Parent Interview; Teacher and Special Ed Teacher Questionnaires; School Administrator and Coordinator Questionnaires, Tracking, and Recruitment; and Child Hearing Screening

Early Childhood Longitudinal Study Kindergarten Class of 2010-11 (ECLS-K:2011) Spring Second-Grade Full Scale Collection and Third- and Fourth-Grade Tracking and Third-Grade Recruitment

Appendix C ECLS-K2011 Spring 2nd Grade FS-Classroom Teacher Questionnaires[1]

Parent Interview; Teacher and Special Ed Teacher Questionnaires; School Administrator and Coordinator Questionnaires, Tracking, and Recruitment; and Child Hearing Screening

OMB: 1850-0750

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1850-0750 can be found here:

Document [pdf]

Download: pdf | pdf

APPENDIX C
SPRING SECOND-GRADE
GENERAL CLASSROOM TEACHER
QUESTIONNAIRES

Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)
Spring Second-Grade National Data Collection, Third-Grade Tracking
and Recruitment, Fourth-Grade Tracking

OMB Clearance Package
# 1850-0750 v.12

Spring Second-Grade General Classroom
Teacher Teacher-/Classroom-Level
Questionnaire

Draft

Spring 2013
Teacher Questionnaire
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
Rockville, Maryland
Use a black or blue ball point pen to complete this questionnaire.

RETURN THIS COMPLETED QUESTIONNAIRE DIRECTLY
TO YOUR SCHOOL COORDINATOR OR AN ECLS-K:2011
STAFF MEMBER. DO NOT MAIL THIS QUESTIONNAIRE
UNLESS YOU ARE ASKED TO DO SO BY STUDY STAFF
AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

S_ID

T_ID

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 18500750. Approval expires XX/XX/XXXX. 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. 20006-5574.

The collection of information in this survey is authorized by 20 U.S.
Code, Section 9541. Participation is voluntary. You may skip questions
y
ou
do
not
wi
s
h
t
o
answer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
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.

Draft

Dear Teacher,
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. You have received this questionnaire because
you are the teacher of one or more of the children who are participants in this study.
This questionnaire contains several sections:
a) Classroom and student characteristics
b) Class organization and resources
c) Instructional activities and curricular focus
d) Parent involvement
e) Evaluation and grading practices
f ) School and staff activities
g) Views on school climate and the school environment
h) Teacher background
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
i
ndi
vi
dual
s
wi
l
l
be
combi
ned
t
o
pr
oduce
s
t
at
i
s
t
i
cal
r
epor
t
s
;
no
i
nf
or
mat
i
on
t
hat
i
dent
i
f
i
es
you
wi
l
l
be
i
ncl
uded
i
n
any reports or provided to students, their parents, or other school staff.
Please record your answers directly on the questionnaire by marking the appropriate answer (as instructed on
page 5) or by writing your responses in the space provided. Your best estimates are acceptable answers.

DEFINITIONS
For the purposes of this study, the following definitions apply:
Kindergarten: Traditional year of school primarily for 5-year-olds prior to first grade.
Transitional (or readiness) kindergarten: Extra year of school for kindergarten-age eligible children who
are judged not ready for kindergarten.
Transitional first (or prefirst) grade: Extra year of school for children who have attended kindergarten but
have been judged not ready for first grade.
English language learner (ELL): A student whose native language is one other than English and whose
skills in listening, speaking, reading, or writing English are such that he or she has difficulty understanding
school instruction in English.

Draft

TYPES OF LANGUAGE INSTRUCTION EDUCATIONAL PROGRAMS (LIEPS)

