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pdfAPPENDIX D
TEACHER SURVEY
1. Teacher Letter
2. Teacher Questionnaire
TEACHER SURVEY COVER LETTER
Dear [TEACHER NAME]:
Your school is participating in the national Evaluation of the Teacher Incentive Fund (TIF) conducted
by Mathematica Policy Research for the U.S. Department of Education. This important study will produce
valuable information on the impact of performance-based incentive programs on student achievement and
teacher and principal mobility.
As part of the study, a sample of teachers is being asked to complete a Web-based survey this spring
and annually thereafter through spring 2015. You have been selected to be included in this sample. Each
survey will take about 30 minutes of your time. This first survey is designed to learn about teachers’
understanding of the TIF program, your attitude toward it, as well as to collect demographic characteristics,
educational background, and professional experience information.
While your participation is voluntary, the information collected from teachers like you will be
extremely important to the study’s findings. We will mail you a check for $20 in appreciation of your
participation upon receipt of the completed survey this year and each subsequent year.
The information you provide in this survey will be kept strictly confidential and will not be
shared with anyone outside the study team. District officials, principals, and school staff will not
have access to the survey’s data. Responses will be presented only in aggregate form and will not
identify any individual or school.
Please use the information below to access the TIF teacher survey.
Go to https://www.xxxxxxx.org/
At the login screen, enter the following:
Login ID: [username]
Password: [password]
If you have any questions, please contact Annette Luyegu, the deputy survey director, toll free at 866xxx-xxxx, or by email at [email protected].
Thank you for your cooperation and participation in this important study.
Sincerely,
Sheila Heaviside
Survey Director
OMB Control No.: XXXX-XXXX
Expiration Date: XX/XX/20XX
Mathematica Reference No.: 06715
[PROGRAM NAME]
SPRING 2012
TEACHER SURVEY
This survey is part of the evaluation of the Teacher Incentive Fund (TIF), a federally funded initiative on
performance pay for educators. The survey includes questions about your background, your teaching and
other responsibilities, and your involvement in professional development.
We would like you to know that:
1.
This survey is voluntary, but your response is critical for producing valid and reliable data. You may
skip any questions you do not wish to answer; however, we hope that you answer as many questions
as you can. Your answers to questions will not affect your teaching position now or in the future and
will not be shared with any members of the school or district administration or anyone else other than
the researchers. Participation in the teacher survey will not impose any risks to you as a respondent.
If you have any questions about your rights as a research volunteer, you can contact Jennifer
Stavrakos at Public/Private Ventures IRB, toll free 800-755-4778 x4410.
2.
The U.S. Department of Education wants to protect the privacy of individuals who participate in
surveys. All information you provide will be kept strictly confidential and used for research purposes
only. Your answers will be combined with those from other surveys, and no information identifying
individual principals or their schools will be released.
Thank you very much for your help with this survey.
Please return the completed form to:
Mathematica Policy Research, Inc.
707 Alexander Road
Building 3, Suite 304
Princeton, NJ 08540
ATTN:
If you have questions, please contact:
Ms. Xxxx
Phone: 866-xxx-xxxx (toll free)
FAX: 202-863-1763
E-mail: [email protected]
This survey is authorized by law: (1) Sections 171(b) and 173 of the Education Sciences Reform Act of
2002, Pub. L. 107-279 (2002); and (2) Section 9601 of the Elementary and Secondary Education Act
(ESEA), as amended by the No Child Left Behind (NCLB) Act of 2001 (Pub. L. 107-110).
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this
information collection is estimated to average 30 minutes per respondent, including the time to review instructions, gather the data needed,
and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have comments or
concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of
Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.
A. YOUR EDUCATION AND CERTIFICATION
A1.
Please tell us about your educational degrees.
Column A:
Indicate whether you hold each of the degrees.
Column B:
For each degree that you hold, indicate the name of the college or institution
from which you received that degree.
Column C:
Indicate the major field(s) of study using the Field of Study Codes table
below.
Column D:
Indicate the year in which this degree was awarded.
