Teacher Background Questionnaire

Attachment 6

Thinking Reader
Teacher Background Questionnaire

Instructions

Please write legibly and firmly, answering each question to the best of your ability.

_______________________________________________________________________________________

Education and Professional Certification

1. What academic degree(s) do you hold? (MARK ALL THAT APPLY).

 No degree  Master's

 Associate degree  Doctorate (e.g., Ph.D.)

 Bachelor's  First professional degree (e.g., M.D., L.L.B., J.D., D.D.S.)

 Education specialist/professional diploma based on at least one year of work (e.g., credential, 6-yr certificate)

2. Which of the following describes the teaching certificate you currently hold? (MARK ALL THAT APPLY).

 Regular or standard certificate or advanced professional certificate

 Probationary certificate (issued after satisfying all requirements except the completion of a probationary period)

 Provisional or other type of certificate given to persons who are still participating in what the state calls an "alternative certification program"

 Temporary certificate (requires some additional college coursework, student teaching, and/or passage of a test before regular certification can be obtained)

 Waiver or emergency certificate (issued to persons with insufficient teacher preparation who must complete a regular certification program in order to continue teaching)

 I have received National Board Certification

 I am currently working toward National Board Certification

 I do not have any of the above certifications

3. Are you endorsed or certified in any of the areas below? (MARK ALL THAT APPLY).

 Elementary Education  Early Childhood Education  Special Education

 English  Language arts  Reading specialist

 Foreign Language  Language Therapy  Speech Therapy

 English-as-a-second-language (ESL) or English for Speakers of Other Languages (ESOL) or English Language Learners (ELL) or Limited English Proficiency (LEP)

 Other (please specify): ____________________________________

4. Counting this year, how many years have you taught as an elementary or secondary teacher? Include any full-time teaching assignments, part-time teaching assignments, and long-term substitute assignments. If less than 4 months total experience, enter "0." ______ Years

5. Counting this year, how many years have you taught as a 6^th grade teacher? Include any full-time teaching assignments, part-time teaching assignments, and long-term substitute assignments in 6^th grade. If less than 4 months total experience, enter "0." ______ Years

Current Classrooms

Please think about all the English/Language Arts sections you are teaching this year when answer the items in this section.

6. a) How many students are enrolled in your current classes? ______ Students

b) How do your current classes compare to previous classes you have taught?

Fewer students More students About the same number of students

7. a) How many English Language Learners (ELL) students are assigned to your current classes?

______ ELL students

b) How does this number of ELL students compare to the number of ELL students you have taught in previous classes?

Fewer students More students About the same number of students

8. a) Of all of the students in your current classes, how many have an Individual Education Plan (IEP) because they have disabilities or are special education students?

______ IEP students

b) How does this number of IEP students compare to the number of IEP students in your previous classes?

Fewer students More students About the same number of students

9. What is the 6^th grade core reading program or anthology?

_______________________________________________________

Thank you for your participation.

Paperwork Burden Statement

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–XXXX. The time required to complete this information collection is estimated to average 10 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. 20202–4700. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: OK Park, U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Washington, DC, Washington, D.C. 20208.

Responses to this data collection will be used only for statistical purposes.  The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual.  We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.

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