Spring Special Education Teacher Questionnaire

APPENDIX E.2
ECLS-K
Spring 2007 Special Education Teacher Questionnaire B

Special Education Teacher
Questionnaire B
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
1650 Research Boulevard
Rockville, Maryland 20850

LABEL

Use a #2 pencil to complete this questionnaire.

According to the Paperwork Reduction Act of 1995, no persons are required to
respond to a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is 1850-0750.
Approval expires 01/31/2009. The time required to complete this information
collection is estimated to average 10 minutes per response, including the time to
review instruction, search existing data resources, gather the data needed, and
complete and review the information collected. If you have any comments
concerning the accuracy of the time estimate or suggestions for improving the survey
instrument, please write to: U.S. Department of Education, Washington, D.C.
20202-4700. If you have comments or concerns regarding the status of your
individual response to this survey, write directly to: National Center for Education
Statistics, 1990 K Street, N.W., Washington, D.C. 20006-5650.

The collection of information in this survey is authorized by Public Law 107279 Education Sciences Reform Act of 2002, Title I, Part C, Sec. 151(b) and
Sec. 153(a). Participation is voluntary. You may skip questions you do not
wish to answer; however, we hope that you will answer as many questions as
you can. Your responses are protected from disclosure by federal statute (PL
107-279, Title I, Part C, Sec. 183). All responses that relate to or describe
identifiable characteristics of individuals may be used only for statistical
purposes and may not be disclosed, or used, in identifiable form for any other
purpose, unless otherwise compelled by law. Data will be combined to produce
statistical reports. No individual data that links your name, address, telephone
number, or identification number with your responses will be included in the
statistical reports.

INTRODUCTION
Dear Special Education Teacher/Related Services Provider,
The Early Childhood Longitudinal Study Kindergarten Class of 1998-1999 (ECLS-K) is
collecting information from the special education teachers/service providers of students
who are in the study who have Individual Education Programs (IEPs). We are gathering
information from these students’ regular classroom teachers as well. Our purpose is to
investigate the relationship between the students’ achievement and various school,
classroom, and home factors. This questionnaire collects information on the special
education/related services received by the student identified on the cover of this
questionnaire.
Obviously, only you can provide this information. Therefore, although we realize you are
very busy, we urge you to complete this questionnaire as accurately as possible.
Approximate answers, especially where we are asking for numbers, are completely
acceptable. The information you provide is being collected for research purposes. All
responses that relate to or describe identifiable characteristics of individuals may be used
only for statistical purposes and may not be disclosed, or used, in identifiable form for any
other purpose, unless otherwise compelled by law. Data will be combined to produce
statistical reports. No individual data that links your name, address, telephone number, or
identification number with your responses will be included in the statistical reports.

THANK YOU VERY MUCH FOR YOUR HELP.

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MARKING DIRECTIONS
PLEASE READ CAREFULLY AND USE A SOFT LEAD (#2) PENCIL TO COMPLETE THIS
QUESTIONNAIRE.
CHECKING BOXES
It is important that you check the box next to your answers and print clearly.
Shown below is the correct way to mark your answers, along with examples of incorrect ways.

Correct Mark:

Incorrect Marks:
Light and thin, outside the box, thick or scrawled.

PRINTING ANSWERS IN BOXES:
Print entire answer in box. Answers should be printed clearly and should not touch or cross any of
the box lines. Do not cross zeroes or sevens. That is, do not write a zero with a line through it like
this – 0, and do not write a seven with a line through it like this – 7.
Write digits like this:

1234567890
Write words like this:

Harry Potter

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1.

Is this student currently receiving special education services or gifted/talented
services through an IEP? MARK ONE.
Special education services due to a disability (GO TO Q2)
Gifted/talented services (SKIP TO END. YOU DO NOT NEED TO COMPLETE SPECIAL EDUCATION
TEACHER QUESTIONNAIRE A.)

2.

