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pdf2010 National Household Education Surveys Program
Early Childhood Program Participation Survey
REVISED: February 23, 2010
OMB No. 1850-0768
Approval Expires 08/31/2010
The National Household Education Survey
Our Children’s Future: A Survey of Young Children’s Care and Education
Thank you for helping us with this
survey. Based on the information
we received from your household
in your last survey, we’re asking
you to complete this final step.
Sponsored by
U.S. Department of Education
National Center for Education Statistics
Instructions
In response to the survey you answered earlier, we recorded that the
child/youth listed below has not yet started kindergarten. If this child is
attending public or private school or is homeschooled for kindergarten through
12th grade or equivalent, please call us at the toll-free number below so we can
be sure you received the correct survey.
These questions should be filled in by a parent or guardian who knows about:
{SAMPLED CHILD}
Please answer all the survey questions thinking about this child or youth.
This information is also at the top of each page for your reference.
the box that best represents your answer.
To answer a question, simply mark
Please use a black or blue pen, if available, to complete this survey.
If this questionnaire has been sent to the wrong household or the child/youth
listed above does not live here, please call to let us know.
Our toll-free number is 1-888-880-3033.
We are authorized to collect this information by Section 9543, 20 US Code. 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. Your answers may be used only for statistical
purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required
by law (Section 9573, 20 US Code). Your responses will be combined with those from other participants
to produce summary statistics and reports.
This survey is estimated to take an average of 20 minutes, including time for reviewing instructions, 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: Andrew Zukerberg National Center for
Education Statistics, U.S. Department of Education, 1990 K Street NW, Room 9036, Washington, DC
20006-5650. Do not return the completed form to this address.
1
1. Childhood Care and
Programs
4. How old is the relative who provides the
most care to this child?
► Thank you for your help with the
previous survey your household
completed.
age
5. Is this care provided in your home or
another home?
► Answer all the survey questions
thinking about the child listed below:
■ Own home
■ Other home
■ Both
{SAMPLED CHILD}
► Care Your Child Receives from
Relatives
6. How many days each week does this child
receive care from this relative?
These questions ask about different types
of child care this child may now receive on a
regular basis from someone other than his/her
parents or guardians.
|__| days each week
7. How many hours each week does this child
receive care from this relative?
|__|__| hours each week
1. Is this child now receiving care from a
relative other than a parent on a regular
basis, for example, from grandparents,
brothers or sisters, or any other relatives?
■ No
■ Yes
8. How old was this child in years and months
when this particular regular care
arrangement with this relative began?
|__ years
GO TO question 17
9. What language does this relative speak most
when caring for this child?
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
2. Are any of these care arrangements
regularly scheduled at least once a week?
■ No
■ Yes
GO TO question 17
3. These next questions are about the care that
this child receives from the relative who
provides the most care. How is that relative
related to this child?
Mark
months
ONE only.
■ Grandmother/Grandfather
■ Aunt /Uncle
■ Brother /Sister
■ Another relative
1
10. Will this relative care for this child when the
child is…
No
▼
13. How much does your household pay for
this relative to care for this child, not
counting any money that may be received
from others to help pay for care?
Yes
▼
Write ‘0’ if your household does not pay this
relative for care.
a. Sick but does not have a
fever? ....................................
$
b. Sick and has a fever? ...........
Is that amount per…
GO TO question 15
12. Do any of the following people, programs, or
organizations help pay for this relative to care
for this child?
Mark
ONE box for each item below.
No
▼
Round to
the nearest
dollar.
■ Hour
■ Day
■ Week
■ Month
■ Year
■ Every 2 weeks
■ Other
Specify: ____________
11. Is there any charge or fee for the care this
child receives from this relative, paid either
by you or some other person or agency?
■ No
■ Yes
.00
14. How many children from your household is
this amount for, including this child?
Yes
▼
■ This child only
■ 2 children
■ 3 children
■ 4 children
■ 5 or more children
a. A relative of this child outside
your household who provides
money specifically for that
care, not including general
child support? ...........................
b. Temporary Assistance for
Needy Families, or TANF? .......
c. Another social service, welfare,
or child care agency? ...............