Programs that focus on developing students' literacy in two languages
Two-way immersion program (TWI) or two-way bilingual program: The goal of these programs is to
develop strong skills and proficiency in both students' home language and English. These programs may
also be called dual language programs. These programs include students whose native language is not
English (but who all speak the same non-English language) and students whose native language is English.
Instruction is provided in both languages, typically starting with a smaller proportion of instruction in
English, and gradually moving to half of the instruction in each language. Students typically stay in these
programs throughout elementary school.
Developmental bilingual program, late exit transitional program, or maintenance bilingual education
program: The goal of these programs is to develop some skills and proficiency in students' home language
and strong skills and proficiency in English. Content is taught in both languages by teachers fluent in both
languages. These programs may also be called dual language programs. Instruction at lower grades is in
the students' home language with a gradual transition to English. Students typically transition into
mainstream classrooms with their English-speaking peers. The programs can vary in the focus placed on
acquiring literacy in students' home language, but students generally do continue to receive some degree
of support in their home language after the transition to English classrooms.
Transitional program, early exit bilingual program, or early exit transitional program: The goal of these
programs is to develop English proficiency skills as soon as possible, without delaying learning of
academic core content. Instruction begins in students' home language but rapidly moves to English.
Students typically are transitioned into mainstream classrooms with their English-speaking peers as soon
as possible.
Heritage language program or indigenous language program: The goal of these programs is to develop
literacy in two languages. Content is taught in both languages by teachers fluent in both languages.
These programs typically target non-English speakers with weak literacy skills in their home language.
Programs that focus on developing students' literacy solely in English
Sheltered English instruction or content-based English as a Second Language (ESL) program: The goal of
these programs is to develop proficiency in English while learning content in an all-English setting.
Students from various linguistic and cultural backgrounds can be in the same class. Instruction is adapted
to students' proficiency in English and is supported by visual aids and support in the students' home
languages as available. Fully developed prototypes of this program include Sheltered Instruction
Observational Protocol (SIOP) and Specially Designed Academic Instruction in English (SDAIE).
Structured English Immersion (SEI): The goal of SEI is to develop fluency in English. This program usually
serves only English language learners. All instruction is in English, though the instruction is adjusted to the
English proficiency level of students so subject matter is comprehensible. Teachers may have some
receptive skills in the students' home language(s) and generally use sheltered instructional techniques.
Pull-out English as a Second Language (ESL) or English Language Development (ELD): The goal of
these programs is to develop fluency in English. ELL students leave their mainstream classroom for part
of the day to receive ESL instruction, which generally focuses on grammar, vocabulary, and
communication skills, not academic content. There typically is no support provided for students' home
languages.
Push-in English as a Second Language (ESL) program: The goal of push-in ESL is to develop fluency in
English. Students receive ESL instruction in a mainstream classroom, with instruction in English with some
native language support if needed. The ESL teacher or an instructional aide provides clarification,
translation if needed, and uses ESL strategies.

THANK YOU VERY MUCH FOR YOUR HELP.
1

National Clearinghouse for English Language Acquisition. (n.d.). Types of language instruction educational programs (LIEPs).
Retrieved [January 6, 2012] from http://www.ncela.gwu.edu/files/uploads/5/Language_Instruction_Educational_Programs.pdf.

Draft

MARKING DIRECTIONS
PLEASE
READ CAREFULLY
USE AOR
BLACK
OR
BLUE
BALLPEN
POINT
TO LEAD
PLEASE READ
CAREFULLY
AND USEAND
A BLACK
BLUE
BALL
POINT
ORPEN
A SOFT
COMPLETE
THIS
QUESTIONNAIRE.
DO
NOT
USE
PENCIL
OR
FELT-TIP
PEN.
(#2) PENCIL TO COMPLETE THIS QUESTIONNAIRE. DO NOT USE A FELT-TIP PEN.

MARKING BOXES
I
t
i
s
i
mpor
t
ant
t
hat
you
mar
k
an
“X”
i
n
t
he
box
next
t
o
your
answer
s
and
pr
i
nt
cl
ear
l
y.
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:
Compl
et
el
ybl
ackoutt
heboxoft
hei
ncor
r
ectans
werandmar
kan“X”i
nt
heboxnex
tt
ot
he
correct answer.

PRINTING ANSWERS IN BOXES:
Answers should be printed clearly and should not touch or cross any of the box lines. Do not
cr
oss
zer
oes
or
sevens.
That
i
s,
do
not
wr
i
t
e
a
zer
o
wi
t
h
a
l
i
ne
t
hr
ough
i
t
l
i
ke
t
hi
s
–
0, and do not
write a seven with a line through it like this –7.
Write one number per box like this:

Write words like this:

John Smith

Draft

SECTION A. CLASSROOM AND STUDENT CHARACTERISTICS

A1.

As
of
t
oday'
s
dat
e,
how
many
chi
l
dr
en…
WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN IN A PARTICULAR CATEGORY, WRITE "0."
Number of
children
a. Are currently enrolled in your class?
b. Have joined the class since the beginning of the
school year?
c. Have left the class since the beginning of the
school year?

A2.

How many hours per day does your class normally meet? WRITE THE NUMBER TO THE
NEAREST HOUR.
Hours/day

A3.

How many days per week does your class normally meet? WRITE NUMBER IN BOX.
Days/week

A4.

Do you currently teach a multigrade class? MARK ONE RESPONSE.
Yes
No (SKIP TO Q A6)

Draft

A5.

What grade levels are included in your class? MARK ALL THAT APPLY.
a. Prekindergarten
b. Transitional (or readiness) kindergarten
c. Regular kindergarten
d. Transitional/pre-1st grade
e. 1st grade
f.

2nd grade

g. 3rd grade
h. 4th grade
i.

A6.

5th grade or higher

As of today's date, how many children in your class are the following ages? WRITE NUMBER
IN BOX. IF THERE ARE NO CHILDREN OF A PARTICULAR AGE, WRITE "0."
Number of
children
a. 4 years old or younger
b. 5 years old
c. 6 years old
d. 7 years old
e. 8 years old
f.

9 years old

g. 10 years old
h. 11 years old or older
i.

Total class enrollment (sum of a through h)

Draft

A7.

As of today's date, how many children in your class belong to each of the following
racial/ethnic groups? WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN OF A
PARTICULAR RACE/ETHNICITY, WRITE "0." IF YOU ARE NOT SURE ABOUT A CHILD'S
RACE/ETHNCITY, PLEASE CATEGORIZE HIM OR HER WHERE YOU THINK HE OR SHE FITS
BEST.
Number of
children
a. Hispanic/Latino of any race
b. American Indian or Alaska Native, not Hispanic or
Latino
c. Asian, not Hispanic or Latino
d. Black or African American, not Hispanic or Latino
e. Native Hawaiian or Other Pacific Islander, not
Hispanic or Latino
f.

White, not Hispanic or Latino

g. Two or more races, not Hispanic or Latino
h. Total class enrollment (sum of a through g)

A8.

As of today's date, how many boys and girls are there in your class? WRITE NUMBER IN BOX.
IF NONE, WRITE "0."
Number of
children
a. Number of boys
b. Number of girls
c. Total class enrollment (sum of a and b)

Draft

A9.

How many of the children in your class are repeating this grade this year? WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of children repeating this grade

A10.

How many children in your class ...
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of
children
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented program?
c. Are below grade level in their English reading skills?
d. Are about on grade level in their English reading skills?
e. Are above grade level in their English reading skills?
f.

Are below grade level in their mathematics skills?

g. Are about on grade level in their mathematics skills?
h. Are above grade level in their mathematics skills?
i.

Are tardy, on an average day?

Are absent, on an average day?

Draft

A11.

At this point in the school year, how would you rate the behavior of the children in your class?
MARK ONE RESPONSE.
Group misbehaves very frequently and is almost always difficult to handle.
Group misbehaves frequently and is often difficult to handle.
Group misbehaves occasionally.
Group behaves well.
Group behaves exceptionally well.

A12.

How many children in your class have a diagnosed disability? WRITE NUMBER IN BOX. IF
NONE, WRITE "0" AND SKIP TO Q A15.
Number of children

A13.

How many of those children with a diagnosed disability are currently receiving special health
or educational services or accommodations for their disabilities, for example, speech therapy,
assistance by an aide in the classroom, or testing accommodations? WRITE NUMBER IN BOX.
IF NONE, WRITE "0."
Number of children

A14.

How many of those children with a diagnosed disability need more help than they are currently
receiving? WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of children

Draft

THE NEXT SERIES OF QUESTIONS ASKS ABOUT THE USE OF DIFFERENT LANGUAGES IN THE
CLASSROOM BY TEACHERS, CHILDREN, AND OTHER ADULTS.

A15.

Are any languages other than English used by teachers, aides, or other adults in your
classroom? MARK ONE RESPONSE.
Yes
No (SKIP TO Q A18)

A16.

How often is a non-English language used by teachers, aides, or other adults in your class in
the following ways? MARK ONE RESPONSE ON EACH ROW.
Less
than half
the time

Never
a. For academic instruction in
reading/literacy
b. For academic instruction in
mathematics
c. For academic instruction
in other subjects
d. For instructional support (for
example, explaining directions)
e. For conversation

About
half the
time

More
than half
the time

All the
time

Draft

A17.

What languages are used for academic instruction in your class? MARK ALL THAT APPLY.
a. English
b. Spanish
c. French
d. Vietnamese
e. A Chinese language
f.

Japanese

g. Korean
h. A Filipino language
i.

Arabic

An Asian Indian language

k. Sign language
l.

A18.

Other language (PLEASE SPECIFY)

In what languages are the books or other written materials in your classroom? MARK ALL
THAT APPLY.
a. English
b. Spanish
c. French
d. Vietnamese
e. A Chinese language
f.

Japanese

g. Korean
h. A Filipino language
i.

Arabic

An Asian Indian language

k. Sign language
l.

Other language (PLEASE SPECIFY)

Draft

A19.

