Cognitive Interviews for the 2010 National Household Education Survey (NHES) Study Draft Questionnaires

2010 National Household Education Surveys
Parent and Family Involvement
in Education Survey
For parents of children enrolled in school

REVISED: February 23, 2010

OMB No. 1850-0768

Approval Expires 08/31/2010

The National Household Education Survey
A Survey about Students’ and Families’ Experience with Their Schools

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 attends school. If this child is homeschooled
instead of attending public or private school, or if this child has not yet
started kindergarten, 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



To answer a question, simply mark
answer.



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. Child’s Schooling
► Thank you for your help with the
previous survey your household
completed.

th

■ No
■ Yes

{SAMPLED CHILD}
1. This child’s grade may be shown above. To
confirm this child’s grade please mark the
grade or year of school this child is attending.

3. What type of school does this child attend?

■ Private, Catholic
■ Private, religious

ONE only.

■ Child has not yet started kindergarten

GO TO question 6

but not Catholic

Please STOP now and call 1-888-8803033 so we can verify you received the
correct survey.

■ Private, not religious
■ Public school

Kindergarten – Including Transitional K
and Pre-first grade

■ Full-day kindergarten
■ Partial-day kindergarten

4. Is it his/her regularly assigned school?

■ No
■ Yes

Elementary through Middle school

■ First grade
■ Second grade
■ Third grade
■ Fourth grade
■ Fifth grade
■ Sixth grade
■ Seventh grade
■ Eighth grade

th

2. (If enrolled in 9 – 12 grade) Is he/she
currently enrolled in advanced placement
classes?

► Answer all the survey questions
thinking about the child listed below:

Mark

th

If the child is enrolled in 9 grade or
higher (high school) answer question 2,
otherwise GO TO question 3.

5. Is this school a charter school?

■ No
■ Yes

If this child is
not assigned a specific
grade select the grade
he/she would be in at
a school with regular
grades.

6. Did you move to your current neighborhood
so that this child could attend his/her current
school?

■ No
■ Yes

High School

■ Ninth grade - freshman
■ Tenth grade - sophomore
■ Eleventh grade - junior
■ Twelfth grade - senior
1

7. Did you consider other schools for this child?

■ No
■ Yes

13. Please tell us about this child’s grades
during this school year. Overall, across all
subjects, what grades does this child get?

GO TO question 10

■ Mostly A’s
■ Mostly B’s
■ Mostly C’s
■ Mostly D’s and lower
■ This child’s school does not give these

8. In deciding between schools, did you seek
information on the performance of the
schools you were considering, like test
scores, dropout rates, and so on?

■ No
■ Yes

grades

9. Is the school this child attends your first
choice, that is, the school you
wanted most him/her to attend?

14. Since the beginning of this school year, how
many times have any of this child’s
teachers or his/her school contacted any
adult in your household about each of the
following:

■ No
■ Yes

Write ‘0’ if none.

10. Since the beginning of this school year,
has this child been in the same school?

Number

a. Any behavior problems this child
is having in school? ......................

■ No
■ Yes

b. Any problems this child is having
with school work? ..........................

11. In which month did this child start at
his/her current school?

c. Good or improved behavior in
school? .........................................

month (1 through 12)
12. How much do you agree or disagree with
the following statements:

d. Good or improved school work?...
14E. Since the beginning of this school year,
how many days has this child been
absent from school?

“This child enjoys school.”

■ Strongly agree
■ Agree
■ Disagree
■ Strongly disagree

days

► Continue with question 15 on the next
page.

“This child likes his or her teachers.”

■ Strongly agree
■ Agree
■ Disagree
■ Strongly disagree

2

15. Since starting kindergarten, has this child
repeated any grades?

■ No
■ Yes

18. How far do you expect this child to go in
his/her education?

GO TO question 17

Mark

■ Complete less than a high school diploma
■ Graduate from high school
■ Attend a vocational or technical school

16. What grade or grades did he/she repeat?
Mark

all that apply.

Elementary through Middle school

after high school

■ Kindergarten
■ First grade
■ Second grade
■ Third grade
■ Fourth grade
■ Fifth grade
■ Sixth grade
■ Seventh grade
■ Eighth grade

■ Attend two or more years of college
■ Earn a bachelor’s degree
■ Earn a graduate degree or professional
degree beyond a bachelor's

19. How would you describe his/her work at
school?
Mark

ONE only.

■ Excellent
■ Above average
■ Average
■ Below average
■ Failing

High school

■ Ninth grade - freshman
■ Tenth grade - sophomore
■ Eleventh grade - junior
■ Twelfth grade - senior

► Continue with section 2, question 20 on
the next page.

17. Has this child ever had the following
experiences?
Mark

ONE only.

Yes or No for each item below.
No Yes

▼

▼

a. An out of school suspension? .......
b. An in school suspension not
counting detentions? .....................
c. Expelled from school? ...................

