Teacher Surveys

OMB Appendix J.
NLTS 2012 Math or Language Arts Teacher Questionnaire

OMB No: xxxx-xxxx
App. Exp: xx/xx/xxxx

NLTS-2012
MATH OR LANGUAGE ARTS TEACHER QUESTIONNAIRE
Thank you in advance for the time spent completing this questionnaire—it is vital to the success of this important
U.S. Department of Education study. Study findings will be critical as federal, state and local agencies work to improve
the quality of services and outcomes for youth with and without disabilities.
Be assured that your answers will be completely confidential; no information will be reported that identifies you or your
student.
For the NLTS-2012, Mathematica Research Policy and DIR are authorized to collect data under law
20 U.S.C. 123g;34CFR Part 99.
This questionnaire is to be completed by either the mathematics or language arts teacher of the class taken by the
student identified below. If the student takes that class in a special education setting, the special education teacher
should complete the questionnaire. References to “this student” means the student named below.

STUDENT NAME
Mathematics or Language Arts
If you prefer to complete the questionnaire on our secure website, you may do so at XXXXXX.XXX. Your log-in and
password are XXXXXXX XXXXXXX. You may also call XXX-XXX-XXXX to complete the questionnaire by telephone or
if you have any questions about the study or the participation of your school, staff, or students. Alternately, you may
email us at XXXXXXX, or visit our web site at XXXXXXXX.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a
valid OMB control number. The valid OMB control number for this information collection is 1850-0882. The time required to complete this information
collection is estimated to average 30 minutes, including the time to review instructions, search existing data sources, gather the data needed and
complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving
this form, please write to: U.S. Department of Education, Washington, DC 20201-4651.

Prepared by Mathematica Policy Research

A. Class Characteristics
A1.

(NLTS2
A1modified)

A5.

What subject do you teach this student? (If you
teach this student in more than one subject,
please answer about the subject named on the
cover of this questionnaire.)

How many of the following are in this class on a
typical day? (Include yourself in the count.)
•

Enter one number for each category.

•

Enter “0” if none.

(NLTS2A5
MODIFIED)

Number

MARK ONE ONLY

A2.

(NLTS2
A1modified)

1

□

2

□

Mathematics (including specialties like
business math)

a. Students with IEPs ..........................

|

|

|

Language Arts (e.g., English, reading,
literature, writing)
GO TO A3

b. All other students (without IEPs) .....

|

|

|

Teachers with special education
certification ......................................

|

|

|

d. Teachers with general education
certification ......................................

|

|

|

e. Classroom aides ..............................

|

|

|

One-to-one instructional assistants
assigned to a specific student .........

|

|

|

g. Other specialists ..............................

|

|

|

h. Adult volunteers ...............................

|

|

|

i.

|

|

|

c.

What mathematics subject do you teach this
student? (If you teach this student in more than
one mathematics subject, please select the first
mathematics class taught during a typical week.)
MARK ONE ONLY
1

□ Arithmetic (fractions, percentages, decimals)
grades 6, 7, 8

f.

□ Pre-Algebra
3 □ Algebra I
4 □ Geometry
5 □ Algebra II
6 □ Trigonometry
7 □ Probability and/or Statistics
8 □ Pre-calculus
9 □ Calculus
10 □ Basic skills or remedial mathematics
2

Other (Please specify) .....................

in high school

B. Instructional Practices

□ Consumer Math
12 □ Other (Please describe)
11

A3.
(NLTS2 A4)

In what grade are the majority of students in this
class?
MARK ONE ONLY

□
□
3□
4□
1
2

A4.
(NLTS2 A3,
REV)

The next questions are about the instructional and
communication practices used in your classroom for
this student and the class as a whole.

6th grade
7th grade
8th grade
9th grade

□
□
7□
8□
5
6

B1.
(NLTS2
B1modified)

10th grade
11th grade
12th grade
Ungraded

MARK ONE ONLY

□
2□
3□
1

How would you characterize the course you
teach this student?
MARK ONE ONLY

□
2□
3□
1

Basic, remedial, or below grade level
Standard or at grade level
Advanced, honors, AP, or above grade level

Prepared by Mathematica Policy Research

Which of the following best describes the
curriculum you use for this student?

1

General education with modification
General education without modification
A curriculum other than the general education
curriculum

B2.