Do any of the children you teach speak a language other than English (aside from English
speakers who are learning a foreign language)? Please include all children who speak a
non-English language, including those who speak English well. MARK ONE RESPONSE.
Yes
No (SKIP TO Q A21)

A20.

Which languages other than English are spoken by one or more children in your class? MARK
ALL THAT APPLY.
a. Spanish
b. Vietnamese
c. A Chinese language
d. Japanese
e. Korean
f.

A Filipino language

g. Arabic
h. An Asian Indian language

A21.

Sign language

Other language (PLEASE SPECIFY)

Do you have any children who are English language learners in your class? (English language
learners are children whose native language is one other than English and whose skills in
listening, speaking, reading, or writing English are such that they have difficulty understanding
school instruction in English.) MARK ONE RESPONSE.
Yes
No (SKIP TO Q B1)

A22.

How many English language learners (ELLs) do you have in your class? WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of ELL children

Draft

A23.

How many of the ELL children in your class receive instruction designed to teach listening
to, speaking, reading, and writing the English language to children with limited English
proficiency in the following ways? WRITE NUMBER IN BOX. IF NONE, WRITE "0."

Number of
children
a. Receive no instruction for ELLs in the school
b. Receive instruction for ELLs within the regular class
c. Receive instruction for ELLs outside the regular class

A24.

If specialized language instruction is provided to second-grade English language learners,
woul
d
you
say
t
hi
s
i
nst
r
uct
i
on
i
s
pr
i
mar
i
l
y…
MARK ONE RESPONSE:
EXAMPLES OF THE PROGRAMS INCLUDED IN EACH CATEGORY ARE PROVIDED BELOW.
SEE PAGE 4 FOR DEFINITIONS OF THESE EXAMPLES.
Programs that focus on developing students' literacy in two languages. For example:






Two-way immersion program or two-way bilingual program
Developmental bilingual program, late exit transitional program, or
maintenance bilingual education program
Transitional program, early exit bilingual program, or early exit transitional program
Heritage language program or indigenous language program

Programs that focus on developing students' literacy solely in English. For example:


Sheltered English instruction or content-based English as a Second
Language (ESL) program



Structured English Immersion (SEI)



Pull-out English as a Second Language (ESL) or English Language Development (ELD)
Push-in ESL program



Other program(s) (PLEASE SPECIFY)

No specialized language program is provided to second-grade English language learners.

Draft

A25.

What languages are spoken by you or any other teacher or aide to the ELL children in your class
for instructional support or conversation? MARK ALL THAT APPLY.

a. English
b. Spanish
c. Vietnamese
d. A Chinese language
e. Japanese
f.

Korean

g. A Filipino language
h. Arabic
i.

An Asian Indian language

Sign language

k. Other language (PLEASE SPECIFY)

A26.

How often do English language learners (ELL children) in your class do each of the following
activities? MARK ONE RESPONSE ON EACH ROW. INCLUDE ACTIVITIES IN YOUR
CLASSROOM OR IN A PULL-OUT PROGRAM.
Once a
month
or less
a. Take assessments to monitor their
English language proficiency
b. Take assessments to assess their
progress in English reading and literacy
skills
c. Work in small groups of ELL children or
individually on intensive English reading
and literacy skills
d. Work in a structured peer-assisted
setting (that is, ELL child is paired with a
non-ELL child)

2-3
times a
month

1-2
times a
week

3-4
times a
week

Daily

Draft

SECTION B. CLASS ORGANIZATION AND RESOURCES

B1.

In a typical day, how much time does a child in your class spend in the following types of
activities? MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS
BREAKS.
Four
Half
About About About hours
No
hour or
one
two
three
or
time
less
hour
hours hours
more
a. Working independently
b. Working on individual tasks under
teacher direction
c. Working with peers under teacher
direction
d. Working in small groups with
teacher
e. Teacher lecture with large group
and/or large group discussion led
by teacher

B2.

During a typical day, how much time per day would you estimate that you spend on classroom
discipline and handling disruptive behavior? MARK ONE RESPONSE.
Less than 15 minutes a day
15 minutes to less than 30 minutes a day
30 minutes to less than 45 minutes a day
45 minutes to less than 1 hour a day
1 hour to less than 2 hours a day
2 hours or more a day

Draft

B3.

How often does the typical child in your class usually work on lessons or projects in the
following general subject areas, whether as a whole class, in small groups, or in individualized
arrangements? MARK ONE RESPONSE ON EACH ROW.

Never

Less
than
once a
week

a. Reading and language arts
b. Mathematics
c. Social Studies
d. Science
e. Music
f.

