HSLS Appendix D - Parent Questionnaire

Appendix D
Parent Questionnaire

1. What is your relationship to [9th grader]? Are you (his/her) biological (mother/father), adoptive (mother/father), step (mother/father) or someone else?

• Biological Mother/Father

• Adoptive Mother/Father

• Stepmother/Stepfather

• Foster Mother/Father

• Female Partner of Parent/Guardian

• Male Partner of Parent/Guardian

• Grandmother/Father

• Other Relative

• Other Guardian

2. (If respondent is not a parent) Does one or both of [9th grader’s] biological or adoptive parents live in the same household as you and [9th grader]?

• Yes, two parents

• Yes, one parent

• No, neither parent

3. (If respondent is a parent or neither parent lives in 9th grader’s household) Do you have a spouse or partner who lives in the same household as you and [9th grader]?

• Yes, a spouse

• Yes, a partner

• No, not applicable

4. (If respondent is a parent who has a spouse or partner OR respondent is not a parent but one or both parents live in household) What is (your spouse’s/your partner’s/this parent’s/these parents’) relationship to [9th grader]?

• Biological Mother/Father

• Adoptive Mother/Father

• Stepmother/Stepfather

• Foster Mother/Father

• Grandmother/Father

• Other Female Relative

• Other Male Relative

• Other Female Guardian

• Other Male Guardian

5. (If respondent is only parent in household) What is your current marital status? OR (If respondent is not a parent)

• Married

• Divorced

• Separated

• Never Married

• Widowed

• Don’t Know

6. What is [9th grader’s] parents’ current marital status? Are they?

• Married

• Divorced

• Unmarried partners

• Separated

• Never Married

• Widowed

• Don’t Know

7. How much of the time does [9th grader] live with you (and your spouse/and your partner/and (his/her) parents)?

• All of the time

• More than half of the time

• Half of the time

• Less than half of the time

• None of the time

8. With whom does [9th grader] live most of the time when (he/she) does not live with you?

• With his/her other parent(s)

• With another adult relative

• With a friend

• At boarding school

• With a nonrelated adult guardian(s)

• By himself/herself

• Other_______________

9. How many brothers and sisters does [9th grader] have? Consider all siblings, including half- and step- and adoptive brothers and sisters, regardless of where they live.

None 1 2 3 4 5 6 or more

a. Full and/or adoptive brother(s) О О О О О О О

b. Half-brother(s) О О О О О О О

c. Step-brother(s) О О О О О О О

d. Full and/or adoptive sister(s) О О О О О О О

e. Half-sister(s) О О О О О О О

f. Step-sister(s) О О О О О О О

10. How many of these siblings are older than [9th grader]?

11. Are you Hispanic or Latino/Latina?

• Yes Go to question 12

• No  Skip to question 13

12. (If yes) Which one of the following are you?

• Mexican, Mexican-American or Chicano

• Other Hispanic

13. Please select one or more of the following choices to best describe your race.

• White

• Black/African American

• Asian

• Native Hawaiian or other Pacific Islander

• American Indian or Alaska Native

14. (If Asian) Which one of the following are you?

• Chinese

• Filipino

• Southeast Asian (Vietnamese, Thai, etc.)

• South Asian (Asian Indian, Sri Lankan, etc.)

• Other Asian

15. Is your (spouse/partner) Hispanic or (Latino/Latina)?

• YesRouted to Q.12

• No Go to Q.16

16. If yes: If your (spouse/partner) is Hispanic or Latino/Latina, please select one of the following choices best describes him/her:

• Mexican, Mexican-American, Chicano

• Other Hispanic or Other Latino/Latina

17. Please select one or more of the following choices to best describe your (spouse’s/partner’s) race. Is (he/she)…?

• White

• Black/African American

• Asian

• Native Hawaiian or other Pacific Islander

• American Indian or Alaska Native

18. If you marked Asian, which of the following is your spouse/partner?

• Chinese

• Filipino

• Southeast Asian (Vietnamese, Thai, etc.)