Note: If you have more than one bachelor’s or master’s degree, in Columns B-D, provide information on
the most recently received degree.
IN EACH ROW, MARK ONE BOX IN
COLUMN A.
IF YOU ANSWER YES IN COLUMN
A, COMPLETE COLUMNS B-D.
A. Degree
Held
Yes
No
B. Name, city, and state of
awarding institution
C. Major
Code
D. Year
Awarded
_____________________
Bachelor’s degree ....................
1
0
_____________________
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Master’s degree .......................
1
0
_____________________
_____________________
Doctorate degree .....................
1
0
_____________________
Other degree (Please specify)
________________________ ......
_____________________
1
0
_____________________
Field of Study Codes
General Education
Elementary Education
101 Early childhood or pre-K, general
102 Elementary grades, general
Other Education
131 Administration
132 Counseling and guidance
133 Educational psychology
134 Policy studies
135 School psychology
136 Other non-subject-matter-specific education
Secondary Education
103 Middle grades, general
104 Secondary grades, general
110
Special Education
Subject Matter-Specific
014
015
016
017
018
019
Arts and music
English and language arts
English as a Second Language (ESL)
Foreign languages
Health or physical education
Mathematics or computer science
020
021
022
023
024
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Spring 2012 Teacher Survey
Natural sciences
Social sciences (includes history, economics,
government, etc.)
Vocational, career, or technical education
Humanities (includes philosophy, religion)
Other
A2.
Which of the following best describes the teaching certificate you currently hold in THIS
state? Mark one box only.
1
2
3
4
5
A3.
Regular or standard certificate or advanced professional certificate.
Certificate issued after satisfying all requirements except the completion of a probationary
period.
Certificate that requires some additional college coursework, student teaching, or passage of
a test before regular certification can be obtained.
Certificate issued to persons who must complete a certification program in order to continue
teaching.
I do not hold any of the above certifications in THIS state.
Go to Question A5.
In what area(s) does the teaching certificate marked in A2 above allow you to teach in this
state? Mark all that apply.
Preschool (birth-Pre-K) .................................................................................. 1
Elementary (K-5) ............................................................................................ 2
Middle grades (6-8)........................................................................................ 3
Secondary grades (9-12) ............................................................................... 4
Specific subject areas (K-12) (Specify area) ____________________ ....... 5
Exceptional children (K-12) (Specify area) ______________________ ....... 6
Other (Specify): ___________________________________________ ....... 7
A4.
Which of the following statements best describes the way that you obtained your
certification? Mark one answer only.
1
Through a traditional teacher certification program as part of a bachelor’s degree
2
Through a traditional teacher certification program as a “5th year” or master’s degree
3
Through the Teach For America (TFA) program
4
Through an alternative route to certification (other than TFA)
5
Other (Specify): ____________________________________
A5.
Do you have, or are you currently pursuing, National Board Certification?
1
Yes
0
No
a. Date obtained or expected
|__|__| / |__|__|__|__|
Month
Year
b. In what discipline is the certification? _______________________
A6.
Since receiving your undergraduate degree, have you worked in a full-time non-teaching
job?
1
Yes
0
No
Go to Question B1
a. For how many years? ........|__|__|
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Spring 2012 Teacher Survey
B. YOUR TEACHING AND OTHER RESPONSIBILITIES
B1.
B2.
Including this school year, how many years have you worked as a teacher?
a. Total years as a teacher ..................
|__|__|
b. Years in your current district ............
|__|__|
Please tell us about the school where you currently teach.
a.
Name of the school: _____________________________________________
b.
Including this year, number of years you have taught at this school .......
|__|__|
Note: If the number above is 2 or greater, go to Question B4. Otherwise, continue with
Question B3.
B3.
In what month and year did you ACCEPT this teaching position at your current school?
|__|__| / |__|__|__|__|
Month
B4.
Year
How influential were the following factors in your decision to work at your current school?
Mark one box in each row.
B5.
NOT A FACTOR
OR NOT
AP P LICABLE
NOT VERY
INFLUENTIAL
HIGHLY
INFLUENTIAL
a. District central office .....................................