Art

g. Physical education
h. Dance/creative movement
i.

Theater/creative dramatics

Foreign language (excluding
English for ELL students)

1 day a
week

2 days
a week

3 days
a week

4 days
a week

5 days
a week

Draft

B4.

On the days children work in these areas, how much time does the typical child in your class
usually work on lessons or projects in the following general subject areas? MARK ONE
RESPONSE ON EACH ROW.
Less
Not
than ½
applicable/ hour a
never
day

½ hour
to less 1 to less
than 1 than 1 ½
hour
hours

1 ½ to
less
than 2
hours

2 to less
than 2 ½
hours

2 ½ to
less
than 3
hours

3 hours
or more

a. Reading and
language arts
b. Mathematics
c. Social Studies
d. Science
e. Music
f.

Art

g. Physical education
h. Dance/creative
movement

B5.

Theater/creative
dramatics

Foreign language
(excluding English
for ELL students)

How many instructional groups based on achievement or ability levels do you currently use for
reading or math?
By "instructional groups" we mean small groups of two or more students that meet in your
classroom or in another classroom as part of their regular instruction. DO NOT INCLUDE
PULL-OUT GROUPS, SUCH AS ESL CLASSES OR GROUPS FORMED ON AN AS-NEEDED
BASIS TO PROVIDE EXTRA INSTRUCTION OR ASSISTANCE WITH ASSIGNED WORK.

Number of
instructional
groups
a. Reading

If your response is zero for
BOTH a and b, skip to B8

b. Mathematics

Draft

B6.

In an average week, how often do you divide your class into instructional groups based on
achievement or ability levels for reading and math activities or lessons? MARK ONE
RESPONSE ON EACH ROW.

Never

Less
than
once a
week

1 day
a week

2 days
a week

3 days
a week

4 days
a week

5 days
a week

a. Reading
b. Mathematics

B7.

On days when you use instructional groups based on achievement or ability levels, how
many minutes per day is your class usually divided into instructional groups for reading
and math activities or lessons? MARK ONE RESPONSE ON EACH ROW.

0
minutes/
day

1-15
minutes/
day

16-30
minutes/
day

31-60
minutes/
day

More than
60
minutes/
day

a. Reading
b. Mathematics

B8.

How many days a week do children have recess? WRITE NUMBER IN BOX. IF NONE, WRITE "0"
AND SKIP TO Q B10.
Days per week

B9.

On days when children have recess, between the school day starting time and the dismissal
time, how many times a day do children have recess? MARK ONE RESPONSE.
Once
Twice
Three or more times

Draft

B10.

In a typical day, how much time do children in your class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW.

No time

1-15 minutes

16-30
minutes

31-45
minutes

Longer
than 45
minutes

a. Lunch
b. Free play indoors
c. Free play outdoors
(including recess)

B11.

Do any of the following staff members provide direct instruction to students in your class who
are struggling or at risk of failure in reading or math? INCLUDE STAFF OTHER THAN
YOURSELF WHO PROVIDE DIRECT INSTRUCTION EITHER IN YOUR CLASS OR IN A PULL-OUT
SETTING. EXCLUDE PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes

a. A READING specialist/interventionist who has specialized
training in reading instruction
b. A MATH specialist/interventionist who has specialized training
in math instruction
c. A special education teacher

B12.

How many hours a week do different types of paid paraprofessionals/aides and/or volunteers
usually work directly with children on instructional tasks either in your classroom or in a pullout setting? WRITE THE NUMBER OF HOURS IN THE APPROPRIATE BOXES BELOW. IF NONE,
WRITE "0."

a. General paraprofessionals/aides

Hours per week

b. Special education
paraprofessionals/aides

Hours per week

c. ESL or bilingual education
paraprofessionals/aides

Hours per week

d. Volunteers (for example, parents, high
school students, community members)

Hours per week

Draft

B13.

How often are the following materials or resources used in your class? MARK ONE RESPONSE
ON EACH ROW.

Not
available

Never

Once a
month
or less

Two or
three
times a
month

Once or
twice a
week

Three or
four
times a
week

Daily

a. Art materials
b. Musical
instruments
c. Costumes for
creative
dramatics/theater
d. Cooking or food
related items
e. Science equipment
(for example,
magnifying glass,
scales, thermometers)

B14.