(NLTS2
B3A/B
modified)

In column A, please indicate how often the class as a whole uses the following instructional materials.
In column B, indicate how often this student uses these materials.
MARK ONE IN COLUMN A
FOR EACH ROW

Column A
The class as a whole
Never
or
Rarely Sometimes Often

MARK ONE IN COLUMN B
FOR EACH ROW

Column B
This student
Never
or
Rarely

Sometimes

Often

a. Textbooks, worksheets, workbooks, curriculumbased materials .......................................................

1

□

2

□

3

□

1

□

2

□

3

□

b. Fiction and non-fiction books, newspapers, and
magazines ...............................................................

1

□

2

□

3

□

1

□

2

□

3

□

c.

1

d. Games and toys used for instructional purposes ....

□
1□

e. Multimedia (the combined use of text, captioning,
graphics, animation, pictures, video, and sound to
present information) .................................................

1

□

2

□

3

□

1

□

2

□

3

□

Computers for word processing, spreadsheets,
and other applications..............................................

1

□

2

□

3

□

1

□

2

□

3

□

g. Computers for academic drills and skills practice ...

1

□

2

□

3

□

1

□

2

□

3

□

h. Computers for accessing information or lessons on
the internet or downloading materials, such as
podcasts ..................................................................

1

□

2

□

3

□

1

□

2

□

3

□

i.

Interactive white boards or smart boards ................

1

j.

Tablet PCs such as iPads........................................

k.

eBooks, eBook readers such as Nook or Kindle,
v-books ....................................................................

1

l.

Digital portfolios (a collection of the student’s work)

1

f.

Manipulatives in class ..............................................

□
1□
□

m. E-pals (electronic pen-pals) .....................................

□
1□

n. Other – Specify: _________________________ ....

1

B3.

□

□
2□
2

□
2□
2

2

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2□
2

2

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3□
3

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3□
3

3

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3□
3

3

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1□
1

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1□
1

1

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1□
1

1

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2□
2

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2□
2

2

□

□
2□
2

2

□

For this student’s class, do you make materials relevant to the curriculum available to parents via the
internet (e.g. information on what is being covered in class)?

□
0□
1

Yes
No

Prepared by Mathematica Policy Research

2

□
3□
3

□
3□
3

3

□

□
3□
3

3

□

B4.

(NLTS2
B7modified &
SIPAB, REV)

In column A, please indicate how often during this academic year the class as a whole engages in the
following instructional activities and groupings. In column B, please indicate how often this student
engages in these activities and groupings.
MARK ONE IN COLUMN A
FOR EACH ROW

MARK ONE IN COLUMN B
FOR EACH ROW

Column A
The class as a whole
Never
or
Rarely
Student-Centered Activities
a. Responds to questions orally (or through student’s
primary mode of communication) ............................
b. Works independently ...............................................
c.

Works with a peer partner or group .........................

d. Performs or presents in front of class or group .......
e. Engages in project-based learning (over multiple
days), individually or as a group ..............................
f. Uses examples from current events to illustrate
application of subject material .................................
g. Uses examples from the world of work to illustrate
application of subject material .................................
Teacher Instruction
h. Receives individual instruction from classroom
teacher .....................................................................
i.
j.
k.

Receives individual instruction from another adult ..
Receives the same material taught in multiple
ways (lecture, demonstration, activities,
discussion) ............................................................
Receives information written on the blackboard or
whiteboard in an alternative format ......................

l. Engages in small-group instruction .........................
Use of Assessments
m. Takes quizzes or tests .............................................
n. Demonstrates knowledge of subject material
through alternatives to assessments (portfolios,
projects, presentations)………………………………
o. Uses diagnostics or interim assessments
developed by you as the teacher .............................
p. Uses diagnostic or interim assessments pre-made
by a vendor (e.g. textbook publisher or
standardized diagnostic) ..........................................
q. Receives instruction based on an assessment of
student learning styles or preferences.....................
Instruction Outside Your Class
r.
s.

Field trips or instruction outside the school .............
Integrated instruction across different classes or
school activities ........................................................

Prepared by Mathematica Policy Research

□
1□
1□
1□
1

Sometimes

□
2□
2□
2□
2

Column B
This student

Often

□
3□
3□
3□
3

Never
or
Rarely

□
1□
1□
1□
1

Sometimes

□
2□
2□
2□
2

Often

□
3□
3□
3□
3

1

□

2

□

3

□

1

□

2

□

3

□

1

□

2

□

3

□

1

□

2

□

3

□

1

□

2

□

3

□

1

□

2

□

3

□

□
1□
1

1

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1□
1

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2□
2

2

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2□
2

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3□
3

3

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3□
3

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1□
1

1

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1□
1

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2□
2

2

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2□
2

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3□
3

3

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3□
3

1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1

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2

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3

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1□
1

3

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2□
2

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3□
3

□
1□
1

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2□
2

□
3□
3

B5.