15. Does this child have any other care
arrangements with a relative on a regular
basis?
d. An employer, not including a
tax-free spending account for
child care? ................................
■ No
■ Yes
e. Someone else? ........................
GO TO question 17
16. How many total hours each week does this
child spend in those other care
arrangements with relatives?
|__|_ hours each week
2
► Care Your Child Receives from Nonrelatives
22. How many hours each week does this child
receive care from this person?
The next questions ask about any care this
child receives from someone not related to
him/her, either in your home or someone else’s
home. This includes home child care providers
or neighbors, but not day care centers or
preschools.
hours each week
23. How old was this child in years and months
when this particular regular care
arrangement with this person began?
17. Is this child now receiving care in your
home or another home on a regular basis
from someone who is not related to
him/her?
■ No
■ Yes
years
24. Was this care provider someone you already
knew?
■ No
■ Yes
GO TO question 34
25. Is this child’s care provider age 18 or older?
18. Are any of these care arrangements
regularly scheduled at least once a week?
■ No
■ Yes
months
■ No
■ Yes
GO TO question 34
26. What language does this care provider
speak most when caring for this child?
19. These next questions are about the care that
this child receives from someone who is not
related to him/her who provides the most
care.
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
Is this care provided in your own home or in
another home?
■ Own home
■ Other home
■ Both
27. Will this care provider care for this child
when this child is…
20. Does this person who cares for this child
live in your household?
No
▼
■ No
■ Yes
a. Sick but does not have a
fever? ....................................
b. Sick and has a fever? ............
21. How many days each week does this child
receive care from this person?
days each week
3
Yes
▼
27A. Would you recommend this care provider
to another parent?
30. How much does your household pay for this
person to care for this child, not counting any
money that may be received from others to
help pay for care?
■ No
■ Yes
Write ‘0’ if your household does not pay this
non-relative for care.
28. Is there any charge or fee for the care this
child receives from this care provider, paid
either by you or some other person or
agency?
■ No
■ Yes
$
Is that amount per…
■ Hour
■ Day
■ Week
■ Month
■ Year
■ Every 2 weeks
■ Other
Specify:
GO TO question 32
29. Do any of the following people, programs, or
organizations help pay for this person to care
for this child?
Mark
ONE box for each item below.
No
▼
.00
Yes
▼
Round to
the nearest
dollar.
31. How many children from your household is
this amount for, including this child?
a. A relative of this child outside
your household who provides
money specifically for that
care, not including general
child support? .........................
■ This child only
■ 2 children
■ 3 children
■ 4 children
■ 5 or more children
b. Temporary Assistance for
Needy Families, or TANF? .....
c. Another social service,
welfare, or child care agency?
32. Does this child have any other care
arrangements with someone who is not a
relative on a regular basis? Do not include
arrangements at day care centers or
preschools.
d. An employer, not including a
tax-free spending account for
child care? ..............................
■ No
■ Yes
e. Someone else? .......................
GO TO question 34
33. How many total hours each week does this
child spend in those other care
arrangements with non-relatives?
hours each week
4
► Day Care Centers and Preschool
Programs Your Child Attends
C. Where is this program located?
Mark
■ In a church, synagogue, or other place of
worship
The next questions ask about any day
care centers and early childhood programs that
this child attends. This does not include care
provided in a private home
.
■ In a public elementary or secondary school
■ In a private elementary or secondary school
■ At a college or university
■ At a community center
■ At a public library
■ In its own building, office space, or storefront
■ Some other place
34. Is this child now attending a day care center,
preschool, or prekindergarten not in a
private home?
■ No
■ Yes
GO TO question 50
35. Does this child go to a day care center,
preschool, or prekindergarten, at least once
each week?
■ No
■ Yes
ONE only.
Specify:
37. Is this program run by a church,
synagogue, or other religious group?
GO TO question 50
■ No
■ Yes
36. The next questions ask about the program
where this child spends the most time.
38. Is this program located at your workplace or
this child’s other parent’s workplace?
