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Please read full page. Consent form at bottom of page. 





Welcome to the Kansas Personal Responsibility Education Program (K-PREP)*! Your student is currently enrolled in a Family and Consumer Science (FCS) course that is participating in this project. The goal of K-PREP is to promote life preparation skills (e.g., healthy relationships, parent-child communication, independent living skills, and more) using the Love Notes Evidence-Based Program (LN EBP) developed by The Dibble Institute. The LN EBP offers youth a conceptual framework aimed at cultivating healthy relationships with self and others by expanding the current curriculum to include: planning and pacing relationships, identifying safe relationships, building self-efficacy and resiliency, improving communication skills, and making informed decisions when it comes to sex and family formation. 


Social Innovation Lab is working in partnership with the Kansas Family, Career, and Community Leaders of America (KS-FCCLA) Foundation to promote positive youth development and reduce the rates of teen pregnancies in Kansas.


*The K-PREP project is a grant funded project sponsored by the Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Family and Youth Services Bureau.  Department of Health and Human Services; Administration for Children and Families; Administration on Children, Youth and Families; and, the Family and Youth Service Bureau, and serves students in classrooms all over the state of Kansas.

Kansas Personal Responsibility Project is funded through Grant Number: HHS-2021-ACF-ACYF-AK-1929


Your student’s FCS teacher has completed training on the Love Notes Evidence-Based Program (LN EBP) and has completed a human subjects protection training course, making her/him qualified and eligible to bring the LN EBP curriculum to their classroom.


K-PREP has a research component that involves pre- and post-surveys, before and after the curriculum. The purpose of the surveys is to assess any changes in attitude or behavior that students experience from participating in the LN EBP program.


As a parent/guardian, your consent is required to allow your student to participate in the surveys. You can access the surveys below to view its content. You do not need to complete these surveys at this time; they are for review only. 


Your student’s confidentiality is our top priority. We have systems in place to protect the identity of any project participant.

  • All surveys are collected electronically through Survey Monkey

  • Only the project evaluator has access to survey responses

  • We will never ask for your student’s full name on any survey

  • Survey responses are not shared with teachers or schools

  • Teachers are required to read a project script to students that provides the following information:

    • ​Students have the right to not participate in any survey

    • Students have the right to withdraw from the study without consequence

All surveys and project details have been approved by an Institutional Review Board (IRB) to further protect students’ and teachers’ anonymity.


Teachers, students, and parents are incentivized to participate in our data collection efforts.

Simply for completing and returning this form (regardless of your permissions for your student), as a parent or guardian, you will receive a $15 gas e-gift card sent within two weeks. 

The gas e-gift card will be emailed to the email address provided within two weeks of completion of the form. You will receive one gift card per student. 

Students will receive a $10 food gift card for completing a pre-survey, and will receive another $10 food gift card for completing a post-survey. Gift cards will be distributed to teachers at the end of the semester. 

Teachers receive all project related materials at no cost, including training and ongoing support from our staff and partners.



We do not anticipate that the K-PREP will involve any physical or non-physical risks, but there may be risks that we cannot predict. We have not experienced any adverse reactions among any participants taking surveys in similar projects.

We cannot guarantee that your student will personally experience benefits from participating in the K-PREP. Others may benefit in the future from the information we learn from the K-PREP evaluation.


If you have any questions, concerns, or issues with K-PREP, please feel free to contact the following:


Michelle Jackson, Project Manager/Evaluator

Midwest Evaluation and Research

Phone: (833) 643-9377 Ext. 716



Sarah Simister, Director of Positive Youth Development Programs

Social Innovation Laboratory

Phone: (620) 487-2464


If you have any questions about your child’s rights as a participant in the K-PREP, please contact Solutions IRB (the body that oversees our protection of student participants) at (855) 226-4472 or


(Please Check One)

Thank you for completing the consent form!

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