初中生心理调查问卷知情同意书Informed Consent for Mental Health Survey of Middle School Students

亲爱的家长:Dear Parents:您好!为了加强中学生心理健康关爱工作,了解我校中学生心理健康发展水平和特点, 提高心理健康教育工作的针对性和有效性,学校心理中心想邀请我们6-12年级的全体学生进行一份心理问卷调查,以便为我们的孩子提供更加专业、有效的支持与服务。现计划如下:The school mental health center would like to invite all the students from grade 6 to grade 12 to fill out a mental health survey. The survey will help us to get to know our secondary school students' mental health development level and characteristics, improve the pertinence and effectiveness of mental health education work and provide students with better professional, adequate support and service. The plan is as follows:一、问卷的选择:我们采用了长处和困难问卷(共25题),这是一份用于儿童青少年(11-17岁)行为、情绪、交往等方面比较全面且安全的评估工具。问卷为自评量表,学生可以根据自己近1个月的实际情况进行答卷。I. Selection of the survey:We used the Strengths and Difficulties Questionnaire (SDQ), a comprehensive and safe assessment tool with 25 questions for children and adolescents (11-17 years old) regarding behavior, emotions, and communication. The survey is self-rated, which students can answer according to their situation in the past month.二、问卷结果的使用及保密原则1、为了保护学生的个人隐私,问卷收集工作只需填写学生学号。2、问卷结果仅由心理中心专业老师保存,个体数据不会被共享。我们主要进行全体数据分析,以便为学术课堂、课外活动、及学生生活各种场景中做充分的支持体系。3、基于保密原则,如果您对自己孩子的问卷结果感兴趣,在孩子同意的情况下,欢迎您前来预约心理中心老师了解孩子的情况;如果您的孩子对问卷结果持保留意见,我们也希望尊重孩子的意见和建议,同时也欢迎您预约心理中心的老师们一起探讨。II. The use and confidentiality of survey results1. To protect students' privacy, only the student number is required to complete the survey.2. The professionals of the Mental Health Center will keep the survey results confidential and won't share individual data. We focus on overall data analysis to develop adequate support systems for academic classrooms, extracurricular activities, and various scenarios of student life.3. Considering confidentiality, if you are interested in the results of your child's survey, with the child's consent, you are welcome to make an appointment with the counselor of the Mental Health Center. If your child has reservations about the survey results, respect your child's opinions and suggestions. In that case, you are also welcome to make an appointment to discuss this with the counselors of the Mental Health Center.三、问卷流程及形式安排请您在9.25号(本周)前签署本同意书,当我们收到您的签名后会以问卷链接的方式发给每个学生。感谢您的合作!III. Steps:1. Please sign the parent informed consent form by September 25 (this week). 2. When we receive your consent, we will send a survey link to your child. 

Q1:您的姓名是 Your name

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Q2:您孩子的姓名是 The name of your child is

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Q3:您孩子的年级是 The grade of your child is

6年级 Grade 6
7年级 Grade 7
8年级 Grade 8

Q4:您孩子的班级是 Your child is in

白班 White 
紫班 Purple

Q5:我已阅读过《初中生心理测评知情同意书》:I have read the Informed Consent for Mental Health Survey of Middle School Students. :

我同意我的孩子参与此次心理测评I agree for my child to complete the survey
我不同意我的孩子参与此次心理测评I disagree for my child to participate in this survey
我希望获得更多信息后再做决定,我的担心是I want to get more information before I make a decision. My concern is

Q6:请您留下手机号,心理老师会通过电话的方式与您取得联系

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Q7:请签您的名字Please sign your name

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初中生心理调查问卷知情同意书Informed Consent for Mental Health Survey of Middle School Students
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