A. Is this child’s program a day care program,
a preschool program, or a prekindergarten
program?
■ No
■ Yes
■ Day care
■ Preschool
■ Prekindergarten
39. How many days each week does this child
go to this program?
days each week
40. How many hours each week does this child
go to this program?
B. Is this program a Head Start or Early Head
Start program?
■ No
■ Yes
hours each week
41. How old was this child in years and months
when he/she started going to this particular
program?
Head Start and Early
Head Start are federally
sponsored preschool programs
primarily for children from lowincome families.
years
5
months
45. Do any of the following people, programs, or
organizations help pay for this child to go to
this program?
42. What language does this child’s main care
provider or teacher at this program speak
most when caring for this child?
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
Mark
No
▼
b. Temporary Assistance for
Needy Families, or TANF? .......
c. Another social service,
welfare, or child care agency? .
■ No
■ Yes
d. An employer, not including a
tax-free spending account for
child care? ................................
43. Does this program provide any of the
following services to this child or your
family?
e. Someone else? ........................
46. How much does your household pay for this
child to go to this program, not counting
any money that you may receive from others
to help pay for care?
ONE box for each item below.
No
▼
Yes
▼
Write ‘0’ if your household does not pay for that
program.
a. Hearing, speech, or vision
testing?................................
$
b. Physical examinations? ......
.00
Is that amount per…
c. Dental examinations? .........
■ Hour
■ Day
■ Week
■ Month
■ Year
■ Every 2 weeks
■ Other
Specify:
d. Formal testing for
developmental or learning
problems? ...........................
e. Sick child care when this
child is sick but does not
have a fever? ......................
f. Sick child care when this
child is sick and has a
fever? ..................................
44. Is there any charge or fee for this program,
paid either by you or some other person or
agency?
■ No
■ Yes
Yes
▼
a. A relative of this child outside
your household who provides
money specifically for that
care, not including general
child support? ...........................
42A. Would you recommend this program to
another parent?
Mark
ONE box for each item below.
GO TO question 48
6
Round to
the nearest
dollar.
2. Finding and Choosing
Care for Your Child
47. How many children from your household is
this amount for, including this child?
■ This child only
■ 2 children
■ 3 children
■ 4 children
■ 5 or more children
50. In the past year, has this child ever attended
a Head Start or Early Head Start program?
■ No
■ Yes
48 . Does this child have any other care
arrangements at a day care center or
preschool on a regular basis?
■ No
■ Yes
Head Start and Early
Head Start are federally
sponsored preschool programs
primarily for children from lowincome families.
51. Counting all arrangements, how many different
care arrangements has this child had in the
past year?
GO TO question 50
■ None
■ One
■ Two
■ Three
■ Four or more
49. How many total hours each week does this
child spend at those day care centers or
preschools?
hours each week
52. What is the main reason your household
wanted a care program for this child in the
past year?
► Continue with section 2.
■ To provide care when a parent was at work
or school
■ To prepare child for school
■ To provide cultural or language learning
■ To make time for running errands
relaxing
■ Did not have care in the past year
7
or
d. The learning activities at the
arrangement?
53. Do you feel there are good choices for child
care or early childhood programs where you
live?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
■ Don’t know / Have not tried to find care
GO TO question 57
■ No
■ Yes
54. How much difficulty did you have finding
the type of child care or early childhood
program you wanted for this child?
e. The child spending time with other kids
his/her age?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
■ A lot of difficulty
■ Some difficulty
■ A little difficulty
■ No difficulty
■ Did not find the child care program you
f.
wanted
The times during the day that this
caregiver is able to provide care?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
55. How important was each of these reasons
when you chose the child care arrangement or
program where this child spends the most
time?
a. The location of the arrangement?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
g. The number of other children in the
child’s care group?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
b. The cost of the arrangement?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
► Continue with section 3, question 57 on the
next page.
c. The reliability of the arrangement?
■ Not at all important
■ A little important
■ Somewhat important
■ Very important
8
3. Family Activities
c.
The next questions ask about this child’s
activities with family members in the past week
or month.
