Teacher background Questionnaire

APPENDIX C
TEACHER BACKGROUND
QUESTIONNAIRE

OMB No.: 1850-0802
Expiration Date: xx/xx/xxxx

BARCODE LABEL

6137-082

TEACHER BACKGROUND
QUESTIONNAIRE
STUDY OF TEACHER
INDUCTION PROGRAMS
Induction refers to a program of professional development and support for beginning teachers. Teacher induction programs
consists of various components and activities and often include mentoring and professional development workshops.
The questions on this baseline form ask about your background, your current teaching experiences, and your plans for the
future. For each item, please mark only one answer, unless instructions say to “MARK (X) ALL THAT APPLY.” Thank you
very much for helping us to learn more about teacher induction.

We want you to know that:
1.

We are asking you these questions to gather information about new teachers’ career
decisions and their experiences with teacher induction.

2.

You may skip any questions you do not wish to answer; however, we hope that you answer
as many questions as you can. Your answers to questions will not affect your eligibility for
any public program.

3.

All responses are confidential. Your responses will be combined with those of other
teachers, and the answers you give will never be identified as yours.

Mathematica Policy Research (MPR)
Princeton, NJ
[email protected]
www.mathematica-mpr.com
For questions, call Pat Nemeth at 877-840-4740
The U.S. Department of Education wants to protect the privacy of individuals who participate in surveys. Your answers will
be combined with other surveys, and no one will know how you answered the questions. This survey is authorized by law
(1) Sections 171(b) and 173 of the Education Sciences Reform Act of 2002, Pub. L. 107-279 (2002); and (2) Section 9601 of
the Elementary and Secondary Education Act (ESEA), as amended by the No Child Left Behind (NCLB) Act of 2001
(Pub. L. 107-110).
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 1850-0802. The time required to complete this information collection
is estimated to average 25 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the
information collected. 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, DC 20202. If you have comments or concerns regarding the status of your individual submission of
this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.

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A. PROFESSIONAL BACKGROUND INFORMATION

YOU MAY USE EITHER A PENCIL OR A PEN.
A1.

Please describe your postsecondary degrees in the chart below.
A.

B.

C.

D.

E.

Year Degree
Awarded

Type of Degree

Name of College
or University

Major Field of Study

Minor Field of Study

|

|

|

A2.

|

|

|

|

|

|

|

|

|

|

|

|

1

! Associate’s

2

! Bachelor’s

2

! Bachelor’s

3

! Master’s

4

! Other (Please specify)

3

! Master’s

4

! Other (Please specify)

Are you currently working toward an advanced degree (for example, Master’s, Ed.D., or Ph.D.) or additional
credits?

1

! Yes

1

! Degree:

0

! No

2

! Additional Credits

GO TO A3

a. NAME OF COLLEGE OR UNIVERSITY:

b. MAJOR FIELD OF STUDY:

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A3.

A10. Approximately how much do you have in
outstanding education loans?

Have you taken a graduate school entrance
exam?
1

! Yes

0

! No

NOTE: If you have consolidated your education
loans with other loans, please estimate the
amount for education, as best as you can.

GO TO A5

!
2!
3!
4!
5!
6!
7!
8!
9!
10 !
11 !
1

A4.

A5.

Do you plan to take a graduate school entrance
exam?
1

! Yes

0

! No

GO TO A6

Which ones have you taken?
MARK (X) ALL THAT APPLY

5

!
!
!
!
!

6

! Other (Please specify)

1
2
3
4

LSAT
GMAT
MCAT
GRE general
GRE subject (Please specify subjects)

Under $5,000
$5,000 to $9,999
$10,000 to $19,999
$20,000 to $29,999
$30,000 to $39,999
$40,000 to $49,999
$50,000 to $59,999
$60,000 to $69,999
$70,000 to $79,999
$80,000 or greater
Don’t know

A11. Which of the following statements most
accurately describes the type of teaching
certificate/license/credential that you
currently hold?
States vary in the types of certificates they issue.
Please select from the list below the statement
that BEST describes the certificate/license/
credential that you hold.
MARK (X) ONE ANSWER ONLY

A6.

Did you apply to a graduate school program?
1

! Yes

0

! No

1

GO TO A8

Year certified |
2

A7.

A8.

A9.

Do you plan to apply to a graduate school
program?
1

! Yes

0

! No

! Yes

0

! No

|

3

4

GO TO A10

|

|

|

! A certificate that is issued to candidates
after satisfying all requirements except the
completion of a probationary teaching period
|

Year certified |

Do you have any outstanding education loans?
1

! A regular or standard state certificate

|

|

|

! A certificate that is issued to candidates with
the expectation that additional requirements
be completed, such as passing a test or
coursework
! An emergency certificate or waiver that is
issued for a specified time period to persons
with insufficient teacher preparation

5

! Other (Please describe)

6

! I am not certified

Are any of these forgivable or assumable loans?
NOTE: Forgivable or assumable loans are erased if
you meet certain teaching requirements.
1

! Yes

0

! No

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A12.

