National Household Education Survey – Survey V2
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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. How would you rate the quality of your community’s public schools?
Excellent
Good
Fair
Poor
Very poor
2. How would you rate the quality of public schools nationally?
Excellent
Good
Fair
Poor
Very poor
3. What do you feel is the most important subject for today’s high school students?
Mark [X] ONE only.
Mathematics
English
Science
History
Art and music, or
Some other subject
4. Do you agree or disagree with the following statements about schools in your community?
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Agree ▼ |
Disagree ▼ |
a. |
They are safe places during the school day |
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b. |
They are safe places during the evening |
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c. |
They maintain good discipline among students |
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f. |
They maintain good relationships with the community |
□ |
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d. |
Gangs are a problem in the schools |
□ |
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e. |
Bullying is a problem in the schools |
□ |
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5. How many computers are in this household that can access the internet or World Wide Web?
|__|__| number
6. In the past 12 months, has anyone in this household taken any type of training session, seminar, or courses to improve the chances of finding a new job?
Yes
No
7. In the past 12 months, has anyone in this household taken any type of training session, seminar, or courses to improve the chances of keeping a current job?
Yes
No
8. In the past 12 months, has anyone in this household taken any type of training sessions, seminars, or courses related to the following topics?
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Yes ▼ |
No ▼ |
a. |
Computer skills |
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b. |
Stress management |
□ |
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c. |
Health or fitness |
□ |
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d. |
Foreign language |
□ |
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e. |
English as a second language |
□ |
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f. |
Hobbies |
□ |
□ |
g. |
Personal finance |
□ |
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9. Are there 25 or more books in your home right now?
Yes
No
10. Are there a variety of magazines and other reading materials in your home?
Yes
No
11. How many hours per week do you spend reading a book, magazine, or newspaper?
|__|__| hours per week
12. How many years have you lived at this address? Write “0” if less than 1 year.
|__|__| years at this address
13. 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
14. How many female adults age 21 or older live at this address?
|__|__| number of females age 21 or older
15. How many male adults age 21 or older live at this address?
|__|__| number of males age 21 or older
16. Of the adults in this household is there anyone who does not read English well?
Yes
No
17. Of the adults in this household is there anyone who does not speak English at home?
N o Skip to Question 19
Y es
18. What language do they speak at home?
Spanish
Another language
S pecify: |_____________________|
19. What is the highest level of education among the adults in this household?
Mark [X] ONE only.
8th 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
19. What is the best phone number to reach you if your household qualifies for this study?
(__|__|__) |__|__|__| – |__|__|__|__|
20. How many male youth or children age 20 or younger live at this address?
|__|__| number of males age 20 or younger
21. How many female youth or children age 20 or younger live at this address?
|__|__| number of females 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.
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Child 1 ▼ |
Child 2 ▼ |
Child 3 ▼ |
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First name/initials/nickname |
name |
name |
name |
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How old is this child? Write ‘0’ if less than 1 year old. |
|__|__| age in years |
|__|__| age in years |
|__|__| age in years |
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What is this child’s sex? |
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Is this child currently |
Skip to child 2 |
Skip to child 3 |
Skip to child 4 |
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What is this child’s current grade or equivalent? |
|__|__| specify grade
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|__|__| specify grade
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|__|__| specify grade
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Child 4 ▼ |
Child 5 ▼ |
Child 6 ▼ |
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First name/initials/nickname (optional) |
name |
name |
name |
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How old is this child? Write ‘0’ if less than 1 year old. |
|__|__| age in years |
|__|__| age in years |
|__|__| age in years |
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What is this child’s sex? |
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Is this child currently |
Skip to child 5 |
Skip to child 6 |
Return survey |
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What is this child’s current grade or equivalent? |
|__|__| specify grade
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|__|__| specify grade
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|__|__| specify grade
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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 |