■ Not at all
■ 1 or 2 times
■ 3 or more times
d. Worked on arts and crafts with this child?
57. About how many books does this child have
of his/her own, including those shared with
brothers or sisters?
■ Not at all
■ 1 or 2 times
■ 3 or more times
number of books
58. How many times have you or someone in
your family read to this child in the past
week?
■ Not at all
■ times
Taught this child songs or music?
61. In the past month, have you or someone in
your family visited a library with this child?
■ No
■ Yes
GO TO question 60
59. About how many minutes on each of those
times do you or someone in your family
read to this child?
► Continue with section 4 on the next page.
minutes
60. In the past week, how many times has
anyone in your family done the following
things with this child?
a. Told this child a story?
■ Not at all
■ 1 or 2 times
■ 3 or more times
b. Taught this child letters, words, or
numbers?
■ Not at all
■ 1 or 2 times
■ 3 or more times
9
4. Things Your Child
May be Learning
67. Is this child able to read story books on
his/her own now?
■ No (please continue with this section)
GO TO section 5
■ Yes
These next questions ask about things
that different children do at different ages. These
things may or may not be true for this child.
68. Does this child ever look at a book and
pretend to read?
■ No
■ Yes
62. Is this child under 2 years old or is he/she 2
years old or older?
■ Under 2 years
■ 2 years or older
GO TO question 70
69. When this child pretends to read a book,
does it sound like a connected story, or
does he/she tell what's in each picture
without much connection between them?
63. Can this child identify the colors red, yellow,
blue, and green by name?
■ Sounds like connected story
■ Tells what’s in each picture
■ Does both
■ No
■ Yes, some of them
■ Yes, all of them
64. Can this child recognize the letters of the
alphabet?
■ No
■ Yes, some of them
■ Yes, most of them
■ Yes, all of them
► Continue with section 5, question 70 on the
next page.
65. How high can this child count?
■ This child cannot count
■ Up to 5
■ Up to 10
■ Up to 20
■ Up to 50
■ Up to 100 or more
66. Can this child write his/her first name, even
if some of the letters are backwards?
■ No
■ Yes
10
5. This Child’s Health
!
70. In general, how would you describe this
child’s health?
■ Excellent
■ Very good
■ Good
■ Fair
■ Poor
72. Is this child receiving services for his/her
condition?
■ No
■ Yes
GO TO question 77
73. Are these services provided by any of the
following sources?
71. Has a health professional told you that this
child has any of the following conditions?
Mark
If you marked yes for any condition in
question 71 continue with question 72. If
you marked no for all conditions then GO
TO question 79, the next section.
Mark
ONE box for each item below.
No
▼
ONE box for each item below.
No
▼
Yes
▼
a. Your local school district ..........
Yes
▼
b. A state or local health or social
service agency .........................
a. A specific learning disability ..
b. An orthopedic impairment .....
c. A doctor, clinic, or other health
care provider ............................
c. A speech or language delay .
d. A serious emotional
disturbance ...........................
74. Are any of these services provided through
an Individualized Family Service Plan (IFSP),
or an Individualized Educational Program or
Plan (IEP)?
e. Deafness or another hearing
impairment ............................
■ No
■ Yes
f. Blindness or another visual
impairment not corrected with
glasses ..................................
GO TO question 77
75. Did any adult in your household work with
the service provider or school to develop or
change this child’s IFSP or IEP?
g. Mental retardation .................
h. Autism ...................................
■ No
■ Yes
i. Attention deficit disorder, ADD
or ADHD................................
j. Pervasive Developmental
Disorder or PDD ...................
k. Another health impairment
lasting 6 months or more ......
11
76. During this school year, to what extent have
you been satisfied or dissatisfied with the
following aspects of this child’s IFSP or
IEP?
d. The service provider’s or school’s
commitment to help your child learn?
■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply
a. The service provider’s or school’s
communication with your family?
■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply
77. Is this child currently enrolled in any special
education classes or services?
■ No
■ Yes
b. The child’s special needs teacher or
therapist?
