My Health My School Survey

School/Academy/College Details

Country

Local authority

Name of school/academy/college

Address of School/Academy/College

Address line 1

Address line 2

Town

Postcode

Telephone

Unique Reference Number (URN) ()

Head Teacher Information

Head teacher name

Head teacher email address

Billing Information Same as main address

Billing name

Billing address line 1

Billing address line 2

Billing town

Billing postcode

Billing contact number

Purchase order number

Survey Manager Information

Forename

Surname

Telephone number

Role

Email address

Please input a maximum of two additional staff contact email addresses below who will also receive updates from us:

Additional email 1

Additional email 2

*Please note that these additional email addresses are for communication purposes only.

Senior Leadership Team (SLT) Agreement

I have sought agreement and support from SLT to complete the My Health, My School Survey I agree

Data Sharing Agreement

We agree for our individual school/academy/college data to be shared with Leeds City Council and the School Nursing Service. We also agree for our pupil’s survey data to be shared with third parties including research and evaluation partners (currently but not confined to University of Leeds and Leeds Beckett University). We will comply fully with the Data Protection Act and future legislation and any requests exercising individual’s rights will be considered, processed and responded to within the relevant statutory timescales. I agree

Result Access Agreement

The School/Academy/College Manager agrees to access the results within 24 hours to check responses for any child protection/safeguarding issues or to identify any risky behaviours that may cause harm. Any issues will be dealt with as per the schools child protection policy. I agree

Survey Information

Please select the year groups that you plan to complete the survey with and when*:

*Please note you will be sent different pupil/student log on details for each year group that you have selected to complete the survey once you have successfully registered:

Year 3 - PE in School only

Year 4 - PE in School only

Year 5

Year 6

Year 7

Year 9

Year 11

Year 12 - Post 16

Year 13 - Post 16

Additional Information

Would you be interested in support/training on:

How to access and/or deliver the survey

How to analyse the results

What is the main reason that you are completing this survey

Where did you find out about the survey

Please note only one staff username and account is available per school/academy/college. Staff username and pupil/student usernames will be sent to you by email upon successful registration and account activation. From this point you will then be able to choose the corresponding passwords by clicking the link on the verification email which should be with you within 10 working days from registration.