1
2
3
4
b. Principal ........................................................
1
2
3
4
c. Other school staff .........................................
1
2
3
4
d. School location .............................................
1
2
3
4
e. Compensation .............................................
1
2
3
4
f. Working conditions .......................................
1
2
3
4
g. Other (Specify): __________________ .....
1
2
3
4
Of the factors listed above, which was the most influential in your decision?
Write the letter of the factor above that was most influential.
|___|
B6.
S OMEWHAT
INFLUENTIAL
Did [Program Name] affect your choice of where or what to teach?
1
0
□
□
Yes
No
Go to Question B8.
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Spring 2012 Teacher Survey
B7.
How has [Program Name] affected your choice of where or what to teach this school year?
Mark all that apply.
1
2
3
4
5
6
B8.
Stayed at my school because of [Program Name]
Changed school to get into [Program Name]
Changed my primary grade or subject of instruction because of [Program Name]
Applied to my school to get into [Program Name]
Applied for position(s) in another school to leave [Program Name]
Applied for position(s) in another school with a better bonus program
Will [Program Name] affect your choice of where or what to teach in the coming school
year?
1
0
B9.
□
□
□
□
□
□
□
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Yes
No
Go to Question B10.
How do you expect [Program Name] will affect your choice of where or what to teach in the
coming school year? Mark all that apply.
1
2
3
4
5
6
□
□
□
□
□
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Stay at my school because of [Program Name]
Change school to get into [Program Name]
Change my primary grade or subject of instruction because of [Program Name]
Apply to my school to get into [Program Name]
Apply for position(s) in another school to leave [Program Name]
Apply for position(s) in another school with a better bonus program
B10. How would you classify your current teaching position at this school? Mark one box only.
1
2
3
4
5
□
□
□
□
□
Regular full-time teacher
Regular part-time teacher
Substitute teacher
Itinerant teacher (assigned to multiple schools)
Other (Specify): _________________________
B11. Please indicate the grade(s) of the students you currently teach at THIS school.
Mark all that apply.
1
1st grade
6
6th grade
11
11th grade
2
2nd grade
7
7th grade
12
12nd grade
3
3rd grade
8
8th grade
13
Kindergarten
4
4th grade
9
9th grade
14
Pre-kindergarten
5
5th grade
10
10th grade
15
Ungraded
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Spring 2012 Teacher Survey
B12.
Do you currently teach one self-contained class (where you teach the same group of
students most or all of the day in multiple subjects) or do you teach several classes of
different students in one or more academic subjects?
I teach one self-contained class ...........................1
Go to Question B14.
I teach several classes of different students ..........2
Go to Question B13.
B13. Which subjects do you currently teach? Mark all that apply.
English / language arts / reading .............................................
1
Mathematics ............................................................................
2
Science ....................................................................................
3
Social studies or history ..........................................................
4
Foreign language ....................................................................
5
Special instruction for English Language Learners (ELL) or
Limited English Proficient (LEP) students ...............................
6
English as a Second Language (ESL) ....................................
7
Visual or performing arts .........................................................
8
Special education ....................................................................
9
Physical education ..................................................................
10
Other (Specify): ______________________________ .........
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Spring 2012 Teacher Survey
B14. For the most recent FULL WEEK, what is your best estimate of the number of hours you
spent on school-related activities during the week? SCHOOL HOURS are the hours that you
are required to be at school, regardless of whether students are there.
(Report hours to the nearest WHOLE HOUR. If you did not spend time on a particular activity
during the week, mark the ‘None’ box.)
School-related activities
Hours spent
a. During school hours
Total school hours in most recent full week
- Must be sum of a(1) thru a(6)
(1) Teaching students in the classroom, small groups, or individually
(2) Supervising students in other activities (e.g., bus duty, hall duty, lunch duty, counseling,
coaching a sport)
(3) Preparation on your own (e.g., lessons, grading, assignments)
(4) Preparation and professional development with colleagues (e.g., common lesson
planning, workshops, staff meetings, mentoring)
_______
0
None
_______
0
None
_______
0
None
_______
0
None
_______
(5) Other activities
0
None
_______
(6) Hours absent from school for any reason
0
b. Non-school hours
Total non-school hours on school-related activities in most recent full week
- Must be sum of b(1) thru b(5)
________
(1) Academic-related activities with students (e.g., tutoring)
(2) Other activities with students (e.g., transporting students, sports coaching, advising a
student group)
(3) Preparation on your own (e.g., lessons, grading, assignments)
(4) Preparation and professional development with colleagues (e.g., common lesson
planning, workshops, staff meetings, mentoring)
0
None
None
_______
0
None
_______
0
None
_______
0
None
_______
0
None
_______
(5) Other school-related activities
0
None
B15. Approximately how many years do you think you will remain in teaching after this school
year?
I will probably teach for
|__|__|
more years.
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Spring 2012 Teacher Survey
C.
SUPPORT AND PROFESSIONAL DEVELOPMENT
Support You Received
C1.
C2.
Did you have any mentor, coach, or colleague who was responsible for supporting your
teaching this year?
0
No
1
Yes
In a typical week of teaching, how frequently did you have scheduled meetings with
mentors or coaches?
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C3.
|
| SCHEDULED MEETING(S) IN A TYPICAL SCHOOL WEEK
On average, how long were these scheduled meetings?
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C4.
Go to Question C5.
|
| MINUTES PER SCHEDULED MEETING
In addition to the scheduled time above, how much unscheduled time did you spend
meeting with mentors or coaches during a typical week of teaching?
|
| HOURS AND |
|
| MINUTES OF UNSCHEDULED TIME
Support You Provided
C5.
C6.
During this school year, were you assigned to mentor or coach another teacher (or
teachers) in your school or district? If so, please indicate whether it was part of [Program
Name]
0
No
1
Yes, part of [Program Name]
2
Yes, but not as part of [Program Name]
Go to Question C8
During a typical week of teaching, how much time did you spend mentoring or coaching
other teachers? Please include both scheduled meetings and informal time but exclude normal
peer collaboration or common lesson planning.
|
| HOUR(S) AND |
|
| MINUTES MENTORING DURING A TYPICAL WEEK OF TEACHING
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Spring 2012 Teacher Survey
C7.
Indicate whether each of the following statements about the support (coaching or
mentoring) you provided to other teachers is true.
Mark Yes or No in each row.
YES
a. I received special training before this year on providing mentoring or
coaching ..................................................................................................
1
0
b. I received special training during this year on providing mentoring or
coaching ..................................................................................................
1
0
c.
I have been given release time for mentoring or coaching .....................
1
0
e. I am a mentor or coach to more than one teacher ..................................
1
0
f.
I am responsible for conducting classroom observations .......................
1
0
g. I have conducted professional development sessions in my school ......
1
0
NO
Professional Development
C8.
Between July 1, 2011 and December 31, 2011, approximately how many hours did you
spend participating in professional development activities? Include courses you have taken
for recertification or advanced certification, workshops sponsored by your school or district,
conferences, or any other training that is relevant to your teaching.
If you did not participate in ANY professional development activities during this time, write ‘0’ and
go to Question C10.
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C9.
|
|
| TOTAL HOUR(S)
Tell us about the professional development activities in which you have participated
between July 1, 2011 and December 31, 2011. For each topic listed, indicate the following:
A: Was the topic the focus of professional development (PD) in which you participated?
B: If yes, approximately how many hours were spent on the topic? (Your best estimate.)
C: In general, how useful was the PD to your teaching?
A. FOCUS OF
PD?
In each row, mark one box in Column
A. If Yes, complete columns B and C.
a Understanding components of
[Program Name] ..........................
b. Understanding performance
measure used as part of
[Program Name] ..........................
c. Direct feedback based upon
individual performance ratings
as measured by [Program
Name] ...........................................
d. Differentiated instructional
strategies based on student
assessments .................................
e. Instructional techniques and
strategies ......................................
f. Aligning curricula to state or
district standards ...........................
YES
NO
B. HOURS
SPENT ON
TOPIC
NOT AT
ALL
S LIGHTLY
S OME WHAT
VERY
US EFUL
1
0
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2
3
4
1
0
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2
3
4
1
0
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2
3
4
1
0
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2
3
4
1
0
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2
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4
1
0
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1
2
3
4
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Spring 2012 Teacher Survey
C. USEFULNESS OF PD TO YOUR TEACHING
Classroom Observation
Note: For the following questions, please consider only instances of formal observations conducted in
your classroom. Formal observations are standardized by using an instrument, rubric or checklist.
C10. How many times during this school year has someone observed you teaching?
Formal classroom observation involves a staff member who observes and takes notes.
|___| OBSERVATION(S) THIS SCHOOL YEAR TO DATE
C11. How many additional times during this school year do you expect to be observed teaching?
|___| MORE OBSERVATION(S) EXPECTED BY THE END OF THE SCHOOL YEAR
C12. How would you describe the professional status of the classroom observer(s)? Please write
the number of individuals from each possible category of observers involved in the formal
classroom observation(s) you have had or expect to have during this school year. Write 0 for those
that do not apply.
a. Principal(s)..............................................................
|___|
b. Assistant or vice principal(s) ...................................
|___|
c. Department head(s)................................................
|___|
d. Math or literacy coach(es) ......................................
|___|
e. Other senior teacher(s) from the school, such as
a mentor, master or lead teacher ........... ...............
|___|
f. Observer(s) not working at your school..................
|___|
g. Other (Specify): ......................................................
|___|
C13. Thinking of the most recent formal observation you received, did it include feedback
intended to help you improve your teaching?
0
No
1
Yes
C14. Thinking of the most formal recent observation you received, was it designed to make
judgment about your performance?
0
No
1
Yes
C15. Thinking of the most recent formal observation you received, did you receive or do you
expect to receive a written summary of findings? Mark only one answer.
0
I have received or expect to receive a written summary
1
I have not received a written summary but expect to receive one
2
I have not received a written summary and do not expect to receive one
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Spring 2012 Teacher Survey
C16. Did you receive a numeric score of your performance?
0
1
No
Go to Question C18.
Yes
Go to Question C17.
C17. What was your score?
_________OUT OF MAXIMUM SCORE OF ____________
C18. Did you receive oral feedback?
No
Yes
0
1
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Spring 2012 Teacher Survey
D.
D1.
PERCEPTIONS ABOUT YOUR SCHOOL AND [PROGRAM NAME]
How satisfied are you with each of the following in aspects of your school this year?
Mark one box in each row.
VERY
DIS S ATIS FIED
a. Opportunities for professional advancement ....
1
b. Opportunities to enhance my skills ...................
1
c.
1
Opportunities to earn extra pay ........................
d. Use of formal classroom observations to
assess my skills ................................................
e. Use of student achievement scores to assess
my effectiveness ...............................................
f.
1
1
Recognition of accomplishments ......................
1
g. Quality of interaction with colleagues ...............
1
h. Colleagues’ effort ..............................................
1
i.
Morale in the school .........................................
1
j.
Overall job satisfaction .....................................
1
D2.
S OMEWHAT
DIS S ATIS FIED
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2
2
2
2
2
2
2
2
2
2
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S OMEWHAT
S ATIS FIED
3
3
3
3
3
3
3
3
3
3
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VERY
S ATIS FIED
4
4
4
4
4
4
4
4
4
4
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How much do you agree or disagree with each statement?
Mark one box in each row.
S TRONGLY
DIS AGREE
a. Teachers who do the same job should receive
the same pay. ......................................................
1
b. Standardized student test scores in my district
measure what students have learned. ................
1
c. My principal is a good judge of teacher talent. ....
1
d. I am glad that I am participating in [Program
Name] .................................................................
1
e. My job satisfaction has increased due to
[Program Name] ................................................
1
f. I feel increased pressure to perform due to
[Program Name] ................................................
1
g I have less freedom to teach the way I would
like to teach due to [Program Name] .................