■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply
78. Does this child’s condition affect his/her
ability to learn?
■ No
■ Yes
► Continue with section 6, question 79 on the
next page.
c. The service provider’s or school’s ability
to accommodate the child’s special
needs?
■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply
12
6. Child’s Background
84. For this school year, does this child usually
live at this address or another address (for
example because of a joint custody
arrangement)?
79. In what month and year was this child born?
month
year
Do not include vacation properties.
■ Child usually lives at this address
■ Child usually lives at another address
80. Where was this child born?
■ One of the 50 United States or the District
of Columbia
85. What l anguage d oes th is c hild s peak m ost
at home?
GO TO question 82
■ One of the U.S. territories
Mark
(Puerto Rico, Guam, American Samoa,
U.S. Virgin Islands, or Mariana Islands)
ONE only.
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
■ Child has not started to speak
■ Another country
81. How old was this child when he/she first
moved to the 50 United States or the District
of Columbia?
age
82. Is this child of Spanish, Hispanic, or Latino
origin?
!
■ No
■ Yes
If you marked ‘English’ or ‘Child has not
started to speak’ in question 85 GO TO
question 87, otherwise continue with
question 86.
86. Is this child currently enrolled in English as
a second language, bilingual education, or
an English immersion program?
83. What is this child’s race? You may mark
one or more races.
■ American Indian or Alaska Native
■ Asian
■ Black or African American
■ Native Hawaiian or other Pacific Islander
■ White
■ No
■ Yes
► Continue with section 7, question 87 on the
next page.
13
7. Child’s Parents and
Guardians
PARENT 1 - Answer questions 88 to 102 about
the first parent or guardian marked in question 87:
88. Is this parent or guardian the child’s…
■ Birth parent,
■ Adoptive parent,
■ Step parent,
■ Foster parent,
■ Grandparent, or
■ Other guardian
87. Please mark all of the people who live in the
household with this child, including
yourself, and indicate the number where
appropriate
Mark
all that apply.
This child’s…
Number
■ Mother
■ Father
■ Brother
■ Sister
■ Aunt
■ Uncle
■ Grandmother
■ Grandfather
■ Cousin
■ Other relative
■ A girlfriend or female partner of this child’s
89. Is this person male or female?
■ Male
■ Female
90. What is the current marital status of this
parent or guardian?
Mark
ONE only.
■ Married or in a civil union
■ Living with a partner
■ Separated
■ Divorced
■ Widowed
■ Never married
91. What was the first language this parent or
guardian learned to speak?
parent or guardian
■ A boyfriend or male partner of this child’s
Mark
parent or guardian
ONE only.
GO TO question 93
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
■ Other nonrelatives
The following questions are about the adults
in your household who are this child’s parents or
main guardians.
Please answer questions 88 to 102 about the first
parent or guardian marked in question 87 and
questions 103 to 117 about the second parent or
guardian marked in question 87, if applicable.
14
92. What language does this person speak most
at home now?
Mark
97. What is the highest grade or level of school
that this parent or guardian completed?
ONE only.
Mark
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
ONE only.
■ 8 grade or less
■ 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)
■ Some graduate or professional education
th
93. Where was this parent or guardian born?
■ One of the 50 United States or the District
of Columbia
GO TO question 95
but no degree
■ One of the U.S. territories
■ Master’s degree (MA, MS)
■ Doctorate Degree (PhD, EdD)
■ Professional degree beyond Bachelor’s
(Puerto Rico, Guam, American Samoa,
U.S. Virgin Islands, or Mariana Islands)
■ Another country
degree (MD, DDS, JD, LLB)
94. How old was this person when he or she
first moved to the 50 United States or the
District of Columbia?
98. Is he or she currently attending or enrolled
in a school, college, university, or adult
learning center, or receiving vocational
education or job training?
■ No
■ Yes
age
95. Is this person of Spanish, Hispanic, or Latino
origin?
■ No
■ Yes
99. Which of the following best describes this
person’s employment status?
Mark
ONE only.
■ Employed for pay or income
■ Self employed
■ Unemployed or
96. What is this person’s race? You may mark
one or more races.
