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Dear Parent,

Please help us. Our policy is to have a parentís permission before we invite a child who is younger than 14 years of age to complete our YouthSurveyTM surveys.

All survey questions are designed by a panel of educators and mental health professionals with the advice of parents. We do so to be sure that the questions are proper and respectful as well as interesting and informative.

If you will provide us with the email address of your child[ren] under 14 years of age (or your own e-mail address if they do not have one), we will contact them (or you) to participate in our surveys. For each completed survey, they receive a modest and appropriate gift. Their email addresses are kept in confidence.

Please complete the form below. It will only take a few minutes of your time. In exchange for your permission, we will send you copies of all Poll results in the future free of charge and with our appreciation.

You may withdraw your permission for your child to take our poll at any time and we will not invite your child to participate further.

Thank you.

Robert Gordon, JD, PhD
Clinical & Forensic psychologist

All fields marked * below are required.

Yes, you may invite my child or children to take USA Youth Survey Questions.

Your Details * Your Name:
E-mail address:
Your Child * Child's Name:
Child's Age:
Child's E-mail address (if applicable):
Your Child Child's Name:
Child's Age:
Child's E-mail address (if applicable):
Your Child Child's Name:
Child's Age:
Child's E-mail address (if applicable):





For more information please write to: welcome@gordonpoll.com

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