Bear Valley Big Bear High / Big Bear Middle Fontana Fontana High / Southridge Middle Morongo Yucca Valley High / La Contenta Middle Escondido Union High Valley High (Continuation), Escondido High / Middle School Selection TBD Grossmont Union High Chaparral High El Cajon Valley High Cajon Valley Union Montgomery Middle San Diego Sweetwater Union High Atascadero Lucia Mar San Luis Coastal Lincoln High / Creative, Performing, and Media Arts Sweetwater High / Montgomery Middle Atascadero High / Atascadero Junior High Lopez Continuation High Morro Bay High / Laguna Middle

4 San Mateo Santa Barbara Redwood City Sequoia Union High South San Francisco Santa Barbara Clifford Carlmont High South San Francisco High Dos Pueblos Senior High / La Colina Junior High East Side Union High Apollo High James Lick High Santa Clara Berryessa Union Piedmont Middle Fremont Union High Fremont High Mountain View-Los Altos Union High Los Altos High San Jose Broadway High Fall River Joint Fall River Junior-Senior High / Fall River Junior- Senior High Shasta Enterprise Parsons Junior High Shasta Union High Enterprise High Redding Sequoia Middle Vacaville Vacaville High / Willis Jepson Middle Solano Santa Rosa High Elsie Allen High / Lawrence Cook Middle, Nueva Vista High, Ridgway High (Continuation) Ceres Ceres High / Blaker-Kinser Junior High Denair Denair High / Denair Middle Stanislaus Modesto City High Peter Johansen High Sylvan Union Elizabeth Ustach Middle Tulare Porterville Granite Hills High / Sequoia Middle Conejo Valley Westlake High / Sequoia Middle Ventura Fillmore Fillmore Senior High / Fillmore Middle Simi Valley Royal High / Hillside Middle Yolo Esparto Esparto High / Esparto Middle

5 FAX to: Sixteenth Biennial Statewide California Healthy Kids Survey (CHKS) ( ) Contact Form Gregory Austin WestEd 4665 Lampson Ave Los Alamitos, CA Fax: Dear Dr. Austin: Yes, please proceed with survey administration. Our district will help coordinate the survey see contact information provided below. Yes, please contact the school(s) directly. The schools will decide about participation. ************************************************************************ DISTRICT NAME AND TITLE ADDRESS PHONE FAX By: (Signature) WestEd Fax: