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pdfPre-Elementary Education Longitudinal StudyKINDERGARTEN
Early Childhood Teacher
Questionnaire
school
ELEMENTARY
W4
Pre
school
W4
S
PE E
L
Funded by the U.S. Department of Education
Institute of Education Sciences
National Center for Special Education Research
Pre-Elementary Education Longitudinal Study
Early Childhood Teacher
Questionnaire
Who should complete this questionnaire?
Your school district is participating in an important U.S. Department of Education study called
the Pre-Elementary Education Longitudinal Study (PEELS). The child named on the label is one
of more than 3,000 children nationwide who are taking part in PEELS. This questionnaire is the
only source of information about the educational programs and services for this child. Because
of this, your participation is vitally important.
Please complete this questionnaire and return it in the postage-paid envelope within 3 weeks.
Answer all questions to the best of your knowledge and use your best guess when answering
questions for which you are not quite sure of the answer. However, try as best you can to avoid
responses that represent complete guesses. If necessary, please consult with colleagues in
answering questions. Be assured that your answers will be confidential, and no information will
be reported that identifies you, this child, or this school. We have enclosed $10 as a token of
our appreciation.
If you have any questions about the study or the questionnaire, please feel free to call the PEELS
toll-free hot line at 1-888-534-8348, send an email to [email protected], or visit the PEELS web
site at www.peels.org.
Thank you in advance for your contribution to this very important study.
Sincerely,
Elaine Carlson
Project Director, PEELS
Questions?
Dear Early Childhood Professional:
Call the PEELS
toll-free hot line:
1-888-534-8348
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.
The valid OMB control number for this information collection is 1850-0809. The time required to complete this information collection is estimated to average 20 minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any
comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington,
D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Special
Education Research, Institute of Education Sciences, U.S. Department of Education, 555 New Jersey Ave., NW, Washington, D.C. 20208.
OMB Control # 1850-0809, Expiration date: 1/31/08
This questionnaire should be completed by the teacher or service provider who knows the child
whose name appears on the label above and can describe the early childhood program or special
education and related services for this child.
●
Can you tell us about the child whose name appears on the label?
1
2
●
No
Can you tell us about this child’s early childhood program?
1
2
●
Yes
Yes
No
Can you tell us about special services this child receives (e.g., speech therapy)?
1
2
Yes
No
If you answered NO to ALL three questions:
DO NOT COMPLETE THIS QUESTIONNAIRE. PLEASE PASS THE QUESTIONNAIRE ON TO THE PERSON
WHO IS BEST ABLE TO DESCRIBE THIS CHILD’S PROGRAM OR SPECIAL SERVICES.
If you answered YES to ANY of the three questions:
PLEASE PROCEED TO SECTION A ➜
note:
Any question referring to IEPs (Individualized Education Program for a child with a disability) is meant to
refer also to IFSPs (Individualized Family Service Plan for a child with a disability) in states using the latter
plan for children ages 3 through 5.
1
Section A:
A4. How many of the following people are usually in the room during the majority
of this child’s time in the classroom? PLEASE ENTER ONE NUMBER ON EACH LINE.
CHILD’S EXPERIENCE IN YOUR PROGRAM
COUNT EACH PERSON ONLY ONCE. ENTER “0” IF NONE.
REMINDER: “This child” refers to the child whose name appears on the label.
Number
of people
A1. Does this child attend an early childhood class with other children?
PLEASE
1
2
8
✓CHECK ONE.
Yes
➜
a. Early childhood or preschool teachers (not special education)
b. Special education teachers
Continue with Question A2
No
Don’t know
}
c. One-to-one assistants or aides assigned to this child
Go to Question B1
d. One-to-one assistants or aides assigned to any other
child in this child’s class
A2. What are the total numbers of preschoolers with IEPs and without IEPs enrolled in
this child’s class? PLEASE ENTER ONE NUMBER ON EACH LINE. IF THE CHILD IS
ENROLLED IN MORE THAN ONE CLASS, PLEASE RESPOND FOR THE CLASS IN WHICH
THE CHILD SPENDS THE MOST TIME.
f. Special education aides
g. Other specialists or therapists
Number of preschoolers with IEPs in child’s class
Number of preschoolers without IEPs in child’s class
e. Early childhood or preschool aides
“0,” go to
} IfQuestion
A4
h. Nurse or other medical personnel
i. Adult volunteers
A3. Among the children without IEPs in this child’s main classroom, how many are currently under formal review for special education services? PLEASE ENTER ONE NUMBER.
j. Other
Number of children under formal review
A5. Approximately how many TOTAL hours per week does this child spend in
your classroom or instructional setting?
TOTAL number of hours per week
A6. Approximately how much school time per week does this child currently spend in
the following settings? PLEASE INDICATE EITHER MINUTES OR HOURS PER WEEK
Number of
minutes/week
a. Regular education classroom
b. Special education setting
c. Therapy setting (office, small room, etc.)
d. Non-special education setting outside of
the classroom specifically for remedial or
special assistance
e. Home instruction
2
3
OR
Number of
hours/week
A7. What percentage of the day does this child spend in the following activities?
THE PERCENTAGES YOU PROVIDE SHOULD TOTAL 100%. PLEASE EXCLUDE TIME FOR
LUNCH AND RECESS IN CALCULATING PERCENTAGES.
Activity code
o. Toys: tools (e.g., hammer, stethoscope, cash register, cell phone)
15
p. Dolls and stuffed animals
16
q. Commercial toys (e.g., action figures, Barbie)
17
a. Instructional or therapy services outside the classroom
%
b. Adult-directed whole class activities
%
c. Adult-directed small group activities
%
r. Commercial educational toys (e.g., light-bright, puzzles,
sorting cups, bead stringing)
18
d. Adult-directed individual activities
%
s. Musical instruments
19
e. Child-selected activities
%
t. Tape or CD player with tapes and CDs
20
f. Other (Specify: ____________________________________)
%
u. Nap/rest time
21
v. Breakfast
22
w. Lunch/snack
23
x. Hot lunch
24
100%
A8. What kinds of activities and materials are routinely available to this child in your
classroom or program? PLEASE
CHECK ALL THAT APPLY.
✓
Activity code
a. Arts and crafts projects and materials, clay, or playdough
01
y. Commercial television/videotapes
25
b. Blocks, Legos, K’nex, other building toys
02
z. Educational television/videotapes
26
c. Sand and water play
03
aa. Flashcards
27
d. Playhouse, toy kitchen, dishes, plastic food
04
bb.Counting and number materials
28
e. Dress-up, costumes, puppets, theater props
05
cc. Alphabet and language materials
29
f. Children’s books and magazines
06
g. Sensory table (e.g., cornmeal, beans, and other tactile materials)
07
h. Paper, coloring books, crayons, pencils, pens
08
i. Playground equipment (e.g., climbing structure, swings, trikes or
bikes, digging tools)
09
j. Balls (of various sizes), Nerf-style toys, sports equipment
10
k. Computer and software
11
l. Video games
12
m. Board games
13
n. Toys: vehicles and work machines (e.g., cars, trains, trucks,
backhoe loaders)
14
4
continued >
A9. Of the items specified earlier, what three activities or materials does this child
engage in most often in your classroom or program? Do not include meals or naps.
USE THE ACTIVITY CODE THAT CORRESPONDS WITH THE ACTIVITY FROM A8.
Activity code from list
a. Most frequent activity
b. Second most frequent activity
c. Third most frequent activity
5
A10. During play time, how does this child compare with other children in the class in
CHECK ONE.
terms of physical activity? PLEASE
1
2
3
4
5
✓
A lot less active than most
2
3
4
5
1
2
3
4
8
A little more active than most
A lot more active than most
02
03
04
05
06
07
08
98
04
05
✓
Far fewer than most
06
07
08
Fewer than most
✓CHECK ALL THAT APPLY.
a. I give parents regular written progress reports.
b. I call them on the phone, send email, or send notes home.
c. I speak with parents before or after school when this child is
being dropped off or picked up.
d. We have regularly scheduled parent-teacher meetings.
e. We share a daily or weekly journal for this child.
f. There is a regular system for communicating with parents
(e.g., newsletter or phone tree).
g. Parents have access to the school’s web site with information
specifically for parents.
h. Other (Specify:______________________________________)
As many as most
More than most
A15. During this school year, approximately how often have you and this child’s parents
or guardians communicated (by phone, in person, or in writing) about his/her
progress, excluding routine progress reports or report cards? PLEASE
CHECK ONE.
Far more than most
✓CHECK ONE.
1
2
3
4
Very appropriate
0
Somewhat appropriate
Not very appropriate
✓
At least once a week
A few times a month
About once a month
Less than once a month
Never
Not at all appropriate
Don’t know
A16. How involved is this child’s parent or guardian in his/her school experiences
(e.g., monitoring homework or child’s progress in school)? PLEASE
CHECK ONE.
A13. Which of the following methods do you commonly use to assess how well this child
CHECK ALL THAT APPLY.
is doing in your class? PLEASE
01
01
03
About the same as most
A12. Overall, how appropriate do you think this child’s placement is in your classroom?
PLEASE
PLEASE
02
A little less active than most
A11. Compared to his/her classmates, how many friends does this child have in
your classroom? PLEASE
CHECK ONE.
1
A14. How do you communicate with the parents or guardians of this child?
✓
a. Impressions based on experience with child and written notes
about specific events
b. Direct observation with general anecdotal notes
1
2
3
4
8
✓
Not at all involved
Not very involved
Fairly involved
Very involved
Don’t know
c. Direct observation with checklist of skills
d. Direct assessment or testing
e. Video/audio recording
f. Portfolios of child’s work samples
g. Other (Specify: __________________________________________________)
h. Child progress is not formally monitored
i. Not sure
6
7
A17. The following are statements commonly associated with various educational
philosophies. Which three statements best describe your approach to working
with this child?
•
•
•
•
Write the number 1 next to the most important approach.
Write the number 2 next to the second most important approach.
Write the number 3 next to the third most important approach.
Leave 5 squares blank.
A19. Which of the following strategies were used before the child started in your program
in order to support this child’s transition into your school, program, or classroom?
PLEASE
✓CHECK ONE IN EACH ROW.
No
Yes
Don’t
know
a. You received the child’s previous records.
1
2
8
b. The sending program provided information about
this child.
1
2
8
c. Someone from your program provided parents with
written information about your program.
1
2
8
d. Someone from your program called the child’s parents.
1
2
8
b. We believe that teaching children the knowledge and skills they need
to succeed in school is critical. Structured learning experiences in
academic content areas are a central part of the program.
e. The parents or guardians of this child were encouraged
to meet the staff before the child entered the school
or program.
1
2
8
c. We emphasize principles of behavior modification and precision
teaching. Target behaviors are specified and skills are sequenced
and taught using strategies such as modeling, prompting, fading,
and reinforcing of successive approximation.
f. This child and family visited your classroom or school.
1
2
8
g. Someone from your program visited the child’s home.
1
2
8
h. Someone from your program visited the child’s
previous setting.
1
2
8
i. Someone from your program met with staff of the
sending program specifically about this child.
1
2
8
j. Someone from your program participated in IEP
development for this child.
1
2
8
k. Your staff developed preparatory strategies specifically
for this child (e.g., behavior plans, school scheduling
modifications).
1
2
8
l. Other (Specify: __________________________________)
1
2
8
Rank 1, 2, 3
Use each number
only once.
a. We assume that children learn naturally when they are developmentally ready. The interest of the child and age appropriateness
of skills are emphasized in determining program content.
d. We combine developmental theory with a behavioral model to identify
target behaviors and use behavioral strategies when appropriate.
e. We emphasize the way individual children and parents/guardians
influence each other’s behavior. Interventions target primarily the
parent/guardian, who is taught to interpret the child’s behavior
and respond appropriately.
f. We focus on a child’s medical diagnosis and concentrate on
therapeutic interventions.
g. We recognize that the child is a member of a family system and base
services on the perceived strengths and priorities of family members.
h. Other (Specify: ______________________________________________
_____________________________________________________________)
A18. Where was this child enrolled or receiving services 1 year ago? PLEASE
1
2
3
4
Exact same setting as now
Same school setting but different classroom
Not sure, don’t know where child was
Some other program or at home
8
}
}
✓CHECK ONE.