To what extent do you use the following behavior strategies?

(PBIS)

MARK ONE ON EACH ROW

Never

Sometimes

Always

a. I convey my behavior expectations to students and reinforce those
expectations through my curriculum ............................................................

0

□

1

□

2

□

b. I provide a continuum of consequences for behavior infractions ................

0

□

1

□

2

□

c.

I consistently reinforce positive behaviors ...................................................

0

□

1

□

2

□

d. I share information on individual student behavior among teachers and
used this information in my decision making ...............................................

0

□

1

□

2

□

C. Accommodations and Supports
IF STUDENT DOES NOT HAVE AN IEP OR 504 PLAN, CHECK THIS BOX AND SKIP TO SECTION D
ON PAGE 8.

C1.

□

Which of the following accommodations or modifications, if any, are provided to this student to help him or
her in this class?

(NLTS2B8)

MARK ONE FOR EACH ROW

Accommodations/Modifications

Yes

a. More time in taking tests .......................................................................................
b. Tests read to student ............................................................................................
c.

Modified tests ........................................................................................................

d. Alternate tests or assessments ............................................................................
e. Modified grading standards ..................................................................................
f.

Slower-paced instruction ......................................................................................

g. Additional time to complete assignments .............................................................
h. Shorter or different assignments ..........................................................................
i.

More frequent feedback ........................................................................................

j.

Physical adaptations (e.g. modifications to the classroom, special desks) ..........

k.

Large print or Braille books ...................................................................................

l.

Other – Specify: _______________________________________________

Prepared by Mathematica Policy Research

4

□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1

No

□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0

Don’t
Know

□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d

C2.

Which of the following additional supports or assistance, if any, are provided to this student to help him or
her succeed in this class?
MARK ONE FOR EACH ROW

Additional Supports or Assistance

Yes

a. Reader or interpreter, including sign language ...............................................
b. Teacher aide, instructional assistant, or other personal aide ..........................
c.

□
1□
1

Student progress monitored by special education teacher or related service
provider ............................................................................................................

1

d. Peer tutors .......................................................................................................

1

e. Tutoring by an adult .........................................................................................
f.

Behavior management program ......................................................................

g. Learning strategies/study skills assessment ...................................................
h. Self-advocacy training .....................................................................................
i.

j.
C3.

□

□
1□
1□
1□
1□

No

□
0□
0

0

□

□
0□
0□
0□
0□
0

Don’t
Know

□
d□
d

d

□

□
d□
d□
d□
d□
d

Computer-based assistive technology. Examples may include: abbreviation
expanders, alternative keyboards, freeform database software, graphic
organizers and outlining information/data managers, optical character
recognition, speech-recognition programs, speech synthesizers/screen
readers, talking calculators, talking spell checkers and electronic
dictionaries, variable-speed tape recorders or word-prediction programs ......

1

□

0

□

d

□

Other – Specify: ..............................................................................................

1

□

0

□

d

□

Which of the following learning aids, if any, are provided to this student to help him or her in this class?
MARK ONE FOR EACH ROW

Learning Aids

Yes

a. Books on tape ...................................................................................................
b. Use of a calculator for activities not allowed other students.............................
c.

Communication aids (Voice synthesizers, Braille, etc.) ....................................

d. Use of computers for activities not allowed other students ..............................
e. Computer software designed for students with disabilities...............................
f.

Computer hardware adapted for student’s unique needs ................................

g. Other accommodations, supports, or learning aids (Please specify) ...............

Prepared by Mathematica Policy Research

5

□
1□
1□
1□
1□
1□
1□
1

No

□
0□
0□
0□
0□
0□
0□
0

Don’t
Know

□
d□
d□
d□
d□
d□
d□
d

The next questions assess the services and supports you receive in your class and the expectations that you
have for this student.
C4.

Which of the following supports, if any, have been provided to you because this student is in your class?
MARK ONE FOR EACH ROW

(NLTS2B9)
(Modified)

Yes
a. Information about this student’s needs or abilities ..........................................
b. Special equipment or materials to use with this student .................................
c.

Smaller student load or class size ...................................................................

d. Consultation services by special education or other staff ...............................
e. Teacher aides, instructional assistant, aides for individual student ................
f.

Co-teaching special education and general education teachers .....................

