OMB #: 1850-0800 Expiration
Date: 4/12/08
Evaluation of the DC Opportunity Scholarship Program
Parent Questionnaire
Spring 2008
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 1850-0800 (expiration 4/12/08). The time required to
complete this information collection is estimated to average 1/4
hour, including the time to review instructions, search existing
data resources, gather the data needed, and complete the information
collection. If you
have any comments concerning the accuracy of the time estimate or
suggestions for improving this form, please contact:
Marsha Silverberg, U.S. Department of Education, Institute of
Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208,
[email protected]. If
you have comments or concerns regarding the status of your
individual submission of this form, e-mail directly to:
[email protected]. 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.
Your child’s name is listed on the cover. Please write his or her name here: ________________________. When you read “your child,” please think about this child only.
Where the terms “child” and “children” have been used in this questionnaire this means children of all ages – from 5-18
Please answer every question.
Part 1: About Your Child
This section asks questions about the child listed on the cover.
Q1. What is the child’s date of birth: |__|__|/|__|__|/|__|__|__|__|
D D M M Y Y Y Y
Q2. Please provide the following information for the school(s) this child attended for the 2007-08 school year:
|
School Name |
School Type ( Check one) |
Grade |
Months Attended (Between September 2007 and June 2008) |
School 1 |
|
1 Neighborhood (assigned) public school 2 Public school (unassigned) (e.g., magnet school or other neighborhood) 3 Public charter school 4 Private, religious school 5 Private, non-religious school |
|
|
School 2 |
|
1 Neighborhood (assigned) public school 2 Public school (unassigned) (e.g., magnet school or other neighborhood) 3 Public charter school 4 Private, religious school 5 Private, non-religious school |
|
|
Q3. How far in school do you expect your child to go?
( Check one)
Some high school, but will not graduate |
1 |
Complete high school |
2 |
Attend but did not complete a 2-year college |
3 |
Attend but did not complete a 4-year college |
4 |
Obtain an associate’s degree (AA, AS) or a certificate |
5 |
Obtain a bachelor’s degree |
6 |
Obtain a master’s degree or other higher degree |
7 |
Not sure |
8 |
Q4a. In the last month, approximately how many days did this child:
( Check one)
|
None |
1-2 Days |
3-4 Days |
5 or more days |
Don’t Know |
a. Miss school |
1 |
2 |
3 |
4 |
5 |
Q4b. In the last month, approximately how many days did this child:
( Check one)
|
None |
1-2 Days |
3-4 Days |
5 or more days |
Don’t Know |
a. Come to school ½ hour or more late |
1 |
2 |
3 |
4 |
5 |
Q5. During the past year, was this child ever suspended from school for disciplinary reasons?
No 1
Yes 2
Don’t know 3
Q6. On average, how long does it take this child to get from home to school each morning?
( Check one)
Under 10 minutes 1
11-20 minutes 2
21-30 minutes 3
31-45 minutes 4
46 minutes to an hour 5
More than one hour 6
Q7. Does this child:
|
( Check one) |
If Yes, how well does this child’s school attend to the particular needs of this child? ( Check one) |
|||
|
Yes |
No |
Very well |
Adequately |
Poorly |
a. Have any physical disabilities? |
1 |
2 |
3 |
4 |
5 |
b. Have any learning disabilities? |
1 |
2 |
3 |
4 |
5 |
c. Speak a language other than English as a primary language? |
1 |
2 |
3 |
4 |
5 |
Q8. Does your child receive any of the following services?
( Check all that apply)
|
Yes |
No |
a. Before-school care |
1 |
2 |
b. After-school care |
1 |
2 |
c. Tutoring in school |
1 |
2 |
d. Tutoring outside of school |
1 |
2 |
Part 2: Questions about This Child’s School
Q9. How satisfied are you with the following aspects of this child’s current school?