Go to Question A23
Continue with Question A19
9
A20. How adequate were the planning and support that were provided to this
child and his/her family during the transition into your class or program?
PLEASE
1
2
3
4
8
CHECK ONE.
✓
2
3
4
Preschool
1
2
3
4
2
3
4
Other
1
2
(Specify: ________________)
Transition planning and support were not
needed for this child or family
b. Different school next year
1
2
(Specify: ________________)
Don’t know
c. Don’t know
1
2
(Specify: ________________)
Not very adequate
✓
Not at all
Somewhat
Please write the name and address of the school (if known) if you expect
this child will attend a different school next year.
Name of new school: _________________________________________________
School address: _______________________________________________________
Extensively
______________________________________________________________________
Not applicable — transition planning not done
CHECK ONE.
✓
A25. Does this child currently have either an IEP or IFSP for children with disabilities?
PLEASE
1
Very easy
Somewhat easy
2
Somewhat difficult
8
Very difficult
A23. Do you anticipate that this child will be involved in any of the following
CHECK ONE.
transitions at the end of this school year? PLEASE
1
Kindergarten
a. Same school as this year
Somewhat adequate
A22. How easy was it for this child to make the transition into your class or program?
PLEASE
✓
Extremely adequate
A21. To what extent were you involved in planning this child’s transition into your class
CHECK ONE.
or program? PLEASE
1
A24. To the best of your knowledge, what school or program and grade level
CHECK ONE.
do you anticipate this child will be in next year? PLEASE
✓
No transitions anticipated this coming year
This preschool to no preschool
}
This preschool class to another preschool class
Preschool to kindergarten
Go to Question A25
}
Continue with Question A24
Yes, this child has an IEP or IFSP
for special education services.
➜
Continue with Question A26
No, this child does not have an IEP or IFSP.
Don’t know.
➜
➜
Go to Question B1
Go to Question A28
A26. How are this child’s IEP goals and objectives primarily addressed in the regular
CHECK THE ONE THAT BEST DESCRIBES HOW
education classroom? PLEASE
✓
GOALS AND OBJECTIVES ARE PRIMARILY ADDRESSED.
00
01
02
03
04
05
06
10
✓CHECK ONE.
Not applicable—the child is not in a regular education classroom.
Not applicable—this child’s IEP goals are not addressed in the regular education
classroom; they are addressed elsewhere.
The special education teacher or aide works individually with
the child on special tasks.
The early childhood education teacher or aide works individually
with the child on special tasks.
Related services personnel work individually with the child on special tasks.
Related services personnel work with the child in group activities.
The goals and objectives are embedded in common classroom activities.
11
A27. Other than at IEP meetings, how do you and other staff come together to
discuss and plan progress and programs for the children with IEPs in your class?
PLEASE
01
02
03
04
05
06
07
08
✓CHECK ALL THAT APPLY.
01
02
03
04
05
06
08
2
3
4
5
✓CHECK ONE IN EACH ROW.
Yes
b. We hold regular weekly meetings.
c. We hold regular biweekly meetings.
d. We hold regular monthly meetings.
e. We provide release time or change program hours so that both special
education and early childhood teachers can attend meetings regularly.
f. We hold common inservice meetings and training sessions for regular
education and special education staff.
g. Other (Specify: __________________________________________________)
h. Not applicable, no other staff serve this child.
✓
Not applicable—we do not currently have children without disabilities enrolled
in this class or program.
No
a. We present a specific disability awareness program
during group times.
1
2
b. We assign children without disabilities to be “helpers”
or “buddies” to this child.
1
2
c. We prompt and reinforce this child for initiating and
maintaining interactions with children without disabilities.
1
2
d. We prompt and reinforce the children without disabilities
for initiating and maintaining interactions with this child.
1
2
e. We structure play and task situations so that they require
interaction between this child and children without disabilities.
1
2
f. Other (Specify: _____________________________________)
1
2
Children with and without disabilities are not in contact with one another.
Classes for children with and without disabilities share common space only
(e.g., playground/lunch room).
Children without disabilities spend part of the day in the classroom for
children with disabilities.
Children with disabilities spend part of the day in a classroom for children
without disabilities.
Children with disabilities spend the entire day in a classroom for children
primarily without disabilities.