Which of the following statements best describes how you earned your teaching certificate?
1

! In a traditional teacher certification program (see below for definition) as part of a bachelor’s degree

2

! In a traditional teacher certification program (see below for definition) as a “5th year” or master’s degree

3

! As part of an alternative teacher certification program (see below for definition)

4

! Other (Please specify)

Traditional teacher certification program – An education program in which a candidate completes the necessary
initial study leading to an entry-level teaching certificate before beginning employment as a school teacher. Higher
education institutions deliver the training as part of a bachelor’s or master’s degree program.
Alternative teacher certification program – A program designed for individuals who already have a post-secondary
degree. Minimal or no education courses or training are required before beginning employment in a school.
Candidates often take courses and receive training while teaching. Training is delivered by higher education
institutions, state agencies, or local school districts. Full certification is received one to three years after beginning the
first teaching job.

A13.

From the list below, select the areas in which you are certified.
MARK (X) ALL THAT APPLY
1

! General elementary education

2

! Bilingual education

3

! Special education (Please specify)

4

! A specific subject area or areas (Please specify)

5

! Other (Please specify)

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A20. How would you describe your student teaching
experience in terms of the classroom teacher
with whom you spent the most time?

A14. Are you currently pursuing state certification?
1

! Yes

0

! No

2

! Already state certified

1

GO TO A16

2

A15. Have you completed all of your coursework for
this certification?
1

! Yes

0

! No

3

! Yes

0

! No

GO TO A18

A17. Have you completed all your course work for this
certification?
1

! Yes

0

! No

! The teacher/experience was adequate but
I could have learned more
! The teacher/experience did not teach/
help prepare me much at all

A21. Did you teach children from families of the
same socio-economic level as children you’re
now teaching?

A16. Are you currently pursuing advanced
professional certification?
1

! The teacher/experience was excellent and
I felt I learned a lot

A22.

GO TO A18

1

! Yes

0

! No

Are you now teaching in the same school
where you student taught?
1

! Yes

0

! No

A18. Did you student teach?
1

! Yes

0

! No

A23. NOT INCLUDING STUDENT TEACHING, have
you ever worked in a classroom before this
current school year?

GO TO A23

NOTE: Student teaching (also called practice
teaching) – A school-based experience for
students enrolled in a post-secondary
education institution that is supervised by
both a certified experienced teacher and a
university or college supervisor. It is
generally a requirement of pre-service
teachers who have completed the education
coursework leading to a degree and are
seeking certification or licensure to teach in
a public school.

1

! Yes

0

! No

GO TO A25

A19. How many weeks did you student teach?
|

|

| NUMBER OF WEEKS

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A24. NOT INCLUDING THIS SCHOOL YEAR, please indicate the number of years you’ve worked in schools, the
type of school, and the grade level you taught in any of the following positions (either part-time or full-time).
NOTE: Enter “00” in Column A if you have never worked in this capacity
Enter “01” in Column A if you worked less than one year
B. School
MARK (X) ALL THAT APPLY

A. Number
of Years

This
School

Different
Public School

Private
School

C. Grade Level(s)
or Main
Assignment

a. Certified teacher..................................

|

|

|

1

!

2

!

3

!

______________

b. Emergency certified teacher ...............

|

|

|

1

!

2

!

3

!

______________

c.

Teacher aide .......................................

|

|

|

1

!

2

!

3

!

______________

d. Long-term substitute teacher ..............

|

|

|

1

!

2

!

3

!

______________

e. Substitute teacher ...............................

|

|

|

1

!

2

!

3

!

______________

f.

|

|

|

1

!

2

!

3

!

______________

A25.

Other (Please specify) ........................

Which grade level do you currently teach?

A28.

How many of these students are:

x

! Prekindergarten

a.

Hispanic or Latino, or ............................ |

|

|

0

! Kindergarten

b.

Not Hispanic or Latino? ......................... |

|

|

1

! 1st

2

! 2nd

3

! 3rd

a.

American Indian or Alaska Native, ........ |

|

|

4

! 4th

b.

Asian, .................................................... |

|

|

5

! 5th

c.

Black or African American, .................... |

|

|

6

! 6th

d.

7

! 7th

Native Hawaiian or
Other Pacific Islander, or....................... |

|

|

8

! 8th

White? ................................................... |

|

|

9

! Other (Please specify)

A29.

How many are:

e.

A30.

How many of your students . . .
a.

A26.

A27.