In which grade is this student enrolled? MARK ONE.
Fifth grade
Sixth grade
Seventh grade
Eighth grade
Ninth grade
Tenth grade
This is an ungraded classroom

3.

When did this student first have an IEP? MARK ONE.
Before fifth grade
During sixth grade
During seventh grade
During eighth grade
Don’t know

4.

Have you reviewed this student’s records related to special education services
provided before this school year? MARK ONE.
Yes
No, I don’t have access to the records.
No, I have access to the records, but have not reviewed them.

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5.

What is this student’s primary disability as identified on the child’s IEP? MARK
ONE.
Learning disability
Serious emotional disturbance
Speech or language impairment
Mental retardation
Blind/Visual impairment
Deaf/Hard of hearing
Health impairment
Physical impairment
Multiple impairments
Deaf/blind
Developmental delay
Autism
Traumatic brain injury
No classification is given

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6.

For which of the following disabilities did this student receive (or is this student
receiving) special education or related services this school year?
MARK ONE ON EACH LINE.
a. Learning disability

Yes

b. Serious emotional disturbance
c. Speech or language impairment
d. Mental retardation
e. Blind/Visual impairment
f. Deaf/Hard of hearing
g. Health impairment
h. Orthopedic/Physical impairment
i. Multiple impairments
j. Deaf/blind
k. Developmental delay
l. Autism
m. Traumatic brain injury

7.

Is this student receiving any special education or related services because of a
diagnosed Attention Deficit/Hyperactivity Disorder (AD/HD)?
Yes
No

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No

The next set of items refers to this student’s special education experience during the
current school year.
8.

Which of the following best describes the IEP goals for this student during this
school year? MARK ALL OF THE AREAS IN WHICH THIS STUDENT HAD IEP
GOALS.

Academics

Social
Reading

Social skills

Mathematics
Language Arts
Science

Life Skills
Adaptive behavior or self-help skills
Transition and postsecondary goals

Speech And Language
Auditory processing

Physical/Mobility

Listening comprehension

Fine motor skills

Oral expression

Gross motor skills

Voice/speech articulation

Orientation and mobility

Language pragmatics

Other (PLEASE SPECIFY)

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9.

Which of the following related services were provided through the school to this
student during this school year?
MARK ONE ON EACH LINE.
a. Audiology

Yes

No

b. Counseling services
c. Occupational therapy
d. Physical therapy
e. Psychological services
f. Health services
g. Social work services
h. Special transportation
i. Speech or language therapy
j. Orientation services
k. Mobility services
l. Rehabilitation services
Other (PLEASE SPECIFY)

10.

Approximately how many hours per week of direct special education and related
services (that is, service provided directly to the student, from a teacher or another
adult) was this student receiving this school year? WRITE NUMBER IN BOX.

Hours per week

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11.

Did this student receive any of the following?
MARK ONE ON EACH LINE.
a. Adaptive physical education

Yes

No

b. Classroom aides
c. Instruction in Braille
d. Interpreter for the deaf or hard of hearing (oral or sign)
e. Instruction in American Sign Language
f. Instruction in Manual English
g. Instruction in Cued Speech
h. Instruction on the use of Braille
i. Instruction on the use of American Sign Language
j. Instruction on the use of Manual English
k. Instruction on the use of Cued Speech

12.

Was this student’s primary placement a general education classroom? MARK ONE.
Yes
No

13.

Approximately what percentage of the total weekly hours in school did this student
receive special education and related services outside of a general education
classroom but within the school setting? MARK ONE.
0 percent
1-10 percent
11-25 percent
26-50 percent
51-75 percent
76-99 percent
100 percent

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14.

What teaching practices and methods are used with this student? MARK ONE ON
EACH LINE.
MARK ONE ON EACH LINE.
a. One-on-one instruction
b. Small-group instruction
c. Large-group instruction
d. Cooperative learning
e. Peer tutoring
f. Computer-based instruction
g. Direct instruction
h. Cognitive strategies
i. Self-management
j. Behavior management
k. Did not deliver instruction
l. Instruction received through a sign interpreter
m. Don’t know

10

Yes

No

15.

