National Household Education Survey (NHES) 2009 Study - Cognitive Interviews
System Clearance for Cognitive, Pilot and Field Test Studies
PFI Homeschooled Mail Draft
National Household Education Survey (NHES) 2009 Study - Cognitive Interviews
OMB: 1850-0803
2009 National Household Education Surveys
Parent
and Family Involvement
in
Education Survey
For
parents of homeschooled children
DRAFT: December 29, 2008
THE National Household Education Survey
Start Here
We
ask that this survey be filled in by the adult who knows the most
about:
{FILL SAMPLED CHILD}
Please answer all the survey questions thinking about this child or youth.
If
there is no one in this household who has either the same age or
grade given above, or if you are unable to tell which child this
survey is about, please call 1-888-696-5670.
To
answer a question, simply mark
the
box that best represents your answer.
Use a black or blue pen to complete this survey. Do not use felt-tip pen or pencil.
In
response to our first survey, we recorded that the child/youth is
currently homeschooled. If this child attends either public or
private school instead of homeschooling mark the box below and return
this survey in the postage paid envelope and we will send you the
correct survey for this child.
This child attends either public or private school
If this child is currently enrolled in preschool or nursery school, or is not in homeschool grades Kindergarten through 12th or equivalent, mark the box below and return this survey in the postage paid envelope. We will send you the correct survey for this child.
This child is in preschool, nursery school, or not yet in school.
Please
go to then next page and start this survey.
The Privacy Act requires us to tell you that we are authorized to collect this information by Section 411.285a, 42 USC. You do not have to provide the information requested. However, the information you provide will help the Department of Education’s ongoing efforts to learn more about the educational experiences of children and families. There are no penalties should you choose not to participate in this study.
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: National Center for Education Statistics, U.S. Department of Education, 1990 K Street NW, Room 9065, Washington, DC 20006-5650. Do not return the completed form to this address.
Section 1: Your Child’s Homeschooling
1. Is this child getting all of his/her instruction at home, or is he/she getting some at school and some at home?
A
ll
at home GO TO QUESTION 3Some at school & some at home
H
e/she
is not homeschooled at all DO NOT CONTINUE, PLEASE CALL
1-888-696-5670
2. How many hours each week does this child usually go to a school for instruction? Do not include time spent in extracurricular activities.
|___|___|: Hours
3. What grade or year would this child be in if he/she was attending school?
Mark only one.
P
reschool DO
NOT CONTINUE, PLEASE CALL 1-888-696-5670Kindergarten (including Transitional K and Pre-first grade)
First grade
Second grade
Third grade
Fourth grade
Fifth grade
Sixth grade
Seventh grade
Eighth grade
Ninth grade (freshman)
Tenth grade (sophomore)
Eleventh grade (junior)
Twelfth grade (senior)
4. Who is the person that mainly homeschools this child?
Mother
Father
Grandparent
Brother/sister
Another person
Who is that?_________________________
5. Is any of this child’s home instruction taught by a private tutor or teacher?
Yes
No
6. How many days each week is this child homeschooled?
|___| Days
7. About how many total hours per week is he/she homeschooled?
|___||___| Hours
8. Does your family participate in the activities or meetings of a local homeschooling association or other local homeschool group?
Yes
N
o GO
TO QUESTION 10
9. Since September, how many times has your family gone to meetings or participated in the activities of a local homeschooling association or other local homeschool group?
______ Number of times
10. Since September, has this child participated in activities with other children who are homeschooled?
Yes
No
11. Thinking about sources of curriculum or books you use to homeschool this child, please tell us about all the sources that apply to you. In homeschooling this child, have you used materials from any of the following sources?
-
Yes
▼
No
▼
a.
A public library
□
□
b.
Any obtained directly from a homeschooling catalog, publisher, or individual who specializes in homeschooling materials
□
□
c.
Any obtained directly from another educational publisher
□
□
d.
A homeschooling organization
□
□
e.
A church, synagogue, or other religious organization
□
□
f.
Your local public school or school district
□
□
g.
A private school
□
□
h.
A retail bookstore or other store
□
□
i.
Internet sites
□
□
12. Some homeschooled children take courses over the internet taught by people outside the household. Is this child receiving any instruction this way?
Yes
N
o GO
TO QUESTION 14
13. Is that instruction provided by your public school?
Yes
No
14. Thinking about typical grade levels, for which grades was this child schooled at home for at least some classes or subjects?
