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pdfAPPENDIX D
SPECIAL EDUCATION TEACHER
QUESTIONNAIRES
Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)
Spring First-Grade and Fall Second-Grade National Data Collections
OMB Clearance Package
# 1850-0750 v.10
Spring First-Grade Special Education Teacher
Teacher-Level Questionnaire
Spring 2012
Special Education Teacher
Questionnaire A
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
1600 Research Boulevard
Rockville, Maryland 20850-3129
LABEL
Use a black or blue ball point pen or #2 pencil to complete this
questionnaire.
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 1850-0750. Approval expires
05/31/2013. The time required to complete this information collection is estimated to
average 30 minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the
information requested. If you have any comments concerning the accuracy of the time
estimate or suggestions for improving the survey instrument, please write to: U.S.
Department of Education, Washington, D.C. 20202-4537. If you have comments or
concerns regarding the status of your individual response to this survey, write directly to:
National Center for Education Statistics, 1990 K Street, N.W., Room 9086, Washington,
D.C. 20006-5650.
The collection of information in this survey is authorized by 20 U.S. Code, Section
9541. Participation is voluntary. You may skip questions you do not wish to
answer; however, we hope that you will answer as many questions as you can.
Your responses are protected from disclosure by federal statute (20 U.S. Code,
Section 9573). All responses that relate to or describe identifiable characteristics
of individuals 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. Data
will be combined to produce statistical reports. No individual data that links your
name, address, telephone number, or identification number with your responses
will be included in the statistical reports.
1
INTRODUCTION
Dear Special Education Teacher/Related Services Provider,
This questionnaire is an important part of a major longitudinal study of children’s early
educational experiences beginning with kindergarten and continuing through grade 5. The
Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011)
is collecting information from the special education teachers/related service providers of
sampled children who have Individual Education Programs (IEPs) to investigate the
relationship between the children’s academic progress and various school, classroom,
teacher, and home characteristics. This questionnaire collects information about your
background and your work in this school with children with disabilities.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a
question you do not want to answer. However, only you can provide this information.
Although we realize you are very busy, we urge you to complete this questionnaire as
completely and accurately as possible. The information you provide is being collected for
research purposes only and will be protected from disclosure to the fullest extent allowable
by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9573). Information from
multiple individuals will be combined to produce statistical reports; no information that
identifies you will be included in any reports or provided to students, their parents, or other
school staff.
THANK YOU VERY MUCH FOR YOUR HELP.
2
MARKING DIRECTIONS
PLEASE READ CAREFULLY AND USE A BLACK OR BLUE BALL POINT PEN OR A SOFT LEAD (#2)
PENCIL TO COMPLETE THIS QUESTIONNAIRE. DO NOT USE A FELT-TIP PEN.
MARKING BOXES
It is important that you mark an “X” in the box next to your answers and print clearly.
Shown below is the correct way to mark your answers, along with examples of incorrect ways.
Correct Mark:
Incorrect Marks:
Light and thin, outside the box, thick or scrawled.
How to Change an Answer:
Completely black out the box of the incorrect answer and mark an “X” in the box next to the correct
answer.
PRINTING ANSWERS IN BOXES
Answers should be printed clearly and should not touch or cross any of the box lines. Do not cross
zeroes or sevens. That is, do not write a zero with a line through it like this – 0, and do not write a
seven with a line through it like this – 7.
Write one number per box like this:
1
2
3
4
5
6
Write words like this:
John Smith
3
7
8
9
0
1.
What is your gender? MARK ONE RESPONSE.
Male
Female
2.
In what year were you born? WRITE IN YEAR BELOW.
19
ENTER YEAR
3.
Are you Hispanic or Latino? MARK ONE RESPONSE.
Yes
No
4.
Which best describes your race? MARK ONE OR MORE RESPONSES TO
INDICATE WHAT YOU CONSIDER YOURSELF TO BE.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5.
What is the highest level of education you have completed? MARK ONE
RESPONSE.