Please report the following about the computers in your classroom. Please include any
desktop, laptop, or other computer-type device (for example, tablets) used for instructional or
administrative purposes.
In row a, report the number of computers that are located in your classroom everyday and the
number of these with Internet access. IF NONE, WRITE "0."
In row b, report the number of computers that can be brought into your classroom (for
example, laptops on carts) and the number of these that have Internet access. Indicate the
number that are generally brought in at one time. IF NONE, WRITE "0."
Total number of devices
a. Located in your
classroom every day
b. Can be brought into your
classroom (for example,
laptop on carts)

Number with Internet access

Draft

B15.

How frequently do you or your students use computers or the following electronic devices for
instructional purposes? Please include any desktop, laptop, or other computer-type devices.
MARK ONE RESPONSE ON EACH ROW.
Not
available
a. Computer (desktop, laptop or
other computer-type device
such as a tablet)
b. LCD or DLP projector
c. Interactive whiteboard (for
example, SMART Board,
Activboard)
d. Digital camera (still or video)
e. CD player or MP3 player/iPod
f.

DVD player or VCR

g. TV

Never

Rarely

Sometimes

Often

Draft

SECTION C. INSTRUCTIONAL ACTIVITIES AND CURRICULAR FOCUS
Reading and Language Arts Instruction
C1.

How often do you use the following resources to teach reading in your class? MARK ONE
RESPONSE ON EACH ROW.
Never or
hardly ever
a. Basal reading series (a core or
primary reading text for all students)
b. Leveled or guided reading books
(multiple books, each at a specific
reading level)
c. Newspapers and/or magazines
d. Reading kits (usually a boxed product,
which may contain student and teacher
materials, assessment materials, and
manipulatives)
e. Computer software for reading
instruction
f.

A variety of trade books (for
example, novels, collections of poetry,
nonfiction)

g. Materials from other subjects
(for example, science, social studies)
h. Manipulatives (for example, plastic
letters, picture cards, letter cards, tiles)
i.

Big books

Decodable books, sound/symbols books

k. Read-along books paired with
audiobooks
l.

Anthology (collection of literary works,
which may include poems, short
stories, plays, songs, excerpts, etc.)

Once or
twice a
month

Once or
twice a
week

Almost
every day

Draft

C2.

From the first day of school until today, please indicate how many days each of the following
READING skills and concepts has been covered in your class. Please include the time during
which you provide direct instruction as well as the time you spend supervising students as
they work. MARK ONE RESPONSE ON EACH ROW.

Key Ideas and Details

Not
taught

a. Identifying main ideas in fictional text
b. Asking and/or answering questions
to demonstrate understanding of
key details in a text
c. Retelling stories, including main
ideas and details
d. Identifying the central message,
lesson, or moral of a folk tale or fable
e. Describing how characters in a
story respond to major events and
challenges
f.

Identifying the main topic of a
paragraph of informational text

Craft and Structure
g. Describing how words and phrases
give rhythm and/or meaning in a
story, poem, or song
h. Describing the overall structure of a
story, for example how the beginning
introduces the story or how the
ending concludes the action
i.

Identifying differences in the points
of view of characters in a story

Using text features to locate key
facts or information (for example,
captions, bold print, subheadings,
indexes)

k. Students taught to distinguish their
own point of view from that of the
narrator, a character, or the writer
Integration of Knowledge and Ideas
l.

Using information gained from
illustrations or text to demonstrate
understanding of a story's
characters, setting, or plot

m. Comparing and contrasting two
versions of the same story (for
example, Cinderella stories) by
different authors or from different
cultures

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

C2.

(CONTINUED) From the first day of school until today, please indicate how many days each of
the following READING skills and concepts has been covered in your class. Please include the
time during which you provide direct instruction as well as the time you spend supervising
students as they work. MARK ONE RESPONSE ON EACH ROW.

Integration of Knowledge and Ideas
(continued)

Not
taught

n. Explaining how images clarify
informational text (for example, a
photograph or diagram showing
how a machine works)
o. Identifying the reasons an author
gives to support points in an
opinion piece
Range of Reading and Level of Text
Complexity
p. Reading and comprehending
literature, including stories and
poetry
q. Reading informational selections
Phonological Awareness
r.

Segmenting words into phonemes

s. Manipulating phonemes to form
new words
Phonics and Word Recognition
t.

Distinguishing long and short
vowels in one-syllable words

u. Decoding regularly spelled
two-syllable words
v. Reading irregularly spelled words
w. Identifying and knowing the
meaning of common prefixes or
suffixes
Fluency
x. Reading accurately and fluently to
support comprehension
y. Reading and rereading passages
orally with guidance on pacing,
intonation, and expression
z. Using sentence-level context to
gain meaning of a word or phrase

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

C2.