• South Asian (Asian Indian, Sri Lankan, etc.}

• Other Asian

19. In what country (were you/was [9th grader’s] mother) born?

• U.S Skip to question 21

• Not born in US  Go to question 20

20. (If not born in U.S.) At what age did (you/she) come to the United States to stay?

Years

21. In what country (were you/ was [9th grader’s] father) born?

• U.S Skip to question 23

• Not born in US  Go to question 22

22. (If not born in U.S.) How many years ago did (you/he) come to the United States to stay?

Years

23. In what country was [9th grader] born?

• U.S Skip to question 25

• Not born in US  Go to question 24

24. (If not born in U.S.) How many years ago did [9th grader] come to the United States to stay?

Years

25. What grade was (he/she) placed in when (he/she) started school in the United States?

• Pre-K

• K

• 1-9

26. Is any language other than English regularly spoken in your home?

• Yes Go to question 27

• No Skip to question 28

27. (If yes) What languages other than English are spoken in your home?

• Spanish

• Another European language (for example, French, German, Russian, etc.)

• A Chinese language

• A Filipino language

• A Southeast Asian language (for example, Vietnamese, Thai, etc.)

• A South Asian Language (for example, Hindi, Tamil)

• Another Asian Language (for example, Japanese, Korean)

• A Middle Eastern Language (for example, Arabic, Farsi)

• Other

28. Is English also spoken in your home?

• Yes Go to questions 29 and 30

• No Skip to question 31

29. (If yes) What language does [9th grader] usually speak to you in your home?

• Spanish

• Another European language (for example, French, German, Russian, etc.)

• A Chinese language

• A Filipino language

• A Southeast Asian language (for example, Vietnamese, Cambodian, etc.)

• A South Asian Language (for example, Hindi, Tamil)

• Another Asian Language (for example, Japanese, Korean)

• A Middle Eastern Language (for example, Arabic, Farsi)

• other specify__________________

30. (If yes) What language do you usually speak to [9th grader] in your home?

• Spanish

• Another European language (for example, French, German, Russian, etc.)

• A Chinese language

• A Filipino language

• A Southeast Asian language (for example, Vietnamese, Cambodian, etc.)

• A South Asian Language (for example, Hindi, Tamil)

• Another Asian Language (for example, Japanese, Korean)

• A Middle Eastern Language (for example, Arabic, Farsi)

• other specify__________________

31. Has [9th grader] ever been enrolled in an English as a Second Language (ESL) program?

• Yes Go to question 32

• No Skip to question 33

• Don’t know

32. (If yes) Is [9th grader] currently enrolled in an English as a Second Language (ESL) program?

• Yes

• No

• Don’t know

33. In what year (were you/was [9th grader’s] mother) born?

Year

1

9

34. In what year (were you/was [9th grader’s] father) born?

Year

1

9

35. What is the highest level of education you and your spouse/partner have reached? REMINDER: Use “spouse/partner” definition from Question 2 or Question 3.

(mark one response in each column)

You Your Spouse/
Partner

a. Did not finish high school  

b. Graduated from high school or equivalent (GED)  

c. Started but have not completed a degree from a 2-year school or college (such as a vocational or technical school or a junior or community college)  

d. Graduated from a 2-year school (such as a vocational or technical school, a junior college, or a community college)  

e. Started but have not completed a 4-year college degree  

f. Graduated from a 4-year college  

g. Started but have not completed a Master’s degree  

h. Completed a Master’s degree or equivalent  

i. Started but have not completed a Ph.D., M.D., or other advanced professional degree program  

j. Completed a Ph.D., M.D., or other advanced professional degree  

36. (If at least associate’s degree) What was (your) major area of study for (your) [highest degree]?

_____________________________________________________

37. What is the highest level of education (your spouse/your partner/[9th-grader’s] father) has completed?

_____________________________________________________

38. (If at least associate’s degree) What was (his/her) major area of study for (his/her) [highest degree]?

