National Household Education Survey (NHES) 2009 Study - Cognitive Interviews

National Household Education Survey – Core V1

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► This survey should be filled out by an adult household member living at this address.

► Please use blue or black pen.

1. Is this house owned or being bought, rented, or occupied by some other arrangement by you or someone in your household?

Mark [X] ONE only.

• Owned or being bought

• Rented

• Some other arrangement

2. How many years have you lived at this address? Write “0” if less than 1 year.

|__|__| years at this address

3. Can you or anyone else in this household access the internet from a computer in this household?

• Yes

• No

4. How many female adults age 21 or older live at this address?

|__|__| number of females age 21 or older

5. How many male adults age 21 or older live at this address?

|__|__| number of males age 21 or older

6. Of the adults in this household is there anyone who does not read English well?

• Yes

• No

7. Of the adults in this household is there anyone who does not speak English at home?

• N o Skip to Question 9

• Y es

8. What language do they speak at home?

• Spanish

• Another language

S pecify: |_____________________|

9. What is the highest level of education among the adults in this household?

Mark [X] ONE only.

• 8^th grade or less

• Some high school, but did not graduate

• High school graduate or GED

• Some college or associate’s degree

• Four year college degree (BA or BS)

• Graduate or professional degree beyond a bachelor’s degree

10. What is the best phone number to reach you if your household qualifies for this study?

(__|__|__) |__|__|__| – |__|__|__|__|

11. How many youth or children age 20 or younger live at this address?

|__|__| number age 20 or younger

► If anyone age 20 or younger usually lives in this household, then fill in the rest of this survey.

CHILD 1

► Start with the youngest child who is age 20 or younger.

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

S kip to child 2

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Continue with Child 2. If no one else age 20 or younger lives here return this form in the postage paid envelope provided.

CHILD 2

► Continue with the next youngest child who is age 20 or younger.

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

S kip to child 3

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Continue with Child 3. If no one else age 20 or younger lives here return this form in the postage paid envelope provided.

CHILD 3

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

S kip to child 4

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Continue with Child 4. If no one else age 20 or younger lives here return this form in the postage paid envelope provided.

CHILD 4

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

S kip to child 5

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Continue with Child 5. If no one else age 20 or younger lives here return this form in the postage paid envelope provided.

CHILD 5

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

S kip to child 6

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Continue with Child 6. If no one else age 20 or younger lives here return this form in the postage paid envelope provided.

CHILD 6

1. |__|__|__|__|__|__|__|__|__|__|

First name / initials / nickname

2. How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

3. What is this child’s sex?

• Male

• Female

4. Is this child currently…

Mark [X] ONE only.

• Attending public or private school,

• Home schooled instead of going to public or private school, or

• Not currently in school?

R eturn survey in postage paid envelope.

5. What is this child’s current grade or equivalent?

Mark [X] ONE only.

• Pre-school

• Kindergarten

• 1^st to 12^th grade → specify grade: |__|__|

• Above 12^th grade

► Thank you. Please return this form in the postage paid envelope provided or mail it to:

NHES Study

Westat

1650 Research Blvd.

Rockville, MD 20850