□
1□
1□
1□
1□
1□
1

No

□
0□
0□
0□
0□
0□
0

g. Professional development training on how to adapt instruction to meet the
needs of this student........................................................................................

1

□

0

□

h. Other type of support (Please specify) ............................................................

1

□

0

□

C5.

Don’t
Know

□
d□
d□
d□
d□
d□
d□
d

d

□

In your opinion, how adequate are the supports that are provided to you because this student is in your
class?

(NLTS2 B10)

MARK ONE ONLY

□
1□
2□
3□
4□
n

C6.
(NLTS2 C3)

(NLTS2C4)

Not at all adequate
Not very adequate
Somewhat adequate
Very adequate

Generally, is this student expected to keep up with the other students in this class (using any
accommodations or modifications he or she might need)?

□
0□
1

C7.

Not applicable; none are needed

Yes
No

Generally, does this student keep up with the other students in this class (using any accommodations or
modifications he or she might need)?

□
0□
1

Yes
No

Prepared by Mathematica Policy Research

6

C8.

During this school year, to what extent will this student participate in any state mandated standardized
tests in the subjects you teach him or her?

(NLTS2SPA5a
Modified)

A modification means a change in what is being taught to or expected from the student. Making an assignment easier
so the student is not doing the same level of work as other students is an example of a modification.
• An accommodation is a change that helps a student overcome or work around the disability. Allowing a student who
has trouble writing to give his answers orally is an example of an accommodation. This student is still expected to know
the same material and answer the same questions as fully as the other students, but he doesn’t have to write his
answers to show that he knows the information.
MARK ONE ONLY
•

□
2□
3□
4□
5□
6□
1

C9.
(NEW)

There is no such testing at this grade level

GO TO C11

Student participates in the testing program without accommodations or modifications
Student participates in the testing program with accommodations only
Student participates in the testing program with both accommodations and modifications
Student participates in the testing program with modifications only
Student does not take such tests → GO TO C11

Does this student participate in an alternate assessment in place of the standard state mandated test (in
the subject you teach him/her)?

□
0□
1

Yes
No

C10. Which of the following will this student use to take state mandated standardized tests during this school
year (in the subject you teach him or her)?

MARK ONE FOR EACH ROW

(NLTS2SPA5b
modified)

Yes
a. Extra time to take test .................................................................................................
b. Breaks during test .......................................................................................................
c.

Flexible time of day .....................................................................................................

d. Test spread across more than one day ......................................................................
e. In special setting (small group, special place, etc.) ....................................................
f.

Test read to student ....................................................................................................

g. Large print, large font, or Braille .................................................................................
h. Templates, masking or marker to maintain place .......................................................
i.

Student responses (verbal, pointing) marked by proctor ............................................

j.

Student marks in test booklet (instead of scantron sheet) .........................................

k.

A scribe who writes what the student dictates ............................................................

l.

IF MATH, ASK – ELSE SKIP TO C10m: Use of calculators on mathematics tests ...

m. Taking the test in a different language, including sign language................................
n. Other testing accommodation (Please specify) ..........................................................

□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1□
1

No

□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0□
0

Don’t
Know

□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d□
d

C11. During this school year, have you attended an Individualized Education Plan (IEP) meeting about special
education services for this student?
(NLTS2 B5)
MARK ONE ONLY

□
1□
0□
n

Not applicable; this student does not receive special education
Yes
No

Prepared by Mathematica Policy Research

7

D. Student’s School Behavior
The following questions focus on this student’s grades, performance, and classroom behaviors such as
completing homework and participating in group discussions.
D1.
(NLTS2 C5,
modified)

Relative to other students in class, is this student’s performance in the top quartile, second quartile, third
quartile, or bottom quartile?
MARK ONE ONLY

□ Top quartile (top 25% of students)
2 □ Second quartile
3 □ Third quartile
4 □ Bottom quartile (bottom 25% of students)
1

D2.

How often does this student do each of the following in this class?

(NLTS2-C6)

MARK ONE FOR EACH ROW
Rarely

a. Completes homework on time ..............................
b. Takes part in group discussions ...........................
c. Stays focused on class work.................................
d. Withdraws from social contact or class activities ..
e. Works to the best of his or her ability ....................

□
1□
1□
1□
1□
1

Sometimes

□
2□
2□
2□
2□
2

Usually

□
3□
3□
3□
3□
3

Almost
Always

□
4□
4□
4□
4□
4

Not
Applicable

□
n□
n

The next questions are about the student’s communication, engagement, and externalizing behavior.
D3.
(SSiS)

This item has been removed for the draft being made public in the OMB package submission. It cannot be displayed in
public forum for copyright reasons.