( Check one box per row)
|
Very dissatisfied |
Dissatisfied |
Satisfied |
Very Satisfied |
Does not apply |
a. Location of school |
1 |
2 |
3 |
4 |
|
b. School safety |
1 |
2 |
3 |
4 |
|
c. Class sizes |
1 |
2 |
3 |
4 |
|
d. School facilities |
1 |
2 |
3 |
4 |
|
and students |
1 |
2 |
3 |
4 |
|
of students’ progress |
1 |
2 |
3 |
4 |
|
religious traditions’ |
1 |
2 |
3 |
4 |
|
h. Parental support for the school |
1 |
2 |
3 |
4 |
|
i. Discipline |
1 |
2 |
3 |
4 |
|
j. Academic quality |
1 |
2 |
3 |
4 |
|
k. Racial mix of students |
1 |
2 |
3 |
4 |
|
special needs |
1 |
2 |
3 |
4 |
5 |
Q10. How serious are the following problems at this child’s school?
( Check one on each row)
|
Very serious |
Somewhat serious |
Not |
a. Kids destroying property |
1 |
2 |
3 |
b. Kids being late for school |
1 |
2 |
3 |
c. Kids missing classes |
1 |
2 |
3 |
d. Fighting |
1 |
2 |
3 |
e. Cheating |
1 |
2 |
3 |
f. Racial conflict |
1 |
2 |
3 |
g. Guns or other weapons |
1 |
2 |
3 |
h. Drug distribution |
1 |
2 |
3 |
i. Drug and alcohol use |
1 |
2 |
3 |
j. Availability of textbooks/supplies |
1 |
2 |
3 |
k. Availability of computers |
1 |
2 |
3 |
l. Teacher absenteeism |
1 |
2 |
3 |
Q11. What overall grade would you give this child’s current school?
( Check one)
Excellent (A) 1
Good (B) 2
Fair (C) 3
Unsatisfactory (D) 4
Failing (F) 5
Q12. During this school year (2007-08), how often did you do the following in this child’s school:
( Check one box on each row)
|
Never |
Once |
2 or 3 times |
4 or more times |
a. Attend parent-teacher conferences |
1 |
2 |
3 |
4 |
b. Volunteer in the school |
1 |
2 |
3 |
4 |
c. Attend a PTA (or other similar organization) meeting) |
1 |
2 |
3 |
4 |
d. Receive report cards about this child’s performance |
1 |
2 |
3 |
4 |
e. Receive information about this child’s school, such as newsletters and school notices |
1 |
2 |
3 |
4 |
f. Receive notification if the child was sent to the office for disruptive behavior |
1 |
2 |
3 |
4 |
g. Accompany students on class trips |
1 |
2 |
3 |
4 |
Q13. In the past MONTH, how often did you do the following?
( Check one box on each row)
|
Never |
Once |
2 or 3 times |
4 or 5 times |
6 or more times |
a. Help this child with his or her homework |
1 |
2 |
3 |
4 |
5 |
b. Help this child with reading or math that was not part of his or her homework |
1 |
2 |
3 |
4 |
5 |
c. Talk to this child about his or her experience in school |
1 |
2 |
3 |
4 |
5 |
d. Work with child on school project |
1 |
2 |
3 |
4 |
5 |
Part 3: Questions about choosing schools and the DC Opportunity Scholarship Program
Q14. What was the most important consideration in your choice of schools for this child for this school year?
|
Mark Only One |
|
1 |
|
2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
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11 |
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12 |
Q15. What was the second most important consideration in your choice of schools for this child for this school year?
|
Mark Only One |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
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11 |
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12 |
Q16. What was the third most important consideration in your choice of schools for this child for this school year?
|
Mark Only One |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
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10 |
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11 |
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12 |
Q17. Do you plan to send this child to the same school next year?
No q1
Yes q2 (Go to question 19)
Q18. Why will the child not be attending the same school next year?
( Check all that apply)
|
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|
q01 |
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q02 |
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q03 |
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q04 |
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q05 |
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q06 |
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q07 |
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q08 |
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q09 |
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q10 |
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q11 |
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q12 |
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q13 |
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q14 |
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q15 |
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q15 |
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q16 |
Q19. What was the most important reason for why you applied for a DC Opportunity Scholarship for this child?
|
Mark Only One |
|
1 |
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2 |
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3 |
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4 |
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5 |
|
6 |
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7 |
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8 |
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9 |
Q20. What was the second most important reason for why you applied for a DC Opportunity Scholarship for this child?
|
Mark Only One |
|
1 |
|
2 |
|
3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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9 |
Q21. What was the third most important reason for why you applied for a DC Opportunity Scholarship for this child?
|
Mark Only One |
|
1 |
|
2 |
|
3 |
|
4 |
|
5 |
|
6 |
|
7 |
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8 |
|
9 |
Q22. Did this child get an offer of a scholarship to attend a private school through the DC Opportunity Scholarship program?