1
h. [Program Name] has harmed the
collaborative nature of teaching ..........................
1
i. [Program Name] has caused teachers to
work more effectively ..........................................
1
j. [Program Name] is fair .......................................
1
k. The process used to determine how bonuses
are determined was adequately explained to
me .......................................................................
1
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Spring 2012 Teacher Survey
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DIS AGREE
2
2
2
2
2
2
2
2
2
2
2
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AGREE
3
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3
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3
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S TRONGLY
AGREE
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E. COMPENSATION AND EVALUATION
E1. When did you first learn about your school’s participation in [Program Name]?
|__|__| / |__|__|__|__|
Month
Year
E2. Did you vote in favor of your school participating in [Program Name]?
Yes
0 No
9 Not applicable
1
The following questions refer to your before-tax earnings from teaching and other employment.
Consider the current school year to run from July 1, 2011 to June 30, 2012.
E3. During the current school year, what is your academic-year base teaching salary? Round to
the nearest $100.
$ |__|__|__| , |__| 0 | 0 |
E4. Does your base teaching salary include additional compensation for any leadership roles you
may have performed this year?
Yes
0 No
1
NOTE: For the remainder of the questions in this section, please think about all policies and
programs in effect at your school, and not just [Program Name].
E5. Are student achievement and/or formal classroom observations used to evaluate your
performance?
Yes
0 No
1
Go to Question E7.
E6. What criteria are used to measure your performance?
Mark Yes or No in each row.
a.
YES
NO
Student achievement level (e.g., average scores, proficiency
rates, or Adequate Yearly Progress – AYP) ..............................
1
0
Student achievement growth (value-added, average gains)
at the school level.......................................................................
1
0
Student achievement growth in certain student groups (e.g.,
grade level, team, subject, etc.) .................................................
1
0
d.
Student achievement growth in your class(es) .........................
1
0
e.
Performance based on formal observations (i.e.,
standardized by using an instrument, rubric or checklist)
f.
Other (Specify): ________________________________ ........
1
0
b.
c.
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Spring 2012 Teacher Survey
E7.
E8.
Are any of the factors listed below used to evaluate teachers’ performance in your school?
Mark Yes or No in each row.
YES
a.
Your attendance .........................................................................
1
0
b.
Your participation in school activities .........................................
1
0
c.
Principal’s or other administrator’s professional judgment.........
1
0
d.
Reviews from other teachers .....................................................
1
0
e.
Student attendance ....................................................................
1
0
f.
Parent or student input ...............................................................
1
0
g.
Other 1 (Specify): _____________________________ ..........
1
0
h.
Other 2 (Specify): _____________________________ ..........
1
0
NO
Are any teachers at your school eligible for additional pay (beyond their base salary)?
Yes
0 No
1
E9.
Go to Question E11.
Are you eligible for additional pay (beyond your base salary)?
Yes
0 No
1
E10. For which of the following factors are teachers at your school eligible to receive additional
pay? For each Yes answer, indicate the maximum amount that a teacher at your school could
receive, and the amount you expect to receive.
A. Ma xim u m
B. Am o u n t
Elig ib le ?
YES
a. Teaching in a hard-to-staff school (e.g., schools
serving large proportions of economically
disadvantaged or low-performing students) ................
b. Teaching high-need subjects (e.g., math, science,
or special education) ...................................................
NO
amount
p o s s ib le
yo u e xp e c t
to re c e ive
1
0
$________
$________
1
0
$________
$________
Attending professional development activities or
enrolling in graduate-level courses .............................
1
0
$________
$________
d. An automatic bonus for participating in [Program
Name] ........................................................................
1
0
$________
$________
e. Job performance, as measured by student
achievement growth and/or classroom
observations ................................................................
1
0
$________
$________
f.
1
0
$________
$________
c.
Other (Specify): __________________________ .....
E11. Can teachers at your school receive additional pay for taking on added roles or
responsibilities during the regular school day?