Other (Specify: ___________________________________________________)
A31. Overall, how adequate are the supports that are provided to this child because of
CHECK ONE.
his/her disabilities? PLEASE
1
2
3
4
8
0
✓
Very adequate
Somewhat adequate
Not very adequate
Not at all adequate
Don’t know
No support is needed
Not sure; don’t know.
A29. Does your program support social interaction between this child and
children without disabilities?
1
PLEASE
a. Staff communicate on an as-needed basis.
A28. How would you characterize the way children with and without disabilities are
primarily brought together in this child’s class or program? PLEASE
CHECK ONE.
00
A30. Does your program use any of the following methods to support social interaction
between this child and children without disabilities?
Yes.
➜
Continue with Question A30
Not applicable—we do not currently have children
without disabilities enrolled in this class or program.
Not applicable—this child does not have contact with
children without disabilities during our program.
Not applicable—no support is needed.
No.
12
}
A32. Overall, how adequate are the supports and resources that are provided to you for
CHECK ONE.
this child because of his/her disabilities? PLEASE
1
2
3
4
Go to Question A31
8
0
✓
Very adequate
Somewhat adequate
Not very adequate
Not at all adequate
Don’t know
No support is needed
13
Section B:
SOCIAL SKILLS RATING SYSTEM
CHILD BEHAVIOR
This questionnaire is designed to measure how often a student exhibits certain social skills.
Ratings of problem behaviors are also requested.
REMINDER: “This child” refers to the child whose name appears on the label.
B1. How long have you taught or worked with this child? PLEASE
1
2
3
✓CHECK ONE.
Less than 2 months
2 to 6 months
More than 6 months
Read each of the items on B4 and B5 and think about this student’s behavior during the past
month or two. Decide how often the student does the behavior described.
•
•
•
If the student never does this behavior, check the 0.
If the student sometimes does this behavior, check the 1.
If the student very often does this behavior, check the 2.
Here are two examples:
How Often?
B2. During October of this school year, how many part or full days was this child present?
PLEASE ENTER THE NUMBER OF DAYS.
Number of days present
B3. During October of this school year, how many days did you expect this child to be
present? PLEASE ENTER THE NUMBER OF DAYS.
Number of days expected
Never
Sometimes
Shows empathy for peers.
0
1
Asks questions of you when
unsure of what to do in
schoolwork.
0
1
Very
Often
2
✓
✓
2
This student very often shows empathy for classmates. Also,
this student sometimes asks questions when unsure of schoolwork.
Please do not skip any items. In some cases you may not
have observed the student perform a particular behavior. Make an
estimate of the degree to which you think the student would
probably perform that behavior.
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American Guidance Service, Inc., 4201 Woodland
Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to Westat for research purposes only. All rights reserved. www.agsnet.com
14
15
B4. PLEASE
✓CHECK ONE IN EACH ROW TO INDICATE HOW OFTEN THE STUDENT DOES
THE BEHAVIOR DESCRIBED.
How Often?
How Often?
Never
1. Controls temper in conflict
situations with peers.
0
Sometimes
1
Never
Very
Often
0
1
2
2
16. Produces correct schoolwork.
0
1
2
17. Appropriately tells you when
he or she thinks you have
treated him or her unfairly.
0
1
2
18. Accepts peers’ ideas for
group activities.
0
1
2
19. Gives compliments to peers.
0
1
2
20. Follows your directions.
0
1
2
21. Puts work materials or
school property away.
0
1
2
22. Cooperates with peers
without prompting.
0
1
2
23. Volunteers to help peers
with classroom tasks.
0
1
2
24. Joins ongoing activity or group
without being told to do so.
0
1
2
25. Responds appropriately when
pushed or hit by other children.
0
1
2
26. Ignores peer distractions
when doing class work.
0
1
2
27. Keeps desk clean and neat
without being reminded.
0
1
2
2
28. Attends to your instructions.
0
1
2
2
29. Easily makes transition
from one classroom activity
to another.
0
1
2
30. Gets along with people
who are different.
0
1
2
0
1
2
3. Appropriately questions
rules that may be unfair.
0
1
2
4. Compromises in conflict
situations by changing own
ideas to reach agreement.