[PRINT ONLY GRADES (E-elementary, M-middle, OR S-senior high) UP TO THOSE ELIGIBLE FROM SCREENER.]
[MAY PERFORM BETTER AS A SELECT ALL THAT APPLY.
-
Yes
▼
No
▼
a.
All Grades
□
□
b.
Kindergarten
□
□
c.
First grade
□
□
d.
Second grade
□
□
e.
Third grade
□
□
f.
Fourth grade
□
□
g.
Fifth grade
□
□
h.
Sixth grade
□
□
i.
Seventh grade
□
□
j.
Eighth grade
□
□
k.
Ninth grade
□
□
l.
Tenth grade
□
□
m.
Eleventh grade
□
□
n.
Twelfth grade
□
□
15. There are many different reasons that parents choose to homeschool their children. Did you choose to homeschool this child because:
-
Yes
▼
No
▼
a.
You are concerned about the school environment, such as safety, drugs, or negative peer pressure.
□
□
b.
You are dissatisfied with the academic instruction at other schools.
□
□
c.
You prefer to teach this child at home so that you can provide religious or moral instruction.
□
□
d.
This child has a physical or mental health problem that has lasted six months or more.
□
□
e.
This child has a temporary illness that prevents him/her from going to school.
□
□
f.
This child has other special needs that you feel the school can’t or won’t meet.
□
□
g.
You are interested in a nontraditional approach to children’s education.
□
□
h.
You have another reason for homeschooling your child.
□
□
Write your other reason: →
16. Of the reasons you choose to homeschool your child, which one would you say is the most important to you?
[NOTE: IN CATI ONLY OPTIONS SELECTED IN QUESTION 16 WERE DISPLAYED.
-
Yes
▼
No
▼
a.
You are concerned about the school environment, such as safety, drugs, or negative peer pressure.
□
□
b.
You are dissatisfied with the academic instruction at other schools.
□
□
c.
You prefer to teach this child at home so that you can provide religious or moral instruction.
□
□
d.
This child has a physical or mental health problem that has lasted six months or more.
□
□
e.
This child has a temporary illness that prevents him/her from going to school.
□
□
f.
This child has other special needs that you feel the school can’t or won’t meet.
□
□
g.
You are interested in a nontraditional approach to children’s education.
□
□
h.
You have another reason for homeschooling your child.
□
□
Write your other reason: →
17. How far do you expect this child to go in his/her education?
Mark only one.
Complete less than a high school diploma
Graduate from high school
Attend a vocational or technical school after high school
Attend two or more years of college
Earn a bachelor’s degree
Earn a graduate degree or professional degree beyond a bachelor's
Section 2: Family Activities
! |
If this child is in kindergarten, 1st, 2nd, 3rd, 4th, or 5th grade continue with QUESTION 18 If he/she is in any other grade GO TO QUESTION 19. |
18. In the past week, has anyone in the family done the following things with this child?
-
Yes
▼
No
▼
a.
Told him/her a story
□
□
b.
Done activities like coloring, painting, pasting, or using clay
□
□
c.
Played board games or did puzzles with him/her
□
□
19. In the past week, has anyone in the family done the following things with this child?
-
Yes
▼
No
▼
a.
Worked on a project with him/her like arts and crafts, building, making, or fixing something
□
□
b.
Played sports, active games, or exercised together
□
□
c
Discussed with him/her how to manage time
□
□
d.
Talked with him/her about the family’s history or ethnic heritage
□
□
20. In the past month, has anyone in the family done the following things with this child?
-
Yes
▼
No
▼
a.
Visited a library
□
□
b.
Visited a bookstore
□
□
c.
Gone to a play, concert, or other live show
□
□
d.
Visited an art gallery, museum, or historical site
□
□
e.
Visited a zoo or aquarium
□
□
f.
Attended an event sponsored by a community, religious, or ethnic group
□
□
g.
Attended an athletic or sporting event outside of school in which this child was not a player
□
□
Section 3: This Child’s Health
21. In general, how would you describe this child’s health?
Excellent
Very good
Good
Fair
Poor
22. Has a health professional told you that this child has any of the following disabilities?
-
Yes
▼
No
▼
a.
A specific learning disability
□
□
b.
Mental retardation
□
□
c.
A speech or language delay
□
□
d.