Have an Individual Education
Plan (IEP)? ........................................... |

|

|

Is this the grade level you prefer teaching?
1

! Yes

0

! No

DO NOT include gifted and talented
students.

What is the total number of students enrolled
in the class you taught during the most recent
FULL WEEK of teaching?
|

|

| STUDENTS

b.

Have a 504 Service Agreement? ......... |

|

|

c.

Were approved for free or
reduced-price lunches? ........................ |

|

|

d.

Are in an ESL/ELL program? ............... |

|

|

e.

Receive Title I Services?...................... |

|

|

INDICATE:

A31.
a. |

|

| NUMBER OF BOYS

b. |

|

| NUMBER OF GIRLS

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Are you a member of a teachers’ union or an
employee association similar to a union?
1

! Yes

0

! No
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B. YOUR TEACHING CAREER
B1.

SINCE GRADUATING FROM COLLEGE, have you
held a full-time job other than your current
teaching job?
1
0

B2.

B3.

! Yes
! No, this is my first job
GO TO B3
since college

SINCE GRADUATING FROM COLLEGE, please
tell us about the job you held the longest
BEFORE your current teaching position.

Thinking back to your job search activities before
your current teaching position, did you interview
for any non-teaching jobs?
1

! Yes

0

! No

GO TO B6

B4.

Describe the kinds of jobs you interviewed for.

B5.

Did you receive any job offers?

DO NOT include a job that was an official part of
your teacher preparation program (for instance,
student teaching).
a.

What was your job title?

1

b.

c.

! Self-employed

What were your responsibilities? What did you
do in this job? (Please be specific)

What did your employer make, do, or sell?

B6.

1

! Yes

0

! No

For your current teaching position, did you
interview at . . .
Yes

No

a. Other schools within your

d.

Was this job in the public or private sector?
MARK (X) ONE ANSWER ONLY

e.

1

! Public

2

! Private, for profit

3

! Private, not for profit

current district?.............................. 1 !

0

!

b. Other school districts?................... 1 !

0

!

0

!

c. Other types of schools

(e.g., private or parochial)? ........... 1 !

How many years did you work in this job?
|

|

| NUMBER OF YEARS
(Enter “01” if you worked less than one year)

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B7.

Did the school district allow you any input as to
where you would be placed?

B11. Which of the following statements best describes
your plans?

1

! Yes

MARK (X) ONE ANSWER ONLY

0

! No

1

2

B8.

Is the school you’re teaching in the one that you
wanted to be placed in?
1

! Yes

0

! No

2

! Had no preference

3

4

GO TO B10

5

6

B9.

Did any of the following reasons influence your
preference in a particular school?

7

MARK (X) ALL THAT APPLY
1
2

3

4

! I plan to teach at least until I am eligible
for retirement
! I will probably continue teaching unless
another opportunity presents itself
! I plan to leave teaching as soon as I can
! I plan to pursue another education-related
career at some point
! I plan to pursue another career outside
the field of education at some point
! I plan to have children and stop teaching
at some point
! I plan to stop working outside the home
at some point for reasons not related to children
! I am going to see if I like teaching before
I make plans

! The principal’s leadership

8

! A program of support and information provided
to beginning teachers

9

! I am undecided at this time

10

! Other (Please specify)

! The grade level/subject in which there was an
opening
! Other opportunities offered to you such as
coaching a sports team, etc.

5

! The school’s organization/environment

6

! The school’s location

7

! Knew other teachers in the school

8

! Did student teaching at same school

9

! Other reason (Please specify)

B12. Approximately how many years do you think you
will remain in teaching after this year?
I will probably teach for . . .

|

|

| more years

B10. Prior to being hired, had you heard about a new
teacher induction program in the district?
1

! Yes

0

! No

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The following questions refer to your before-tax earnings from teaching and other employment. Consider
the current school year to run from July 1, 2005 to June 30, 2006.
B13. During the current school year, what is your academic–year, base teaching salary?
$|

|

|

|,|

|

|

|.| 0 | 0 |

B14. Does your base teaching salary include additional compensation for teaching in a more challenging school?
1

! Yes

0

! No

B15. During the current school year, do you, or do you expect to, earn any additional compensation from this
school system for extracurricular or additional activities such as coaching, student activity sponsorship,
or professional development activities?
1

! Yes

0

! No

a. How much? $ |

|

|,|

|

|

|.| 0 | 0 |

B16. During the current school year, do you, or do you expect to, earn additional compensation from working in
any job OUTSIDE this school system?
1

! Yes

0

! No

a. How much? $ |

|

|,|

|

|

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C. PERSONAL BACKGROUND INFORMATION
C1.

| 1 | 9 |

C2.

2

| YEAR

C9.

2

! Female

Do you currently own or rent the residence where
you live, or do you live with your parents?