Comprehension

Not
taught

aa. Identifying character, setting, and
plot
bb. Generating questions about
character, setting, and plot
cc. Predicting what might occur next
in the text
Writing
dd. Writing an opinion piece, giving
reasons for the opinion
ee. Writing an informational piece that
contains a clear topic with
supporting details
ff. Writing a narrative with two or more
appropriately sequenced events
gg. Using temporal words or phrases to
signal the order of events

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

Mathematics Instruction
C3.

From the first day of school until today, please indicate how many days each of the following
MATH skills and concepts has been covered in your class. Please include the time during
which you provide direct instruction as well as the time you spend supervising students as
they work. MARK ONE RESPONSE ON EACH ROW.

Operations and Algebraic Thinking
a. Adding and subtracting
numbers equal to 20 or less

Not
taught

b. Solving word problems by adding
or subtracting numbers equal to
100 or less
c. Determining whether a group of
objects (20 or fewer) has an even
or odd number of members
d. The meaning of the signs for
equal, greater than, and less than
e. Working with equal-sized groups
of objects to gain an
understanding of multiplication
f.

Multiplying two one-digit whole
numbers to find the product

Number and Operations in Base Ten
g. Skip-counting by 5s, 10s,
and/or 100s
h. Counting to 1000, starting at
any number less than 1000
i.

Reading and writing numbers
up to 1000

Identifying the numbers that
represent the hundreds, tens,
and ones places in a three-digit
number

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

C3.

(CONTINUED) From the first day of school until today, please indicate how many days each of
the following MATH skills and concepts has been covered in your class. Please include the
time during which you provide direct instruction as well as the time you spend supervising
students as they work. MARK ONE RESPONSE ON EACH ROW.

Number and Operations in Base Ten
(continued)

Not
taught

k. Comparing three-digit numbers,
using the symbols >, =, and <
l.

Finding 10 more or 10 less than a
given two-digit number, without
counting

m. Finding 100 more or 100 less
than a given three-digit
number, without counting
n. Adding four two-digit numbers
using strategies based on place
value
o. Multiplying one-digit whole
numbers by 10
Measurement and Data
p. Comparing the length of two objects
indirectly by using a third object
(nonstandard measurement)
q. Measuring the length of an object
in standard units, using tools such
as rulers, yardsticks, meter sticks,
and/or measuring tapes
r.

Measuring to determine how
much longer one object is than
another

s. Estimating the length of an object
in standard units, such as inches,
feet, centimeters, and/or meters
t.

Solving word problems involving
lengths that are given in the same
units, using addition or subtraction

u. Telling time using both analog
and digital clocks

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

C3.

Measurement and Data (continued)

Not
taught

v. Telling time to the nearest five
minutes (for example, 6:05, 6:10,
or 6:15)
w. Writing time to the nearest five
minutes (for example, 6:05, 6:10,
or 6:15)
x. Solving word problems involving
quarters, dimes, nickels, and
pennies
y. Obtaining and recording data (for
example, measuring and
recording the lengths of three or
more objects)
z. Drawing a picture graph and/or a bar
graph to represent a data set with up
to four categories
aa. Answering questions about the
data in a picture graph and/or a
bar graph, for example, comparing
one category with another
Geometry
bb. Identifying the difference between
defining attributes of shapes (for
example, triangles are three-sided)
versus non-defining attributes (for
example, color, size)
cc. Identifying triangles, quadrilaterals,
pentagons, hexagons, and cubes
dd. Drawing shapes when given specified
attributes (for example, the number
of angles or the number of sides)
ee. Measuring area by counting unit
squares (square centimeters, square
inches, etc.)
ff. Describing portions of simple shapes
using the words halves, fourths, and
quarters

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

Science and Social Studies Instruction
C4.

From the first day of school until today, please indicate how many days each of the
following SCIENCE skills and concepts has been covered in your class. Please include the
time during which you provide direct instruction as well as the time you spend supervising
students as they work. MARK ONE RESPONSE ON EACH ROW.

Not
taught
a. Using all 5 senses to make
observations
b. Using tools (for example, lenses,
thermometers, rulers) to gather
information about objects
c. Classifying and comparing
objects by their properties
(for example, weight or size)
d. Making logical predictions
(hypotheses) based on
observations
e. Drawing conclusions based
upon evidence
f.

Communicating scientific
findings orally or in writing

g. Using graphs or charts to
describe findings

On
1-5
days

On
6-10
days

On
11-15
days

On
16-20
days

On
more
than 20
days

Draft

C5.

For this school year as a whole, please indicate if each of the following SCIENCE or SOCIAL
STUDIES topics or skills is taught either in your class in its own unit or lesson or as part of a
unit/lesson on a different topic. MARK ONE RESPONSE ON EACH ROW.