A serious emotional disturbance
□
□
e.
Deafness or another hearing impairment
□
□
f.
Blindness or another visual impairment not corrected with glasses
□
□
g.
An orthopedic impairment
□
□
h.
Autism
□
□
i.
Attention deficit disorder, ADD or ADHD
□
□
j.
Pervasive Developmental Disorder or PDD
□
□
k.
Another health impairment lasting 6 months or more
□
□
! |
If you marked yes for any disability in QUESTION 22 continue with this section. If you marked no for all disabilities then GO TO QUESTION 30. |
23. Is this child receiving services for his/her condition?
Yes
N
o GO
TO QUESTION 28
24. Are these services provided by any of the following sources?
-
Yes
▼
No
▼
a.
Your local school district
□
□
b.
A state or local health or social service agency
□
□
c.
A doctor, clinic, or other health care provider
□
□
25. Are any of these services provided through an Individualized Educational Program or Plan, or IEP?
Yes
N
o
GO TO QUESTION 28
26. Did any adult in your household work with the school to develop or change this child’s IEP?
Yes
No
27. During this school year, to what extent have you been satisfied or dissatisfied with the following aspects of this child’s IEP (Individualized Education Program or Plan)?
-
Very satisfied
▼
Somewhat satisfied
▼
Somewhat dissatisfied
▼
Very dissatisfied
▼
Does not apply
▼
a.
The school’s communication with your family
□
□
□
□
□
b.
The child’s special needs teacher or therapist
□
□
□
□
□
c.
The school’s ability to accommodate the child’s special needs
□
□
□
□
□
d.
The school’s commitment to help your child learn
□
□
□
□
□
28. Is this child currently enrolled in any special education classes or services?
Yes
No
29. Does this child’s disability affect his/her ability to learn?
Yes
No
Section 4: Your Child’s Background
30. In what month and year was this child born?
|___|___| |___|___|___|___|
MONTH YEAR
31. Where was this child born?
O
ne
of the 50 states or the District of
Columbia GO TO QUESTION 33One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Some other country
32. How old was this child when he/she first moved to the 50 states or the District of Columbia?
|___|___| AGE
33. Is this child of Spanish, Hispanic, or Latino origin?
Yes
No
34. What is this child’s race? You may mark more than one.
Mark [X] all that apply.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
35. What language does this child speak most at home?
Mark [X] only one.
E
nglish GO
TO SECTION 5Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
36. Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program?
Yes
No
Section 5: Child’s Mother or Female Guardian
37. Does this child have a mother, stepmother or female guardian living in the same household?
Yes
N
o GO
TO SECTION 6
38. Is this person the child’s…
Birth mother,
Adoptive mother,
Stepmother,
Foster mother,
Grandmother, or
Other female guardian?
39. How old was this woman when she first became a mother or guardian to any child?
|___|___| AGE
40. What is the marital status of this child’s mother or female guardian?
Married
Separated
Divorced
Widowed
Never married
4
1. What
was the first language this child’s mother or female
guardian learned to speak?
Mark [X] only one.
E
nglish GO
TO QUESTION 43Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
42. What language does she speak most at home now?
Mark [X] only one.
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
43. Where was this child’s mother or female guardian born?
O
ne
of the 50 United States or the District of
Columbia GO TO QUESTION 45One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Some other country
44. How old was she when she first moved to the 50 United States or the District of Columbia?
|___|___| AGE
45. Is she of Spanish, Hispanic, or Latino origin?
Yes
No
46. What is her race? You may mark more than one.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander?
47. What is the highest grade or year of school that she completed?
Up to 8th grade
High School, but no diploma
High school diploma or equivalent (GED)
Vocational diploma after high school
Some college, but no degree
Associates degree (AA, AS)
Bachelor’s degree (BA, BS)
Master’s degree (MA, MS)
Doctorate Degree (PhD, EDD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)
48. Is she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?
Yes
No
49. Which of the following best describes her employment status?
Mark [X] only one.
Employed for pay or income
Self employed
O
ut
of work for more than one year GO TO QUESTION 51Out of work for less than one year
A
homemakerR
etired GO
TO QUESTION 52Disabled or unable to work
50. (Employed or Self employed:) About how many hours per week does she usually work for pay or income, counting all jobs?
|___|___| GO TO QUESTION 52
HOURS
51. (Out of work:) Has she been actively looking for work in the past 4 weeks?