0
1
2
5. Responds appropriately to
peer pressure.
0
1
2
6. Says nice things about himself
or herself when appropriate.
0
1
2
7. Invites others to join in
activities.
0
1
2
8. Uses free time in an
acceptable way.
0
1
2
9. Finishes class assignments
within time limits.
0
1
2
11. Responds appropriately to
teasing by peers.
12. Controls temper in conflict
situations with adults.
13. Receives criticism well.
14. Initiates conversations
with peers.
0
0
0
0
0
1
1
1
1
1
Very
Often
15. Uses time appropriately
while waiting for help.
2. Introduces herself or himself to
new people without being told.
10. Makes friends easily.
Sometimes
2
2
2
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
continued >
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
16
17
B5. Problem Behaviors
PLEASE
CHECK ONE IN EACH ROW TO INDICATE HOW OFTEN
THE STUDENT DOES THE BEHAVIOR DESCRIBED.
✓
How Often?
Never
Sometimes
Very
Often
Section C:
ABOUT YOU
C1. About how many years have you been working with children ages 3 through 5 and
children with disabilities? PLEASE GIVE YOUR BEST ESTIMATE.
1. Fights with others.
0
1
2
a. Number of years working with children ages 3 through 5
2. Has low self-esteem.
0
1
2
b. Number of years working with children with disabilities
3. Threatens or bullies others.
0
1
2
4. Appears lonely.
0
1
2
5. Is easily distracted.
0
1
2
6. Interrupts conversations
of others.
0
1
2
7. Disturbs ongoing activities.
0
1
2
8. Shows anxiety about being
with a group of children.
0
1
2
9. Is easily embarrassed.
0
1
2
10. Doesn’t listen to what
others say.
0
1
2
11. Argues with others.
0
1
2
12. Talks back to adults
when corrected.
0
1
2
13. Gets angry easily.
0
1
2
14. Has temper tantrums.
0
1
2
15. Likes to be alone.
0
1
2
16. Acts sad or depressed.
0
1
2
17. Acts impulsively.
0
1
2
18. Fidgets or moves
excessively.
0
1
2
c. Number of years working with children ages 3 through 5
with disabilities
C2. About how many years have you been in your current job?
PLEASE GIVE YOUR BEST ESTIMATE.
Number of years in current job
C3. Which of the following employee benefits are provided as part of your job?
PLEASE
1
2
3
4
5
6
✓CHECK ALL THAT APPLY.
a. None
b. Paid vacation and holidays
c. Paid sick leave
d. Health insurance
e. Contribution to a retirement plan
f. Other
C4. How satisfied are you with working with young children? Would you say you are...
PLEASE
1
2
3
4
5
✓CHECK ONE.
Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
Please continue with Section C: “About You” on the next page. ➜
18
19
Below are listed a variety of disciplines in which early childhood professionals might hold
degrees, certificates, or licenses. Please use the codes next to each discipline to answer
Questions C8 and C9.
C5. How likely are you to continue working in your current job through
CHECK ONE.
the next school year? PLEASE
1
2
3
4
✓
Very likely
Somewhat likely
Code
Somewhat unlikely
1
2
3
4
5
8
Discipline
Audiology
10
Occupational therapy
02
Child development
11
Orientation/mobility
03
Elementary/secondary education
12
Physical therapy
04
Early childhood education
13
Psychology
05
Early childhood special education
14
Public health
06
Family therapy/counseling
15
Social work
Children with disabilities should be taught in special classrooms but
should have some time each day to socialize with children who do not
have disabilities.
07
Medicine
16
Special education
08
Nursing
17
Speech/language pathology
The child’s placement should depend on the severity or type of disability.
09
Nutrition
18
Other (Specify: __________________)
✓CHECK ONE.
Children with disabilities should be taught full time in separate classrooms
that are specially designed and programmed for children with disabilities.
All children with disabilities should be taught full time in regular early
childhood classrooms.
C8. Please check each kind of degree you have received. Then, using the discipline
codes above, please write in the discipline(s) or subject area(s) of your degree(s).
Other (Specify: ____________________________________________________)
No opinion, or not sure.