Which of the following best describes the curriculum materials used with this
student?
MARK ONE BOX IN THE GENERAL EDUCATION
CLASSROOM COLUMN AND ONE BOX IN THE
SPECIAL EDUCATION CLASSROOM COLUMN.
General education curriculum materials were used
without modification

In the general
In the special
education
education
classroom
classroom/program

Some modifications in general education curriculum
materials were made
Substantial modifications in general education
curriculum materials were made
Specially designed commercial materials were used
Teacher-designed materials were used
Student not in this setting
Don’t know

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16.

To what extent was this student expected to achieve the same general education
goals as other students at his/her grade level? MARK ONE.
Student was expected to attain grade level achievement for all of the academic
content standards
Student was expected to attain grade level achievement for some of the
academic content standards
Student was expected to attain grade level achievement for only a few of the
academic content standards
Student was not expected to attain grade level achievement for any of the
academic content standards
There are no academic content standards at this grade level
Don’t know

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17.

Which of the following assistive technologies and devices did this student use this
school year? MARK ALL OF THE ASSISTIVE TECHNOLOGIES THIS STUDENT
USED.
Student did not use any assistive technologies (GO TO Q18)

Mobility aids

Learning aids (non-computer)

Vans, vehicles

Tape recorders

Wheelchairs

Calculators

White canes

Electronic spelling devices

Communication aids
Electronic with voice
output (e.g., Touch Talker)
Nonelectronic (e.g.,
manual printing board)

Computer hardware designed or adapted for
students with disabilities (e.g., alternate
keyboards, switch interface)
Used solely by individual student
Shared with other students

Hearing assistance
Hearing aids
FM loops
TTYs/TDDs
Cochlear implants
Real time captioning

Computer software designed for students with
disabilities
Reading
Writing
Mathematics
Other (PLEASE SPECIFY)

Visual aids
Braille texts
Electronic Braille devices
Digital texts
Magnifying devices
Close captioned television
CCTV)

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18.

Does this student have a computer, laptop, or word processing device assigned to
him/her for use full time? MARK ONE.
Yes
No

19.

On average, how often did you meet with general education teacher(s) to discuss
this student’s program and progress during this school year? MARK ONE.
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year (SKIP TO Q21)
Not applicable to my work with this student (SKIP TO Q21)

20.

On average, how long were the meetings with the general education teacher(s) to
discuss this student’s program? MARK ONE.
1 to 15 minutes
16 to 30 minutes
31 to 45 minutes
46 to 60 minutes
More than 60 minutes

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21.

Approximately how often have you communicated with this student’s parents
during this school year about this student’s program or progress (by phone, in
person, or in writing)? MARK ONE.
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year

22.

During the past year, did this student receive any of the following formal individual
evaluations for purposes of developing IEP goals?
MARK ONE ON EACH LINE.
a. Psychological

Yes

No

b. Speech/language
c. Vision
d. Hearing
e. Learning style
f. Motor skills
g. Academics
Other (PLEASE SPECIFY)

23.

What percentage of this student’s current IEP goals have been met or nearly met at
this point in the school year? MARK ONE.
76 to 100 percent
51 to 75 percent
26 to 50 percent
1 to 25 percent
Zero percent

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24.

Which of the following best expresses the likelihood that this student will continue
to receive some level of special education services (through an IEP) in the next
school year? MARK ONE.
Definitely will continue in special education
Very likely to continue in special education
Rather likely to continue in special education
Rather unlikely to continue in special education
Highly unlikely to continue in special education
Will not continue in special education (will be dismissed from services)

25.

To what extent did this student participate in any grade-level assessment
administered as part of the school’s testing program during the current school year?
MARK ONE.
Student did not participate in the school’s testing or assessment program
Student participated in alternate assessments and no regular assessments
Student participated in some alternate assessments and some regular
assessments
Student participated fully in the school’s testing or assessment program
Don’t know

26.

Date questionnaire completed:

MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION.

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