■ American Indian or Alaska Native
■ Asian
■ Black or African American
■ Native Hawaiian or other Pacific Islander
■ White
out of work
■ Stay at home
GO TO question 101
parent
■ Retired
■ Disabled or
unable to work
15
GO TO question 102
PARENT 2 - Answer questions 103 to 117 about
100. (If employed or self employed) About how
many hours per week does he or she usually
work for pay or income, counting all jobs?
the child’s second parent or guardian marked in
question 87:
103. Is this person the child’s…
GO TO question 102
■ Birth parent,
■ Adoptive parent,
■ Step parent,
■ Foster parent,
■ Grandparent, or
■ Other guardian
hours
101. (If unemployed or out of work) Has this
parent or guardian been actively looking for
work in the past 4 weeks?
■ No
■ Yes
102. In the past 12 months, how many months (if
any) has this person worked for pay or
income?
104. Is this person male or female?
■ Male
■ Female
Months
!
If this child does not have a second
105.What is the current marital status of this
parent or guardian?
parent or guardian who lives in this
Mark
household, GO TO question 121.
ONE only.
■ Married or in a civil union
■ Living with a partner
■ Separated
■ Divorced
■ Widowed
■ Never married
106. What was the first language this parent or
guardian learned to speak?
Mark
ONE only.
GO TO question 108
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
16
112. What is the highest grade or level of school
that this parent or guardian completed?
107.What language does this person speak
most at home now?
Mark
ONE only.
Mark [X] ONE only.
■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
■ 8 grade or less
■ 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)
■ Some graduate or professional education
th
108. Where was this parent or guardian born?
■ One of the 50 United States or the District
of Columbia
GO TO question 110
but no degree
■ One of the U.S. territories
■ Master’s degree (MA, MS)
■ Doctorate Degree (PhD, EdD)
■ Professional degree beyond Bachelor’s
(Puerto Rico, Guam, American Samoa,
U.S. Virgin Islands, or Mariana Islands)
■ Another country
degree (MD, DDS, JD, LLB)
109. How old was this person when he or she
first moved to the 50 United States or the
District of Columbia?
113. Is he or she currently attending or enrolled
in a school, college, university, or adult
learning center, or receiving vocational
education or job training?
■ No
■ Yes
age
110. Is this person of Spanish, Hispanic, or Latino
origin?
■ No
■ Yes
114. Which of the following best describes this
person’s employment status?
Mark
ONE only.
■ Employed for pay or income
■ Self employed
■ Unemployed or
111. What is this person’s race? You may mark
one or more races.
■ American Indian or Alaska Native
■ Asian
■ Black or African American
■ Native Hawaiian or other Pacific Islander
■ White
out of work
GO TO question 116
■ Stay at home
parent
■ Retired
■ Disabled or
unable to work
17
GO TO question 117
123. What is the highest grade or level of school
completed among the adults in this
household?
115. (If employed or self employed) About how
many hours per week does he or she usually
work for pay or income, counting all jobs?
hours
Mark
GO TO question 117
ONE only.
■ 8 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)
■ Some graduate or professional education
th
116. (If unemployed or out of work) Has this
parent or guardian been actively looking for
work in the past 4 weeks?
■ No
■ Yes
117. In the past 12 months, how many months (if
any) has this person worked for pay or
income?
but no degree
■ Graduate or professional degree beyond a
bachelor’s degree
months
124. Is this house…
Mark
ONE only.
■ Owned or being bought by someone in this
8. Your Household
household,
■ Rented by someone in this household, or
■ Occupied by some other arrangement?
121. How old was this child’s birth mother when
she fi rst b ecame a m other o r g uardian to
any child?
125. Other than this address does anyone in this
household currently receive mail at another
address including P.O. Boxes?
Age
■ Don’t know/Child’s birth mother does not live
■ No
■ Yes
in this household.
122. Are there any adults in this household who
do not speak English at home?
■ No
■ Yes
18
9. Questions about You
126. In the past 12 months did your family ever
receive benefits from any of the following
programs?