______________________________________________________

39. During the past week, did (you/[9th grader’s] mother) hold a job for pay or income?

• Yes Go to question 40

• No Skip to question 41

• Not applicable Skip to question 41

40. (If yes) About how many total hours per week do (you/[9th grader’s] mother) usually work for pay or income, counting all jobs?

Total hours per week

41. What is (your/her) job title? If (you/she) had more than one job, describe the one at which (you/she) worked the most hours.

_______________________________________________

42. What (do you/does she) actually do in that job? That is, what are (your/her) main activities or duties?

________________________________________________

43. During the past week, did (your spouse/your partner/[9th grader’s] father) hold a job for pay or income?

• Yes Go to question 44

• No Skip to question 45

44. (If yes) About how many total hours per week does (your spouse/your partner/[9th grader’s father) usually work for pay or income, counting all jobs?

Total hours per week

45. What is (his/her) job title? If (he/she) had more than one job, describe the one at which (he/she) worked the most hours.

___________________________________________________________

46. What (do you/does he) actually do in that job? That is, what are (your/his) main activities or duties?

____________________________________________________________

47. What was your total household income from all sources (including income from work, investment income, alimony, etc.) prior to taxes and deductions in calendar year 2008?

(Verbatim) (if verbatim refused, ask 48)

48. (If 47 refused) Please indicate the range that best estimates your total household income from all sources (including income from work, investments, alimony, etc.), prior to taxes and deductions, for calendar year 2007.

• $14,999 or less

• $15,000 - $34,999

• $35,000 - $54,999

• $55,000 - $74,999

• $75,000 - $94,999

• $95,000 - $114,999

• $115,000 - $134,999

• $135,000 - $154,999

• $155,000 - $174,999

• $175,000 - $194,999

• $195,000 - $214,999

• $215,000 - $234,999

• $235,000 and above

49. Do you?

• Own or pay mortgage on your home

• Rent your home

• Or have some other arrangement

50. Since starting kindergarten, has [9th grader] repeated any grades?

• Yes Go to question 51

• No Skip to question 52

51. (If yes) What grades did (he/she) repeat? (Mark all that apply)

• Kindergarten

• 1st Grade

• 2nd Grade

• 3rd Grade

• 4th Grade

• 5th Grade

• 6th Grade

• 7th Grade

• 8th Grade

• 9th Grade

52. Since starting kindergarten, has [9th grader] skipped any grades?

• Yes Go to Question 53

• No  Skip to Question 54

53. (If yes) What grade(s) did (he/she) skip? (Mark all that apply)

• Kindergarten

• 1st Grade

• 2nd Grade

• 3rd Grade

• 4th Grade

• 5th Grade

• 6th Grade

• 7th Grade

• 8th Grade

54. How many times has [9th grader] changed schools since he/she first entered school? Do not count changes that occurred as a result of promotion to the next grade or level (for example, a move from an elementary school to from a middle school or from a middle school to a high school in the same district). Please enter zero if your 9th grader has not changed schools except for promotion.

Total times changed schools

55. Since the first grade, has [9th grader] ever stopped going to school for a period of a month or more other than for illness, injury or vacation?

• Yes

• No

56. Since the first grade, has [9th grader] ever been suspended (not counting detentions) or expelled from school?

• Yes

• No

57. During the last school year, how many times did [9th grader’s] school contact you (or your spouse/partner) about...?

Never Rarely Sometimes Often

a. [9th grader’s] behavior in school О О О О

b. [9th grader’s] attendance record at school O О О О

c. [9th grader’s] academic performance O О О О

58. Did [9th grader] take algebra in either the 7th or 8th grade?

• Yes

• No

• Don’t know

59. How often did you talk with other parents about teachers, courses, or school events...?

Never Rarely Sometimes Often

a. at [9th grader’s] 8th grade school? О О О О

b. at [9th grader’s] current school? O О О О

60. Did you (or your spouse/partner) attend an open house or orientation at [9th grader’s] high school before this school year began?