Did not complete high school
High school diploma or equivalent/GED
Some college or technical or vocational school
Associate's degree
Bachelor's degree
Master's degree
An advanced professional degree beyond a master’s degree (for example,
Ph.D., MD)
Don’t know
4
6.
What is the highest level of education completed by your own parents? MARK
ONE RESPONSE.
Did not complete high school
High school diploma or equivalent/GED
Some college or technical or vocational school
Associate's degree
Bachelor's degree
Master's degree
An advanced professional degree beyond a master’s degree (for example,
Ph.D., MD)
Don’t know
7.
Counting this school year, how many years have you worked in your current
school, including part time? WRITE THE NUMBER OF YEARS TO THE
NEAREST HALF YEAR (FOR EXAMPLE, 2.5, 3, 3.5).
Years
8.
Counting this school year, how many total years (including part-time) have you
been working with children receiving special education or related services?
WRITE THE NUMBER OF YEARS TO THE NEAREST HALF YEAR (FOR
EXAMPLE, 2.5, 3, 3.5).
Years
9.
Counting this school year, how many total years (including part-time) have you
been working with children in any school? This would include other
assignments such as teaching in a regular classroom or otherwise providing
services to children. WRITE THE NUMBER OF YEARS TO THE NEAREST HALF
YEAR (FOR EXAMPLE, 2.5, 3, 3.5).
Years
5
10.
Which of the following credentials, licenses, or certificates do you have for
working with children with disabilities? MARK YES OR NO ON EACH ROW.
Yes
a. Emergency credential
b. Provisional or temporary credential
c. Disability-specific credential or endorsement
d. Special education credential or endorsement
(for more than one disability category)
e. General education credential
f. Speech/language therapy state license or certification
g. Physical therapy state license or certification
h. Occupational therapy state license or certification
i. Social work license or certification
j. School psychology license or certification
k. Clinical psychology license or certification
l. Certificate of Clinical Competence
m. Other professional license, credential, or endorsement
(PLEASE SPECIFY)
11.
Have you taken the exam for National Board for Professional Teaching
Standards certification? MARK ONE RESPONSE.
Not taken
Taken and passed
Taken and have not yet passed
Taken and awaiting test results
Not applicable
6
No
12.
Have you ever taken a college course in the following areas? MARK YES OR
NO ON EACH ROW.
Yes
a. Early childhood education
b. Early childhood special education
c. Elementary education
d. Child development
e. English as a Second Language (ESL) or teaching English
language learners
f. General special education
g. Learning disabilities
h. Intellectual disability*
i. Orthopedic impairments
j. Serious emotional disturbance
k. Deafness and hearing
l. Blindness and vision
m. Communication disorders
n. Infants and toddlers with disabilities
o. Physical therapy
p. Occupational therapy
q. School psychology
r. Classroom management
1
* Including the condition formerly classified as mental retardation.
7
No
13.
Have you ever taken a college course that addressed issues related to the
following? MARK YES OR NO ON EACH ROW.
Yes
No
a. Using published research evidence to identify and select
effective interventions and supports for students
b. Using formal assessment data to inform the choice of
READING interventions and supports for students
c. Using formal assessment data to inform the choice of MATH
interventions and supports for students
d. Using data to inform the choice of behavioral interventions
and supports for students
14.
Which of the following best describes your current position in this school?
MARK ONE RESPONSE.
Special education teacher
Special education teacher consultant
General education teacher
Special education classroom aide
Speech-language pathologist
Physical therapist
Physical therapy assistant or aide
Occupational therapist
Occupational therapy assistant or aide
School psychologist
School counselor
School social worker
Other (PLEASE SPECIFY)
8
15.
How do you classify your main assignment at this school, that is, the activity at
which you spend most of your time during this school year? MARK ONE
RESPONSE.
Regular full-time teacher/service provider
Regular part-time teacher/service provider
Itinerant teacher/service provider (that is, your assignment requires you to
provide instruction/related services at more than one school)
Long-term substitute (that is, your assignment requires that you fill the role of a
teacher on a long-term basis, but you are still considered a substitute)
Teacher aide
Other (PLEASE SPECIFY)
16.
During this school year, where have you worked with children with IEPs?
MARK YES OR NO ON EACH ROW.
Yes
a. In a general education classroom
b. In a special education classroom
c. In a non-classroom space (for example, office, therapy room,
small work space, mobile van, etc.)
d. Other (PLEASE SPECIFY)
e. I do not work directly with children who have IEPs
9
No
17.
Please indicate the extent to which you agree or disagree with each of the
following statements on working with children. MARK ONE RESPONSE ON
EACH ROW.
Neither
Strongly
disagree
disagree Disagree nor agree
Agree
Strongly
agree
a. I really enjoy my present job.
b. I am certain I am making a
difference in the lives of the
children I work with.
c. If I could start over, I would
choose this career again.
d. I am satisfied with my class
size/caseload.
18.
During this school year, how many children with IEPs have you worked with or
provided services for, on average, each week? (Include children you work with
directly, as well as children for whom you consult with the general education
teacher and/or another special education teacher/service provider) MARK ONE
RESPONSE.
1-10
11-20
21-40
More than 40
Don’t know
19.
Date questionnaire completed:
2012
MONTH
DAY
10
YEAR
Spring First-Grade Special Education Teacher
Child-Level Questionnaire
Spring 2012
Special Education Teacher
Questionnaire B
Child Level
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
1600 Research Boulevard
Rockville, Maryland 20850-3129
LABEL
Use a black or blue ball point pen or #2 pencil to complete this
questionnaire.
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 1850-0750. Approval expires
05/31/2013. The time required to complete this information collection is estimated to
average 20 minutes per response, including the time to review instructions, search
existing data resources, gather the data needed, and complete and review the
information requested. If you have any comments concerning the accuracy of the time
estimate or suggestions for improving the survey instrument, please write to: U.S.
Department of Education, Washington, D.C. 20202-4537. If you have comments or
concerns regarding the status of your individual response to this survey, write directly to:
National Center for Education Statistics, 1990 K Street, N.W., Room 9086, Washington,
D.C. 20006-5650.
The collection of information in this survey is authorized by 20 U.S. Code, Section
9541. Participation is voluntary. You may skip questions you do not wish to
answer; however, we hope that you will answer as many questions as you can.
Your responses are protected from disclosure by federal statute (20 U.S. Code,
Section 9573). All responses that relate to or describe identifiable characteristics
of individuals 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. Data
will be combined to produce statistical reports. No individual data that links your
name, address, telephone number, or identification number with your responses
will be included in the statistical reports.
1
INTRODUCTION
Dear Special Education Teacher/Related Services Provider,
This questionnaire is an important part of a major longitudinal study of children’s early
educational experiences beginning with kindergarten and continuing through grade 5. The
Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011)
is collecting information from the special education teachers/related service providers of
sampled children who have Individual Education Programs (IEPs). We are gathering
information from these children’s regular classroom teachers as well. Our purpose is to
investigate the relationship between the children’s academic progress and various school,
classroom, teacher, and home characteristics. This questionnaire collects information on the
special education/related services received by the child identified on the cover of this
questionnaire.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a
question you do not want to answer. However, only you can provide this information.
Although we realize you are very busy, we urge you to complete this questionnaire as
completely and accurately as possible. You may find at least some of the information we are
asking for in the child’s IEP. All information you provide is being collected for research
purposes only and will be protected from disclosure to the fullest extent allowable by law
(Education Sciences Reform Act of 2002, 20 U.S.C. § 9573). Information from multiple
individuals will be combined to produce statistical reports; no information that identifies you
will be included in any reports or provided to students, their parents, or other school staff.
THANK YOU VERY MUCH FOR YOUR HELP.
2
MARKING DIRECTIONS
PLEASE READ CAREFULLY AND USE A BLACK OR BLUE BALL POINT PEN OR A SOFT LEAD (#2)
PENCIL TO COMPLETE THIS QUESTIONNAIRE. DO NOT USE A FELT-TIP PEN.
MARKING BOXES
It is important that you mark an “X” in the box next to your answers and print clearly.
Shown below is the correct way to mark your answers, along with examples of incorrect ways.
Correct Mark:
Incorrect Marks:
Light and thin, outside the box, thick or scrawled.
How to Change an Answer:
Completely black out the box of the incorrect answer and mark an “X” in the box next to the correct
answer.
PRINTING ANSWERS IN BOXES
Answers should be printed clearly and should not touch or cross any of the box lines. Do not cross
zeroes or sevens. That is, do not write a zero with a line through it like this – 0, and do not write a
seven with a line through it like this – 7.
Write one number per box like this:
1
2
3
4
5
6
Write words like this:
John Smith
3
7
8
9
0
1.
Is this child currently receiving gifted/talented services through an IEP, or has
the child received such services during this school year? MARK ONE
RESPONSE.
Yes
No
2.
Is this child currently receiving special education services through an IEP, due
to a disability, or has the child received such services during this school year?
MARK ONE RESPONSE.
Yes
No (SKIP TO Q30)
3.
In what capacity or capacities do you teach or provide services to this child?
MARK YES OR NO ON EACH ROW.
Yes
No
a. Provide instruction directly to the child
b. Provide related services directly to the child
c. Provide consultation services directly to the child
d. Provide indirect consultation services (for example,
consultation to the child’s teacher)
e. Provide case management
f. Other (PLEASE SPECIFY)
4.
When was this child first determined eligible for special education or related
services? MARK ONE RESPONSE.
Before kindergarten
During kindergarten, started receiving services in kindergarten
During kindergarten, started receiving services in first grade (SKIP TO Q8)
During first grade (SKIP TO Q8)
Don’t know (SKIP TO Q8)
4
5.
To what extent were you involved in planning the transition from last year’s
special education program to this year’s special education program for this
child? MARK ONE RESPONSE.
Not at all
Somewhat
Extensively
6.
To what extent did you communicate with the person(s) who provided special
education for this child last year? MARK ONE RESPONSE.
Not at all
Somewhat
Extensively
I provided special education for this child last year.
7.
Have you reviewed this child’s records related to special education services
provided before this school year? MARK ONE RESPONSE.
Yes
No, I don’t have access to the records.
No, I have access to the records, but have not reviewed them.
No, I provided special education to this child last year.
5
8.
What is this child’s primary disability as identified on the child’s IEP?
PLEASE SELECT THE CATEGORY BELOW INTO WHICH THE CHILD’S
PRIMARY DISABILITY FITS BEST. MARK ONE RESPONSE.
Speech or language
impairments
Orthopedic impairments
Other health impairments
Specific learning disabilities
Autism
Emotional disturbance
Traumatic brain injury
Intellectual disability*
Deaf-blindness
Developmental delay
Multiple disabilities (children
included in this category
should be those who have
more than one primary
disability which do not include
deaf-blindness or
developmental delay)
Visual impairments (including
blindness)
Hearing impairments
(including deafness)
No classification is given
1
* Including the condition formerly classified as mental retardation.
6
9.
For which of the following disabilities has this child received special education
or related services this school year, whether for the child’s primary disability or
another of his/her disabilities? MARK YES OR NO ON EACH ROW.
Yes
No
a. Speech or language impairments
b. Specific learning disabilities
c. Emotional disturbance
d. Intellectual disabilty*
e. Developmental delay
f. Visual impairments (including blindness)
g. Hearing impairments (including deafness)
h. Orthopedic impairments
i. Other health impairments
j. Autism
k. Traumatic brain injury
l. Deaf-blindness
m. Multiple disabilities (children included in this category should
be those who have more than one primary disability which do
not include deaf-blindness or developmental delay)
n. No classification given
2
10.
Has this child received any special education or related services because of a
diagnosed Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity
Disorder (ADHD)? MARK ONE RESPONSE.
Yes
No
*Including the condition formerly classified as mental retardation.
7
THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD’S
SPECIAL EDUCATION EXPERIENCE DURING THE CURRENT SCHOOL YEAR.
11.
Which of the following describe(s) the IEP goals for this child during this
school year? MARK ALL OF THE AREAS IN WHICH THIS CHILD HAS IEP
GOALS.
Academics
Social
Reading
Social skills
Mathematics
General appropriateness of behavior
Language Arts
Science
Life skills
Adaptive behavior or self-help skills
Speech and language
Auditory processing
Physical/Mobility
Listening comprehension
Fine motor skills
Oral expression
Gross motor skills
Voice/speech articulation
Orientation and mobility
Language pragmatics
Other (PLEASE SPECIFY)
8
12.
Which of the following related services have been provided through the school
to this child during this school year? MARK YES OR NO ON EACH ROW.
Yes
a. Audiology
b. Counseling services
c. Occupational therapy
d. Physical therapy
e. Psychological services
f. Health services
g. Social work services
h. Special transportation
i. Speech or language therapy
j. Orientation services
k. Mobility services
l. Rehabilitation services
m. Other (PLEASE SPECIFY)
9
No
13.
Has this child received any of the following? MARK YES OR NO ON EACH
ROW.
Yes
a. Adaptive physical education
b. Assistance from classroom aides (for example, teacher aide,
behavioral assistant, special education aide)
c. Interpreter for the deaf or hard of hearing (oral or sign)
d. Teacher used Braille to provide instruction
e. Child was taught how to use Braille
f. Teacher used American Sign Language to provide instruction
g. Child was taught how to use American Sign Language
h. Teacher used Manual English to provide instruction
i. Child was taught how to use Manual English
j. Teacher used Cued Speech to provide instruction
k. Child was taught how to use Cued Speech
l. Mental health services, personal/group counseling, therapy, or
psychiatric care provided to the child
m. Tutoring/remediation from special education teacher
n. Training, counseling, and other supports/services provided to
this child’s family
14.
Has this child’s primary placement during this school year been a general
education classroom? MARK ONE RESPONSE.
Yes
No
10
No
15.
Approximately how many hours per week of direct special education and
related services (that is, service provided directly to the child, from a teacher or
another adult) has this child received this school year? WRITE NUMBER IN
BOX.
Hours per week
16.
Of the hours of direct special education and related services reported above,
approximately how many of those hours per week were the instruction/services
provided outside of a general education classroom but within the school
setting? WRITE NUMBER IN BOX.
Hours per week
17.
What teaching practices and methods have you and/or other special education
service providers used with this child? MARK YES OR NO ON EACH ROW.
Yes
a. One-on-one instruction
b. Small-group instruction
c. Large-group instruction
d. Cooperative learning
e. Peer tutoring
f. Computer-based instruction
g. Direct instruction
h. Cognitive strategies
i. Self-management
j. Behavior management
k. Instruction received through a sign interpreter
l. Did not deliver instruction
11
No
Don’t
know
18.
Which of the following best describes the curriculum materials used with this
child? MARK ONE BOX IN THE GENERAL EDUCATION CLASSROOM COLUMN
AND ONE BOX IN THE SPECIAL EDUCATION CLASSROOM COLUMN.
a.
In the
general
education
classroom
General education curriculum materials were used
without modification
General education curriculum materials were used
with some modifications
General education curriculum materials were used
with substantial modifications
Specially-designed commercial materials were used
Teacher-designed materials were used
Child not in this setting
Don’t know
12
b.
In the special
education
classroom/
program
19.
Which of the following assistive technologies and devices has this child used
this school year? MARK ALL OF THE ASSISTIVE TECHNOLOGIES THIS CHILD
USED.
