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

National Household Education Survey – Core V2

Start Here

► 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.

2 2. Answer these questions for each child age 20 or younger living in this household starting with the youngest child. It may be helpful to list their first name or initials in the space provided.

Child 1

▼

Child 2

▼

Child 3

▼

First name/initials/nickname

name

name

name

How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

|__|__| age in years

|__|__| age in years

What is this child’s sex?

• Male

• Female

• Male

• Female

• Male

• Female

Is this child currently

• Attending public or private school,

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

• N ot currently in school?

Skip to child 2

• Attending public or private school,

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

• N ot currently in school?

Skip to child 3

• Attending public or private school,

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

• N ot currently in school?

Skip to child 4

What is this child’s current grade or equivalent?

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade

Child 4

▼

Child 5

▼

Child 6

▼

First name/initials/nickname

(optional)

name

name

name

How old is this child?

Write ‘0’ if less than 1 year old.

|__|__| age in years

|__|__| age in years

|__|__| age in years

What is this child’s sex?

• Male

• Female

• Male

• Female

• Male

• Female

Is this child currently

• Attending public or private school,

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

• N ot currently in school?

Skip to child 5

• Attending public or private school,

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

• N ot currently in school?

Skip to child 6

• Attending public or private school,

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

• N ot currently in school?

Return survey

What is this child’s current grade or equivalent?

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade

• Pre-school

• Kindergarten

• 1^st to 12^th grade

|__|__| specify grade

• Above 12^th grade