! Single, separated, divorced, widowed, or
GO TO C6
never married

2

! Rent

3

! Live with parents

4

! Live with someone else rent-free

|

|

|,|

|

|

C10. Do you have any children living with you?
Include birth, adopted, foster, or stepchildren.

|.| 0 | 0 |

How much time does your spouse or partner
spend commuting to or from work each day?

1

! Yes

0

! No

GO TO C12

C11. How many of your children are . . .
a. Under the age of 1? ........................... |

|

|

|

|

| MILES COMMUTING ONE WAY

b. Ages of 1 to 5?................................... |

|

|

|

|

|

c. Ages 6 to 11?..................................... |

|

|

d. Ages of 12 to 18?............................... |

|

|

e. Over the age of 18? ........................... |

|

|

| MINUTES COMMUTING ONE WAY

What is the likelihood that your spouse or
partner’s job will require your family to relocate
in the next five years?

2
3
4

C7.

! Male

! Own (either paying a mortgage or own outright)

What was your spouse or partner’s total income
(before taxes and other deductions) for last year?

1

C6.

1

1

NOTE: Please indicate miles and minutes. Your
best estimate is fine.

C5.

Are you male or female?

! Married or living with a partner

$|

C4.

|

Are you currently married or living with a partner,
or are you single, separated, divorced, widowed,
or have you never been married?
1

C3.

C8.

In what year were you born?

!
!
!
!

C12. Do you live in the same school district where you
teach?

Very likely
Somewhat likely
Somewhat unlikely
Not at all likely

! Hispanic or Latino

0

! Not Hispanic or Latino

2
3
4
5

!
!
!
!
!

! No

|

|

| MILES COMMUTING ONE WAY

|

|

|

| MINUTES COMMUTING ONE WAY

C14. Did you attend elementary school(s) in a school
with a socio-economic level similar to the one
you’re now teaching in?

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

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0

NOTE: Please indicate miles and minutes. Your
best estimate is fine.

Mark the box or boxes that best describes your
race.
1

! Yes

C13. How far do you live from the school where you
teach?

What is your ethnic background?
1

1

9

1

! Yes

0

! No
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D. CONTACT INFORMATION
D1.

The survey you have completed involves brief follow-ups at later times to learn about teachers’ movements
in the labor force. Providing the information below is voluntary, not mandatory. This information will help
us contact you if you move or change jobs. Also, MPR will mail your check to the address you provide below.
Please PRINT your name, your spouse’s name (if applicable), your home address, your telephone number,
and the most convenient time to reach you.
Your Name:
Spouse’s Full Name:
(If applicable)
Street Address:
City:

State:

Home Telephone:

(| | | |) - |
Area Code

|

|

|-| |
Number

|

Zip Code:
|

|

In whose name is the telephone number listed?
MARK (X) ONE ANSWER ONLY
1
2

! My name
! Other (Please specify name)

Cell Phone Number:

(| | | |) - |
Area Code

Social Security Number: |

|

|

|-|

|

|

|

|-| |
Number

|

|-|

|

|

|

|

|

|

|

Home Email Address:
Work Email Address:

D2.

Please indicate the most convenient time to reach you.
a. Best day(s) to reach you

b. Best time of day to reach you

MARK (X) ALL THAT APPLY
1
2
3
4
5
6
7

D3.

!
!
!
!
!
!
!

MARK (X) ONE ANSWER ONLY

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

1
2
3

! Before school starts, in the AM
! After school, in the afternoon
! In the evening

Please indicate today’s date:
|

| |/| | |/ | 2 | 0 | 0 |
Month
Day
Year

|

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D4.

What are the names and addresses of two other people who would know where to get in touch with you during
the coming years? Remember to record the relationship of these persons to you (for example, parent, friend,
sister, cousin, etc.). We will contact these people only if we can’t get in touch with you.
(1) First Person
Name:
Relationship to you:
Street Address:
City:
Home Telephone:

State:
(| | | |) - |
Area Code

|

|

|-| |
Number

|

Zip Code:
|

|

In whose name is the telephone number listed?
MARK (X) ONE ANSWER ONLY
1

! Name entered above

2

! Other (Please specify name)

What is the name and address of another person who would know where to get in touch with you during the
coming years? Don’t list any person who now lives with you. Remember to record the relationship of this
person to you (for example, parent, friend, sister, cousin, etc.).
(2) Second Person
Name:
Relationship to you:
Street Address:
State:

City:
Home Telephone:

(| | | |) - |
Area Code

|

|

|-| |
Number

|

Zip Code:
|

|

In whose name is the telephone number listed?
MARK (X) ONE ANSWER ONLY
1

! Name entered above

2

! Other (Please specify name)

Thank you for completing this survey. Please mail it to MPR in the envelope provided.

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