( Check one)
|
q1 |
(Go to question 26) |
|
q2 |
(Go to question 23) |
|
q3 |
(Go to question 25) |
Q23. Did this child transfer to another school during the 2007-08 school year?
No q1 (Go to question 26)
Yes q2 (Go to question 24)
Q24. Why did this child leave the private school he/she attended?
( Check all that apply)
|
01 |
|
02 |
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03 |
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04 |
|
05 |
|
06 |
|
07 |
|
08 |
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09 |
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10 |
|
11 |
Q25. Why did this child not use the offer of the scholarship?
( Check all that apply)
|
01 |
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02 |
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03 |
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04 |
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05 |
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06 |
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07 |
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08 |
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09 |
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10 |
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11 |
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12 |
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13 |
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14 |
Part 4: Questions about the Child’s Parents or Legal Guardian
Q26. Who is the primary female guardian for this child:
( Check one)
Child's birth mother 1
Child's stepmother 2
Child's grandmother 3
Other female (please specify on the line)
___________________________________ 4
Child has no female guardian 5
Q27. Who is the primary male guardian for this child:
( Check one)
Child's birth father 1
Child's stepfather 2
Child's grandfather 3
Other male (please specify on the line)
___________________________________ 4
Child has no male guardian 5
Q28 Who is completing this questionnaire? Please mark your relationship to the child:
( Check one)
Child's primary female guardian 1
Child's primary male guardian 2
Other (please specify on the line)
_____________________________ 3
Q29. Please mark the HIGHEST level of education that you completed
( Check one)
Beyond eighth grade, not high school graduation |
q1 |
Eighth grade or less |
q2 |
GED |
q3 |
High School Graduation |
q4 |
Less than two years of college |
q5 |
Two year degree from any vocational, trade, or business school |
q6 |
Two or more years of college |
q7 |
Finish college (four or five year degree) |
q8 |
Master degree or higher degree |
q9 |
Q30. How many years have you lived in your current residence?
( Check one box)
Less than 3 months 1
3-11 months 2
1-2 years 3
More than 2 years 4
Q31. Do you currently have a job outside the home, either full-time or part-time?
( Check one box)
Yes, a full time job (35+ hours) 1
Yes, a part time job (less than 35 hours) 2
Not working now, but looking for work 3
Not working now and not looking for work 4
Don’t know 5
Q32. How many years and months have you worked, either part-time or full-time, since leaving school?
____Years ____Months
Part 5: Contact Information
Please Provide Your Current Contact Information:
Last Name: ____________________ First Name: ___________________ MI: ____
Address: ____________________________________________________________________
_____________________________________________________________________
Phone number ______________________________________________________________
Email Address: ______________________________________________________________
Additional Contact Information
Please provide the names and addresses for three people who are likely to know the whereabouts of the child in the future. The contact people listed do not have to be family members and can be friends and/or neighbors of the family.
Contact Information for:
Last Name: ____________________ First Name: ___________________ MI: ____
Address: ____________________________________________________________________
_____________________________________________________________________
Phone number ______________________________________________________________
Email Address: ______________________________________________________________
Relationship to child: ____________________________
Contact Information for:
Last Name: ____________________ First Name: ___________________ MI: ____
Address: ____________________________________________________________________
_____________________________________________________________________
Phone number ______________________________________________________________
Email Address: ______________________________________________________________
Relationship to child: ____________________________
Contact Information for:
Last Name: ____________________ First Name: ___________________ MI: ____
Address: ____________________________________________________________________
Phone number_______________________________________________________________
Email Address: ______________________________________________________________
Relationship to child: ____________________________
Thank you for completing the survey.
File Type | application/msword |
Author | Mike Puma |
Last Modified By | Roseta.Hall |
File Modified | 2007-12-12 |
File Created | 2007-12-12 |