Child did not use any assistive technologies
Mobility aids
Learning aids (non-computer)
Vans, vehicles
Tape recorder
Wheelchair
Calculator
White cane
Electronic spelling devices
Communication aids
Electronic with voice output
(for example, Touch Talker)
Computer hardware designed or adapted
for children with disabilities (for example,
alternate keyboards, switch interface)
Nonelectronic (for example,
manual printing board)
Used solely by individual child
Shared with other children
Hearing assistance
Hearing aids
FM loops
Computer software designed for children
with disabilities
TTYs/TDDs
Reading
Cochlear implants
Writing
Real-time captioning
Visual aids
Braille texts
Mathematics
Other assistive technologies or devices
(PLEASE SPECIFY)
Electronic Braille devices
Digital texts
Magnifying devices
Close-captioned television
(CCTV)
13
20.
Does this child have a computer, laptop, or word processing device assigned
to him/her for use full time? MARK ONE RESPONSE.
Yes
No
21.
On average, how often have you met with general education teacher(s) to
discuss this child’s program or progress during this school year? MARK ONE
RESPONSE.
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year (SKIP TO Q23)
Not applicable to my work with this child (SKIP TO Q23)
22.
On average, how long were the meetings with the general education teacher(s)
to discuss this child’s program or progress? MARK ONE RESPONSE.
1 to 15 minutes
16 to 30 minutes
31 to 45 minutes
46 to 60 minutes
More than 60 minutes
14
23.
Approximately how often have you communicated with this child’s parents
during this school year about this child’s program or progress (by phone, in
person, or in writing, including e-mail)? MARK ONE RESPONSE.
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year
24.
During this school year, has this child received formal individual evaluations in
any of the following areas for purposes of developing IEP goals? MARK YES
OR NO ON EACH ROW.
Yes
a. Psychological
b. Speech/language
c. Vision
d. Hearing
e. Learning style
f. Motor skills
g. Academics
h. Other (PLEASE SPECIFY)
15
No
25.
To what extent is this child expected to achieve the same general education
goals as other children at his/her grade level? MARK ONE RESPONSE.
Child is expected to attain grade level achievement for all of the academic
content standards.
Child is expected to attain grade level achievement for some of the academic
content standards.
Child is expected to attain grade level achievement for only a few of the
academic content standards.
Child is not expected to attain grade level achievement for any of the academic
content standards.
There are no academic content standards at this grade level.
Don’t know
26.
What percentage of this child’s current IEP goals have been met or nearly met
at this point in the school year? MARK ONE RESPONSE.
76 to 100 percent
51 to 75 percent
26 to 50 percent
1 to 25 percent
Zero percent
27.
Which of the following best expresses the likelihood that this child will
continue to receive some level of special education services (through an IEP)
in the next school year? MARK ONE RESPONSE.
Definitely will continue in special education
Very likely to continue in special education
Rather likely to continue in special education
Rather unlikely to continue in special education
Very unlikely to continue in special education
Definitely will not continue in special education (will be dismissed from services)
16
28.
To what extent has this child participated in any grade-level assessment
administered as part of the school’s testing program during the current school
year? MARK ONE RESPONSE.
Child did not participate in the school’s testing or assessment program. (SKIP
TO Q30)
Child participated in alternate assessments and no regular assessments. (SKIP
TO Q30)
Child participated in some alternate assessments and some regular
assessments.
Child participated fully in the school’s regular testing or assessment program.
There is no testing or assessment program at this grade level. (SKIP TO Q30)
Don’t know (SKIP TO Q30)
29.
Did this child receive special accommodations to participate in the school’s
regular testing or assessment program? MARK ONE RESPONSE.
Yes
No
Don’t know
30.
In which grade is this child enrolled? MARK ONE RESPONSE.
Kindergarten
First grade
Second grade
This child is in an ungraded classroom
31. Date questionnaire completed:
2012
MONTH
DAY
17
YEAR
| File Type | application/pdf |
| File Modified | 2011-09-12 |
| File Created | 2011-07-26 |