• Yes

• No

61. Did you request that [9th grader] get or not get a particular 9th grade teacher or course at (his/her) high school?

• Yes

• No

62. In the past year, how often did you (and your spouse/partner) discuss the following subjects with [9th grader]?

Never Rarely Sometimes Often

a. Selecting courses or programs at school О О О О

b. School activities or events О О О О

c. Things [9th grader] has studied in class О О О О

d. [9th grader’s] grades О О О О

e. Your [9th grader’s] plans after leaving

high school О О О О

f. Applying to colleges or

other schools after high school О О О О

g. Jobs [9th grader] might like to have when

(he/she) grows up О О О О

63. How much influence do you think you have on the choices [9th grader] makes about school?

• None

• A little

• Some

• A lot

X1. During the last school year, how often did you and your spouse/partner help [9th grader] with his/her homework?

• Never

• Less than once a week

• Once or twice a week

• 3 or 4 times a week

• 5 or more times a week

X2. How confident do you feel about your ability to help [9th grader] in each of the following subjects?

Very Somewhat Not at all
confident confident confident

a. The math your 9th grader has this year О О О

b. The science your 9th grader has this year О О О

c. The English composition, literature, or reading your 9th grader has this year О О О

64. Are there family rules that are enforced for [9th grader] about the following activities?

Yes No

a. Earning acceptable grades in school О О

b. Doing homework О О

X3. Do you or [9th grader's] (mother/stepmother/foster mother/father/stepfather/foster father) (or another adult in your household) check to see that (his/her) homework is done?

• Yes

• No

65. In a typical week, what is the latest [9th grader] can stay out on school nights (Sunday - Thursday)?

• Not allowed out

• No later than 8:00 PM

• No later than 9:00 PM

• No later than 10:00 PM

• No later than 11:00 PM

• No later than midnight

• As late as (he/she) wants

66. In your opinion, does [9th grader] have a specific learning disability?

• Yes

• No

• Don’t know

67. Does your [9th grader] currently have an Individualized Education Plan (IEP)?

• Yes  Go to question 68

• No  Skip to question 69

• Don’t know  Skip to question 69

68. What is the main disability category for your 9th grader’s IEP? (Mark one)

• Autism

• Deafness

• Deaf-blindness

• Emotional disturbance

• Hearing impairment

• Learning disability

• Mental retardation

• Multiple disabilities

• Orthopedic impairment

• Other health impairment

• Speech or language impairment

• Traumatic brain injury

• Visual impairment (including blindness)

69. Has [9th grader] ever been diagnosed by a doctor as having a specific learning disability?

• Yes

• No

• Don’t know

70. Is [9th grader] currently enrolled in a gifted and talented education (GATE) program?

• Yes

• No

• Don’t know

71. From the start of 8th grade until now, did [9th grader] have any academic instruction outside of school such as from a Saturday Academy, learning center, personal tutor or summer school program?

• Yes Go to Question 72

• No  Skip to Question 74

72. (If yes) In what subjects was this instruction?

• Reading

• Math

• Science

• Writing

Other (specify)________________

73. Was the purpose of any of this instruction to help your 9th grader catch up in school?

• Yes

• No

74. During the last 12 months, has [9th grader] participated in any of the following activities outside of school?

Yes No

a. Music, dance, art, or theater О О

b. Organized sports supervised by an adult О О

c. Religious youth group or religious instruction О О

d. Scouting or another group or club activity О О

e. A math or science camp О О

f. Another camp О O

g. Any other regular activities or lessons О О

75. In the past year, that is, since {month, day}, has anyone in your family done the following activities with your 9th grader?