1
0
Yes
No
Go to Question E12
Go to Question E13
14
TIF – Spring 2012 Teacher Survey
E12. For which of the following roles or responsibilities can teachers earn this additional pay? For
each Yes answer, indicate the maximum amount that a teacher could receive.
YES
NO
B . MAXIMUM
AMOUNT
P OS S IBLE
C. AMOUNT
YOU EXP ECT TO
RECEIVE
a. Mentor teacher ...................................................
1
0
$_______
$_______
b. Master or lead teacher .......................................
1
0
$_______
$_______
c.
Department chair or head ..................................
1
0
$_______
$_______
d. Lead curriculum specialist ..................................
1
0
$_______
$_______
1
0
$_______
$_______
0
$_______
$_______
$_______
$_______
e. Serving on a school-wide committee or task
force ..................................................................
f. Serving on a leadership team in some
capacity (Specify): _____________________ ...
g. Other (Specify): _______________________ .. 1
1
0
E13. Based on your understanding of the criteria used to determine additional compensation
amounts, what do you think is the maximum amount that is available to you for this school
year? Round to the nearest $100.
$ |__|__|__| , |__| 0 | 0 |
E14. What is your best estimate of the actual amount of additional compensation that you will
receive? Round to the nearest $100.
$ |__|__|__| , |__| 0 | 0 |
E15. How confident are you that you will receive at least that much additional compensation?
Write a number between 0 and 100.
____________ % CONFIDENT
15
TIF – Spring 2012 Teacher Survey
F.
F1.
YOUR BACKGROUND
Are you male or female?
1
2
F2.
0
Female
□
□
Yes
No
What is your race? Mark one or more.
1
2
3
4
5
F4.
Male
Are you of Hispanic or Latino origin?
1
F3.
□
□
□
□
□
□
□
White
Black or African American
Asian
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
What is your year of birth?
| 1 | 9 |
F5.
|
| YEAR
What is your marital status?
Mark only one answer.
1
2
F6.
2
0
F8.
Married or living with a partner
Widowed, separated, divorced, or never married
Please check the appropriate box(s) regarding dependent children living with you.
Mark all that apply.
1
F7.
□
□
□
□
□
Age 0 to 4 years
Age 5 to 18 years
No dependent children 18 years or younger
Which statement below describes your living arrangement?
Mark one answer only.
1
Own home (either paying a mortgage or own outright)
2
Rent
3
Living with parents or someone else rent-free
How far do you live from the school where you currently teach?
Please indicate miles AND minutes. Your best estimate is fine.
a. _______ miles
b. ______ minutes
16
TIF – Spring 2012 Teacher Survey
F9. If you have any additional thoughts you would like to share about [Program Name]
please use the space below.
G.
CONTACT INFORMATION
Providing the information requested here is voluntary.
G1.
Please provide your contact information below. We will use it to reach you in case we need
to clarify any of your responses. We will also use the address to mail your check for
completing the questionnaire.
Name: ___________________________________________________________________
Street address: ____________________________________________________________
City: __________________________
State: _______
Home telephone: __________________
Zip Code: ___________
Cell phone: ________________________
Work email: _______________________________________________________________
Home email: ______________________________________________________________
Best time to reach you by phone (day and time): _______________________________
G2.
What are the names and addresses of two other people who would know how to get in touch
with you during the coming years? We will contact these people only if we cannot get in
touch with you. Please do not list anyone who currently lives with you.
(1) First Person’s Name: ____________________________________________________
Relationship to you: ________________________________________________________
Street address: ____________________________________________________________
City: __________________________
State: _______
Home telephone: _____________________________
17
TIF – Spring 2012 Teacher Survey
Zip Code: ___________
(2) Second Person’s Name:__________________________________________________
Relationship to you: ________________________________________________________
Street address: ____________________________________________________________
City: __________________________
State: _______
Zip Code: ___________
Home telephone: _____________________________
Thank you for completing this questionnaire.
18
TIF – Spring 2012 Teacher Survey
| File Type | application/pdf |
| Author | Donna Dorsey |
| File Modified | 2011-09-14 |
| File Created | 2011-09-14 |