Mark
These brief questions are about
the adult that filled in this survey.
ONE box for each item below.
No
▼
Yes
▼
128. How are you related to this child?
a. Temporary Assistance for
Needy Families, or TANF ............
Mark
ONE only.
■ Mother/Father
b. Your state welfare or family
assistance program......................
(birth, adoptive, step, or foster)
■ Aunt/Uncle
■ Grandparent
■ Girlfriend/Boyfriend of this child’s parent or
c. Women, Infants, and Children,
or WIC ..........................................
d. Food Stamps................................
e. Medicaid .......................................
guardian
■ Other relationship – Specify:
f. Child Health Insurance Program
(CHIP) ..........................................
g. Section 8 Housing assistance......
127. Which category best fits the total income of all
persons in your household over the past 12
months?
129. Are you male or female?
■ Male
■ Female
Include your own income.
Include money from jobs or other earnings,
pensions, interest, rent, Social Security payments,
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
■ $60,001 to $75,000
■ $75,001 to $100,000
■ $100,001 to $150,000
■ $150,001 or more
130. How old are you?
age
131. How many years have you lived at this
address?
Write ‘0’ if less than 1 year.
years at this address
19
132. Are you the person in this household who
usually opens the mail?
137. Do you have a working cell phone?
■ No
■ Yes
■ No
■ Yes
138. Of all the telephone calls that you receive
are…
133. Did anyone else complete or help with any
part of this survey?
■ all or almost all calls received on cell
■ No
■ Yes
phones,
■ some received on cell phones and some on
regular phones, or
■ very few or none on cell phones?
134. Do you have access to the internet at this
address?
■ No
■ Yes
GO TO END OF SURVEY
GO TO question 136
Thank you.
135. What type of internet access do you have?
Please return this questionnaire in the
postage-paid envelope provided. If you have
lost the envelope, mail the completed
questionnaire to:
Mark [X] ONE only.
■ Cable
■ DSL
■ FIOS
■ Satellite
■ Dial-up
■ Air Card
■ Other
National Household Education Survey
Westat
1600 Research Blvd. Room XXXX
Rockville, MD 20850-3129
136. Is there at least one telephone inside this
home that is currently working and not a cell
phone?
■ No
■ Yes
20
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21
Commonly Asked Questions
Q: How did you get my address?
A: Your address was randomly selected from among all of the home addresses in the nation. It was
selected using scientific sampling methods to represent other households in the U.S.
Q: Why should I take part in this study? Do I have to do this?
A: You represent thousands of other households like yours, and you cannot be replaced. Your
answers and opinions are very important to the success of this study. You may choose not to
answer any or all questions in this survey. In order for the survey to be representative it is
important that you complete and return this questionnaire.
Q: How will the information I provide be used?
A: Your responses will be combined with those of others to produce statistical summaries and reports.
Your individual data will not be reported. Your answers may be used only for statistical purposes
and may not be disclosed, or used, in identifiable form for any other purpose except as required by
law (Section 9573, 20).
Q: Who is sponsoring the study? Is this study conducted by the Federal Government?
A: The National Center for Education Statistics, within the Department of Education is authorized to
conduct this study (Section 9543. 20). Westat has been contracted to conduct this study. This
study has been approved by the Office of Management and Budget, the office that reviews all
federally sponsored surveys. The approval number assigned to this study is 1850-0768. You may
send any comments about this survey, including its length, to the Federal Government. Write to
Andrew Zukerberg, National Center for Education Statistics, U.S. Department of Education, 1990 K
Street NW, Room 9036, Washington, DC 20006-5650.
You may send e-mail to
[email protected].
Q: Who is Westat?
A: Westat is a research company located in Rockville, Maryland. Westat is conducting this survey
under contract to the U.S. Department of Education. If you have any questions about the study
contact Westat toll-free at 1-888-880-3033.
22
| File Type | application/pdf |
| File Title | 2010 National Household Education Surveys Program |
| Author | Timothy Smith |
| File Modified | 2010-02-25 |
| File Created | 2010-02-25 |