Yes
No
52. In the past 12 months, how many months (if any) has she worked for pay or income?
|___|___|
MONTHS
Section 6: Child’s Father or Male Guardian.
53. Does this child have a father, stepfather or male guardian living in the same household?
Yes
N
o GO
TO SECTION 7
54. Is this person the child’s…
Birth father,
Adoptive father,
Stepfather,
Foster father,
Grandfather, or
Other male guardian?
55. What is the marital status of this child’s father or male guardian?
Married
Separated
Divorced
Widowed
Never married
56. What was the first language the child’s father or male guardian learned to speak?
Mark [X] only one.
E
nglish
GO TO QUESTION 58Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
57. What language does he speak most at home now?
Mark [X] only one.
English
Spanish
A language other than English or Spanish
English and Spanish equally
English and another language equally
58. Where was this child’s father or male guardian born?
O
ne
of the 50 United States or the District of
Columbia GO TO QUESTION 67One of the U.S. territories (Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, or Mariana Islands)
Some other country
59. How old was he when he first moved to the 50 United States or the District of Columbia?
|___|___| AGE
60. Is he of Spanish, Hispanic, or Latino origin?
Yes
No
61. What is his race?
Mark [X] all that apply.
White
Black or African American
American Indian or Alaska Native
Asian
Native Hawaiian or other Pacific Islander
62. What is the highest grade or year of school that he completed?
Up to 8th grade
High School, but no diploma
High school diploma or equivalent (GED)
Vocational diploma after high school
Some college, but no degree
Associates degree (AA, AS)
Bachelor’s degree (BA, BS)
Master’s degree (MA, MS)
Doctorate Degree (PhD, EDD)
Professional degree beyond Bachelor’s degree (MD, DDS, JD, LLB)
63. Is he currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training?
Yes
No
64. Which of the following best describes his employment status?
Mark [X] only one.
Employed for pay or income
Self employed
O
ut
of work for more than one year GO TO QUESTION 66Out of work for less than one year
A
homemakerR
etired
GO TO QUESTION 67Disabled or unable to work
65. (Employed of self employed:) About how many hours per week does he usually work for pay or income, counting all jobs?
|___|___| GO TO QUESTION 67
HOURS
66. (Out of work:) Has he been actively looking for work in the past 4 weeks?
Yes
No
67. In the past 12 months, how many months (if any) has he worked for pay or income?
|___|___|
MONTHS
Section 7: Your Household
68. Please mark all of the people who live in the household with this child, including yourself and those you have already been asked about.
Mark [X] all that apply.
Mother (including birth, adoptive, step, or foster mothers)
Father (including birth, adoptive, step, or foster fathers)
Brother (full, half, adoptive, step, or foster brothers)
Sister (full, half, adoptive, step, or foster sisters)
Aunt
Uncle
Grandmother
Grandfather
Cousin
Other relative
Same sex parent
Girlfriend or partner of this child’s parent or guardian
Boyfriend or partner of this child’s parent or guardian
Other nonrelatives
69. In the past 12 months did your family ever receive benefits from any of the following programs?
-
Yes
▼
No
▼
a.
Temporary Assistance for Needy Families, or TANF
□
□
b.
Your state welfare or family assistance program
□
□
c.
Women, Infants, and Children, or WIC
□
□
d.
Food Stamps
□
□
e.
Medicaid
□
□
f.
Child Health Insurance Program (CHIP)
□
□
g.
Section 8 Housing assistance
□
□
70. In studies like this, households are sometimes grouped according to income. What was the total income of all persons in your household over the past year, including salaries or other earnings, interest, retirement, and so on?
$0 to $10,000
$10,001 to $20,000
$20,001 to $30,000
$30,001 to $40,000
$40,001 to $50,000
$50,001 to $60,000
$60,000 to $75,000
$75,001 to $100,000
$100,001 to $150,000
$150,001 or more
Thank you.
Please return this questionnaire in the postage-paid envelope provided. If you have lost the envelope, mail the completed questionnaire to:
National Household Education Survey
1650 Research Blvd. Room XXXX
Rockville, MD 20850
| File Type | application/msword |
| File Title | WESTAT.DOT |
| Subject | Default Westat Styles |
| Last Modified By | #Administrator |
| File Modified | 2009-02-23 |
| File Created | 2009-02-23 |
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