3

2. Families & School
22. During this school year, has your family
received any of the following:

20. Since the beginning of this school year, has
any adult in this child’s household done any
of the following things at this child’s school?
Mark

a. Notes or emails specifically about this
child from his/her teachers or school
administrators?

Yes or No for each item below.
No

▼

■ No
■ Yes

Yes

▼

a. Attended a general school
meeting, for example, an
open house, or a back-toschool night. .............................

b. Newsletters, memos, emails, or notices
addressed to all parents?

■ No
■ Yes

b. Attended a meeting of the
parent-teacher organization or
association. ..............................

c. Phone calls specifically about this child
from her/her teachers or school
administrators?

c. Gone to a regularly scheduled
parent-teacher conference
with this child’s teacher. ...........

■ No
■ Yes

d. Attended a school or class
event, such as a play, dance,
sports event, or science fair. ....

23. How well has this child’s school been
doing the following things during this
school year?

e. Served as a volunteer in this
child’s classroom or
elsewhere in the school............
f.

a. Letting you know how this child is doing
in school between report cards.

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all

Participated in fundraising for
the school. ................................

g. Served on a school
committee.

b. Providing information about how to help
this child with homework.

h. Met with a guidance
counselor in person. .................

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all

21. During this school year, how many total
times has any adult in the household gone
to meetings or participated in activities at
this child’s school?
number of times

4

c. Providing information about why this
child is placed in particular groups or
classes.

25. To what extent would you say you are
satisfied or dissatisfied with each of the
following:

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all

a. The school this child attends this year?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied

d. Providing information on your expected
role at this child’s school.

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all

b. The teachers this child has this year?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied

e. Providing information in your family’s
native language.

c. The academic standards of the school?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all
■ Does not apply

f.

d. The order and discipline at the school?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied

Providing information on how to help this
child plan for college or vocational
school.

■ Very well
■ Just ok
■ Not very well
■ Does not do it at all
■ Does not apply

e. The way that school staff interacts with
parents?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied

5

3. Homework
30. Does any adult in your household check to
see that this child’s homework is done?

26. How often does this child do homework,
either at home, at an after-school program,
or somewhere else outside of school?

■ No
■ Yes

■ Less than once a week
■ 1 to 2 days a week
■ 3 to 4 days a week
■ 5 or more days a week
■ Never
GO TO section 4
■ Child does not

31. During this school year, about how many
days in an average week does anyone in your
household help this child with his/her
homework?

■ Less than once a week
■ 1 to 2 days a week
■ 3 to 4 days a week
■ 5 or more days a week
■ Never

have homework

27. In an average week, how many hours does
this child spend on homework outside of
school?
number of hours per week

► Continue with section 4 on the next page.

28. How do you feel about the amount of
homework this child is assigned?

■ The amount is about right
■ It’s too much
■ It’s too little

28A. How does this child feel about the amount
of homework he or she is assigned?

■ The amount is about right
■ It’s too much
■ It’s too little

29. Is there a place in your home that is set
aside for this child to do homework?

■ No
■ Yes
■ Child does not do homework at home

6

4. Family Activities
st

!

nd

rd

34. In the past month, has anyone in your
family done the following things with this
child?
Mark
Yes or No for each item below.

If this child is in kindergarten, 1 , 2 , 3 ,
th
th
4 , or 5 grade continue with question 32.
If he/she is in any other grade GO TO
question 33.

32. In th e p ast week, h as a nyone i n your
family d one th e fo llowing th ings with th is
child?
Mark

No
▼
a. Visited a library .....................

Yes or No for each item below.
No
▼

b. Visited a bookstore ...............

Yes
▼

c.

a. Told him/her a story .......................

d. Visited an art gallery,
museum, or historical site .....

b. Done activities like coloring,
painting, pasting, or using clay ......

e. Visited a zoo or aquarium .....

c. Played board games or did
puzzles with him/her ......................

f.

33. In th e p ast week, h as a nyone i n your
family d one th e fo llowing th ings with th is
child?
Mark

Gone to a play, concert, or
other live show ......................

g. Attended an athletic or
sporting event outside of
school in which this child
was not a player....................

Yes or No for each item below.
No
▼

Attended an event
sponsored by a community,
religious, or ethnic group ......

Yes
▼

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 ..

► Continue with section 5, question 35 on
the next page.

7

Yes
▼

5. Child’s Health

!

35. In general, how would you describe this
child’s health?

■ Excellent
■ Very good
■ Good
■ Fair
■ Poor

37. Is this child receiving services for his/her
condition?

■ No
■ Yes
Mark

Yes or No for each item below.

Yes or No for each item below.
No
▼

No
▼

Yes
▼

b. A state or local health or social
service agency .............................

b. An orthopedic impairment...........

c. A doctor, clinic, or other health
care provider ................................

c. A speech or language delay .......
d. A serious emotional
disturbance .................................