Yes No

a. Visited a zoo, planetarium, natural history museum,

transportation museum, or a similar museum? О О

b. Worked or played on a computer together? О О

c. Built or fixed something such as a vehicle or appliance? О О

d. Attended a school science fair? О О

e. Helped [9th grader] with a school science fair project? О О

f. Discussed a program or article about math,

science, or technology? О O

g. Another science, technology, engineering

or math-related activity? (specify)___________________ О О

76. How would you compare boys and girls in...?

Girls are Girls Girls and boys Boys Boys

much are somewhat are the are somewhat are much

better better same better better

a. Reading О О О О О

b. Math О О О О О

c. Writing О О О О О

d. Science О О О О О

77. How important do you think the following subjects are for your 9th grader to meet (her/his) educational goals?

Extremely Somewhat

Important Important Important Unimportant

a. Reading О О О О

b. Math О О О О

c. Writing О О О О

d. Science О О О О

78. How far in school do you want [9th grader] to go? (Please mark only the highest level that applies)

 Did not finish high school

 Graduated from high school or equivalent (GED)

 Started but have not completed a degree from a 2-year school or college (such as a vocational or technical school or a junior or community college)

 Graduated from a 2-year school (such as a vocational or technical school, a junior college, or a community college)

 Started but have not completed a 4-year college degree

 Graduated from a 4-year college

 Started but have not completed a Master’s degree

 Completed a Master’s degree or equivalent

 Started but have not completed a Ph.D., M.D., or other advanced professional degree program

 Completed a Ph.D., M.D., or other advanced professional degree

79. As things stand now, how far in school do you think [9th grader] will actually get? (Please mark only the highest level that applies)

Not finish high school. 

Graduate from high school or equivalent (GED) 

Graduate from high school and attend a 2-year school (such as a

vocational or technical school, a junior college, or a community college)

but not complete a degree 

Graduate from a 2-year school (such as a vocational or technical school,

a junior college, or a community college) 

Graduate from high school and go to

college but not complete a 4-year degree 

Graduate from college 

Obtain a Master’s degree or equivalent 

Obtain a PhD, MD, or other advanced degree 

Don’t know 

80. (If thinks 9th grader will continue education after high school) Do you think [9th grader] will start (his/her) college education at a:

• Vocational or trade school

• 2-year school

• 4-year school

• I have not thought about this yet

81. Do you or does anyone in your family plan to help [9th grader] pay for (his/her) education after high school?

• Yes

• No

• Or you have not thought about this yet?

82. Did anyone help you to complete this questionnaire?

• Yes

• No

83. Who assisted with questionnaire completion?

• My ninth grader named on the front cover

• Another family member

• One of my friends

• Another person in the community

84. Parent’s Name

________________________________________

Last Name First Name MI

85. Address

__________________________________________

(Include number, street, apartment number, P.O. Box, etc.)

________________________________________

City, State, Zip code

86. Home telephone

(______)___________

Area Code

87. Business phone

(______)__________Ext. ___________

Area Code

88. Cell phone

(______)____________

Area Code

89. E-mail address

______________________________________

90. SSN

-

-

91. Student’s SSN

-

-

92. Nonresident parent’s name

________________________________________

Last Name First Name MI

93. Address

__________________________________________
(Include number, street, apartment number, P.O. Box, etc)

________________________________________

City, State, Zip code

94. Home telephone

(______)___________

Area Code

95. Business phone

(______)__________ Ext. ___________

Area Code

96. Relative’s name

________________________________________

Last Name First Name MI

97. Address

__________________________________________
(Include number, street, apartment number, P.O. Box, etc.)

_______________________________________________
City, State, Zip code

98. Home Telephone

(______)___________

Area Code

99. Relative’s relationship to parent

_________________________________________

100. Close friend’s name

______________________________________________

Last Name First Name MI

101. Address

_________________________________________
(Include number, street, apartment number, P.O. Box, etc.)

_____________________________________________
City, State, Zip code

102. Home Telephone

(______)___________________________

Area Code

Appendix D - 0