D4.
(NLTS2C7)

Approximately how often have you communicated with this student’s parent/ guardian(s) during this
school year about his/her progress (by phone, in person, or in writing), including parent / teacher
conferences but not counting routine written progress reports or report cards?
MARK ONE ONLY
0
1
2
3
4
5
6

□
□
□
□
□
□
□

Never
Once
A few times over the school year
Once every other month
Once a month
Once a week or several times a month
Every day or several times a week

Prepared by Mathematica Policy Research

8

E. Teacher Characteristics
The next questions are about you.
E1.

(NLTS2D1)

Are you credentialed to teach the class you are teaching this student at this grade level?

□
0□

Yes

1

E2.
(NLTSD2)

E3.
(New)

For how many years have you been a teacher?
|

|

| YEARS TAUGHT

Are you Hispanic or Latino?

□
0□
1

E4.

No

Yes - Hispanic or Latino
No - Not Hispanic or Latino

Which best describes your race?
MARK ALL THAT APPLY

□
2□
3□
4□
5□
1

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Prepared by Mathematica Policy Research

9

E5.

(NLTS2D5)

During the past 3 years, have you participated in any continuing professional development activities
totaling 8 or more hours to help you in any of the following areas?
Please indicate in Column A whether you have received each kind of continuing professional development.
Then, for each kind of continuing professional development activity in which you participated, indicate in
Column B whether it was adequate.
Column A
Received
professional
development
Yes

No

Column B
Professional
development was
adequate
Yes

No

a. The subject matter content that you teach this student .........................

1

□

0

□

1

□

0

□

b. Working with students who are considered to be “at risk” .....................

1

□

0

□

1

□

0

□

c.

Working with students with disabilities ..................................................

1

□

0

□

1

□

0

□

d. Working with students who struggle academically ................................

1

□

0

□

1

□

0

□

e. Working with students who are English Language Learners (ELL) ......

1

□

0

□

1

□

0

□

f.

Behavior management...........................................................................

1

□

0

□

1

□

0

□

g. Creating a positive school environment, violence prevention ...............

1

□

0

□

1

□

0

□

h. Collaborating with other educators ........................................................

1

□

0

□

1

□

0

□

i.

Working with parents .............................................................................

1

□

0

□

1

□

0

□

j.

Using technology in instruction ..............................................................

1

□

0

□

1

□

0

□

k.

Considering and building on the cultural diversity of students ..............

1

□

0

□

1

□

0

□

l.

Using data on student performance to guide instruction .......................

1

□

0

□

1

□

0

□

m. Other continuing professional development (Please specify) ...............

1

□

0

□

1

□

0

□

Prepared by Mathematica Policy Research

10

E6.

(NLTS2D4)

Please indicate the extent to which you agree or disagree with each of the following statements.
MARK ONE ON EACH ROW

Strongly
Disagree

Disagree

Agree

Strongly
Agree

a. The school leadership has high expectations and
standards for all students and teachers.............................

1

□

2

□

3

□

4

□

b. The principal promotes instructional improvement among
school staff .........................................................................

1

□

2

□

3

□

4

□

c.

This school is a safe place for students.............................

1

□

2

□

3

□

4

□

d. I have adequate training and support for teaching
students with disabilities assigned to my class .................

1

□

2

□

3

□

4

□

e. I have adequate training and support for teaching English
Language Learners (ELL) assigned to my class ...............

1

□

2

□

3

□

4

□

1

□

2

□

3

□

4

□

f.

I have adequate training and support for teaching
students assigned to my class who struggle academically

THANK YOU AGAIN FOR COMPLETING THIS QUESTIONNAIRE.
AS SOON AS WE RECEIVE THIS QUESTIONNAIRE, WE WILL SEND YOUR $25. THANK YOU.
PLEASE ENTER THE ADDRESS TO WHICH WE SHOULD SEND THE CHECK:
Address:
City:
State:

ZIP Code:

May we also have your email and telephone number in case we have any questions about your responses?
Email:

@

Phone: (_______) Area Code

Number

PLEASE RETURN THE QUESTIONNAIRE IN THE POSTAGE-PAID ENVELOPE. IF YOU DO NOT HAVE THE
ENVELOPE, YOU MAY FAX THE QUESTIONNAIRE TO: xxxxxxxxx at xxx-xxx-xxxx OR MAIL IT TO: NLTS-2012
STUDY, xxxxxxxxxxxxxx.

Prepared by Mathematica Policy Research

11