School Information Update

OMB No. XXXX-XXXX

App. Exp.: xx/xx/xxxx

Early Childhood Longitudinal Study – Birth Cohort (ECLS-B)

Fall 2007 School Enrollment and Address Information Update

Prepared for the U.S. Department of Education

National Center for Education Statistics

by RTI International

3040 Cornwallis Road

Research Triangle Park, NC 27709

(919) 541-6000

Assurance of Confidentiality

The collection of information in this survey is authorized by Public Law 100-297 and continued under the auspices of Section 404(a) of the National Education Statistics Act of 1994, Title IV of the Improving America's Schools Act of 1994, Public Law 103-382. 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. No information collected under this authority may be used for any purpose other than the purpose for which it was supplied. Information will be protected from disclosure by federal statute (42 US Code 242m, section 308d). 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 reported.

School Enrollment for {CHILD’S FIRST NAME PRELOADED}

Please check one box for each question below.

Q1. Is your child enrolled in school this year, meaning the 2007-2008 school year?

YES………………………………………….…. (Go to Q3)

NO………………………………………………

Q2. Do you plan to enroll your child in school for the 2007-2008 school year?

YES…………………………………………...

NO……..……………………………………… (Go to next page)

Q3. What grade is your child going to be in this school year? Please check one.

PRESCHOOL………………………………….

KINDERGARTEN……………………………..

FIRST GRADE..…………………………….…

SECOND GRADE……………………………..

OTHER……………………………………........

Please describe other grade __________________________

Please go to next page.

Contact Information Update

Please review the information printed below.

If your address and telephone number are correct, please check the “Contact Information Is Correct” box at the bottom of the page.

If your information has changed, please cross through anything that is incorrect and write your new information in the space provided next to it.

If you plan to move and know your new address and telephone number, please enter it in the space provided below.

If you plan to move and do not know your new address and telephone number, please provide an address or phone number that we can use to reach you (for example, a work number, a cell phone number, or a friend who always knows how to reach you).

CURRENT CONTACT INFORMATION UPDATED CONTACT INFORMATION

[PANEL_INFO ID]

[R_FIRST NAME] [R_LAST NAME]

[ADDRESS LINE 1]

[ADDRESS LINE 2]

[CITY], [STATE] [ZIP]

TELEPHONE: [TELEPHONE]

CHILD’S NAME: [CHILD’S NAME]

TWIN’S NAME: [TWIN’S NAME] {IF TWIN CASE}

If you are moving, on what date do you expect to move to the new address?

_________/________/___________

MONTH / DAY / YEAR

CONTACT INFORMATION IS CORRECT  Thank You!