39. Are any of these services provided through
an Individualized Educational Program or
Plan (IEP)?

e. Deafness or another hearing
impairment ..................................

■ No
■ Yes

Blindness or another visual
impairment not corrected with
glasses........................................

■ No
■ Yes

h. Autism .........................................
Attention deficit disorder, ADD
or ADHD .....................................

j.

Pervasive Developmental
Disorder or PDD .........................

GO TO question 42

40. Did any adult in your household work with
the service provider or school to develop or
change this child’s IEP?

g. Mental retardation .......................

i.

Yes
▼

a. Your local school district ..............

a. A specific learning disability........

f.

GO TO question 42

38. Are these services provided by any of the
following sources?

36. 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 36 continue with question 37. If
you marked no for all conditions then GO
TO question 44, the next section.

k. Another health impairment
lasting 6 months or more ............

8

41. During this school year, to what extent
have you been satisfied or dissatisfied
with the following aspects of this child’s
IEP?

42. Is this child currently enrolled in any
special education classes or services?

■ No
■ Yes

a. The service provider’s or school’s
communication with your family?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply

43. Does this child’s condition affect his/her
ability to learn?

■ No
■ Yes

► Continue with Section 6, question 44 on
the next page.

b. The child’s special needs teacher or
therapist?

■ Very satisfied
■ Somewhat satisfied
■ Somewhat dissatisfied
■ Very dissatisfied
■ Does not apply

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

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

9

6. Child’s Background
49. For this school year, does this child usually
live at this address or another address (for
example because of a joint custody
arrangement)?

44. 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

45. Where was this child born?

■ One of the 50 United States or the District
of Columbia

GO TO question 47

50. What language does this child speak most
at home?

■ One of the U.S. territories

(Puerto Rico, Guam, American Samoa,
U.S. Virgin Islands, or Mariana Islands)

Mark

ONE only.

■ English
■ Spanish
■ A language other than English or Spanish
■ English and Spanish equally
■ English and another language equally
■ Child is not able to speak

■ Another country

46. How old was this child when he/she first
moved to the 50 United States or the
District of Columbia?
age

47. Is this child of Spanish, Hispanic, or Latino
origin?

■ No
■ Yes

!

48. What is this child’s race? You may mark
one or more races.

If you marked ‘English’ or ‘Child is not
able to speak’ in question 50 GO TO
question 52, otherwise continue with
question 51.

51. Is this child currently enrolled in English
as a second language, bilingual education,
or an English immersion program?

■ 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.

10

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.

11

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

12

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

13

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

14

GO TO question 117

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

123. What is the highest grade or level of school
completed among the adults in this household?
Mark

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

GO TO question 117

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

124. Is this house…

months

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?

■ No
■ Yes

Age

■ Don’t know/Child’s birth mother does not live
in this household.

122. Are there any adults in this household who
do not speak English at home?

■ No
■ Yes

15

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

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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 question 139

GO TO question 136

135. What type of internet access do you have?
Mark [X] ONE only.

■ Cable
■ DSL
■ FIOS
■ Satellite
■ Dial-up
■ Air Card
■ Other

136. Is there at least one telephone inside this
home that is currently working and not a cell
phone?

■ No
■ Yes

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139. We would like to identify this child’s school so we can include information about the school in
our study.
Using the list of schools below mark
the box next to the school this child attends. If this
child’s school is not in this list, GO TO question 140.
School Name
▼

Address
▼

City
▼

{SCHOOL 1 UP TO ~40
CHARACTERS}

{ADDRESS 1 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 2 UP TO ~40
CHARACTERS}

{ADDRESS 2 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 3 UP TO ~40
CHARACTERS}

{ADDRESS 3 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 4 UP TO ~40
CHARACTERS}

{ADDRESS 4 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 5 UP TO ~40
CHARACTERS}

{ADDRESS 5 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 6 UP TO ~40
CHARACTERS}

{ADDRESS 6 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 7 UP TO ~40
CHARACTERS}

{ADDRESS 7 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 8 UP TO ~40
CHARACTERS}

{ADDRESS 8 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

{SCHOOL 9 UP TO ~40
CHARACTERS}

{ADDRESS 9 UP TO ~30
CHARACTERS}

{CITY UP TO ~15
CH.}

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!

If you found and marked this child’s school in the list provided in question 139 then SKIP this
question and return your survey in the postage paid envelope. Otherwise continue with
question 140.

140. To help us identify the school this child attends, write the name and address of this child’s
school in the spaces below.
S

Please use block or capital letters for

C

H

O

a. School name
SCHOOL NAME

b. School street address
NUMBER AND STREET ADDRESS

c. School city
CITY

d. School state
STATE

e. School zip code
ZIP

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
Westat
1600 Research Blvd. Room XXXX
Rockville, MD 20850-3129

19

O

L

example:

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.

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