C7. Think about all of your professional education, training, and experience taken
together. Please indicate the extent to which you are adequately prepared to work
with the following:
PLEASE
Code
01
Very unlikely
C6. Which of the following best represents your views on the education of children ages
3 through 5 with disabilities (regardless of the type of class or school you work in)?
PLEASE
Discipline
✓CHECK ONE IN EACH ROW. PLEASE DO NOT MARK BETWEEN THE CIRCLES.
Extremely
well
prepared
Not at all
prepared
a. Preparation to work with
children ages 3 through 5
with disabilities
0
1
2
3
4
5
6
b. Preparation to work with
families of children ages 3
through 5 with disabilities
0
1
2
3
4
5
6
20
PLEASE
✓CHECK AND WRITE IN ALL THAT APPLY.
1
High school diploma or GED
2
Associate degree
Discipline code(s)
3
Bachelor’s degree
Discipline code(s)
4
Master’s degree
Discipline code(s)
5
Doctoral degree
Discipline code(s)
21
C9. Using the discipline codes listed earlier, please write in the space provided here any
discipline(s) in which you hold a professional license, credential, or certificate.
C15. What is your race? PLEASE SELECT ONE OR MORE.
1
2
3
4
Professional license(s), credential(s), or certificate(s) held
5
C10. Did any of your degree or license programs involve training or preparation to work
specifically with children ages 3 through 5 with disabilities? PLEASE
CHECK ONE.
1
2
3
✓
2
No
3
No degree or license
4
C11. Did any of your degree or license programs involve training or preparation to work
specifically with families of children with disabilities? PLEASE
CHECK ONE.
1
2
3
✓
2
No
No degree or license
✓
2
2
e. White
5
6
✓CHECK ONE.
20 years old or younger
21 to 30 years old
31 to 40 years old
41 to 50 years old
51 to 60 years old
More than 60 years old
C17. We want to know what you think about special education for young children.
In the space provided, please print any suggestions or concerns you have regarding
the provision of special education services for young children. (Be assured that your
answers will be confidential.)
________________________________________________________________________________________
________________________________________________________________________________________
No
________________________________________________________________________________________
________________________________________________________________________________________
✓CHECK ONE.
________________________________________________________________________________________
Female
________________________________________________________________________________________
Male
C14. Are you of Hispanic or Latino origin? PLEASE
1
d. Native Hawaiian or Other Pacific Islander
Yes
C13. What is your gender? PLEASE
1
c. Black or African American
Yes
C12. Do you have an immediate family member with a disability (e.g., a spouse, child,
CHECK ONE.
parent, sibling)? PLEASE
1
b. Asian
C16. What is your age? PLEASE
1
Yes
a. American Indian or Alaska Native
Yes
✓CHECK ONE.
Please continue with Section D. ➜
No
22
23
Instructions for Section D of this Questionnaire:
1. Section D of the questionnaire is to be completed only for children with IEPs or 504
plans. Does this child have an IEP or 504 plan?
●
YES, this child DOES have an IEP or 504 plan. Please continue with next question.
●
NO, this child does NOT have an IEP or 504 plan. Please go to page 33 of this
questionnaire.
2. Section D is to be completed by the teacher or specialist most familiar with the child’s
special education and related services. Can you describe this child’s special services?
●
YES. Please continue with Section D on the next page.
●
NO. Please remove Section D and give it to the person who you feel could best answer
questions about this child’s special education or related services. Please provide this
person’s name and phone number below. When this person completes Section D,
please have him or her return it directly to Westat using the self-mailer.
Name:
Phone:
(
)
Thank you for completing
this questionnaire.
Date Completed: ____/____/____
mm dd yy
Please provide your name and contact information below,
so that we can reach you if we have questions.
Your Name:
School/Program Name:
Address:
Phone:
(
)
Email:
Please continue to the back cover.
24
33
Thank you for completing
this questionnaire.
Please return this questionnaire
in the postage-paid envelope to:
Pre-Elementary Education Longitudinal Study
Westat
1650 Research Blvd.
Rockville, MD 20850
WESTAT
21468.1206.80890309
thank you!
National Center for
Special Education Research
| File Type | application/pdf |
| File Title | design 1 |
| File Modified | 2006-12-12 |
| File Created | 2006-12-12 |