Taught in my
class
a. Three states of matter (gas, liquid, solid)
b. Basic needs of plants (water, sunlight, etc.)
c. Characteristics of animal classes (mammals,
reptiles, birds, etc.)
d. Natural resources
e. Shadows and light
f.

Dinosaurs and fossils

g. Solar system and space
h. Weather
i.

Nutrition/healthy foods

Important figures and events in American history

k. Community resources (for example, grocery store, police)
l.

Map-reading skills

m. Different cultures
n. Reasons for rules, laws, and government
o. Community service
p. Current events in the news

Not taught in my
class

Draft

C6.

In an average week, how many days a week is homework assigned? Please count homework
assigned over the weekend as one day. MARK ONE RESPONSE.
0 days (SKIP TO Q D1)
1 day
2 days
3 days
4 days
5 days

C7.

On days when homework is assigned, how much time do you expect children to spend on
homework in the following areas? MARK ONE RESPONSE FOR EACH ROW.
I never
assign
homework

1 to 10
minutes

a. Reading and language arts
b. Math

11 to 20
minutes

21 to 30
minutes

More
than 30
minutes

Draft

SECTION D. PARENT INVOLVEMENT
D1.

How many regularly scheduled conferences do you have with a parent or guardian of each
child in your class during the school year? MARK ONE RESPONSE.
No conferences
One conference
Two conferences
Three or more conferences

D2.

What percentage of children in your class have parents who participate in the following
activities? MARK ONE RESPONSE ON EACH ROW.
None

1-25%

26-50%

51-75%

76% or
more

a. Attend teacher-parent conferences
b. Volunteer regularly to help in your
classroom or another part of the
school
c. Attend open houses or parties
d. Attend art/music events or
demonstrations
D3.

During this school year, have you made contacts with parents in the following ways? MARK
ONE RESPONSE ON EACH ROW.

Never
a. Sent home letters, newsletters,
or other notices addressed to
all parents
b. Shared portfolios or other
collections of children's work for
parents to see
c. Used e-mail, list-serve, or
class/school website to send
out classroom updates or
information to parents
d. Used e-mail or written notes to
address individual questions
or concerns of parents
e. Talked to parents by telephone

One to
two
times

Three
to five
times

Six to
ten
times

11 to
14
times

15 or
more
times

Draft

SECTION E. EVALUATION AND GRADING PRACTICES
E1.

How important is each of the following in evaluating the children in your class for reporting
to parents? MARK ONE RESPONSE ON EACH ROW.
Not
important

Somewhat
important

Very
important

Extremely
important

a. Individual child's achievement
relative to the rest of the class
b. Individual child's achievement
relative to local, state, or
professional standards
c. Individual improvement or
progress over past performance
d. Effort
e. Class participation
f.

Daily attendance

g. Classroom behavior or
conduct
h. Cooperativeness with other
children
i.

E2.

Ability to follow directions

Across all subjects, how often do you use the following to assess your students? MARK ONE
RESPONSE ON EACH ROW.

Never
a. State or local standardized tests
b. Classroom tests or quizzes
(including those made by you
and those from other sources)
c. Individual or group projects
d. Worksheets that you grade
e. Work samples (for example,
writing sample, brief story, report)
f.

Teacher observation of
students' mastery of objectives
or standards

1 or 2
times a
year

3 to 8
1 or 2
1 or 2
times a times a times a
year
month
week

3 or
more
times a
week

Draft

E3.

How often do you use a formal assessment in READING for the following purposes? MARK ONE
RESPONSE ON EACH ROW.

Never

Once a
year

a. To evaluate how well
each student is
responding to the core
curriculum provided in
the general education
classroom
b. To monitor each
student's progress on
specific skills over the
school year
c. To identify the deficits
in specific skills of
struggling students
d. To monitor the
progress of students
who fall below
benchmark levels
e. To determine whether
students need
placement in a more
or less intensive level
of instruction

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

E4.

How often do you use a formal assessment in MATH for the following purposes? MARK ONE
RESPONSE ON EACH ROW.

Never

Once a
year

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

E5.

Which of the following do you use to provide parents with information about their children's
performance? MARK YES OR NO ON EACH ROW.
Yes
No
a. Standard report card (for example, a letter grade assigned
for each subject)
b. Progress report form (narrative report)
c. Competency based checklists
d. Portfolio of child's work
e. Standardized test scores
f. Benchmark assessments

Draft

SECTION F. SCHOOL AND STAFF ACTIVITIES
F1.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No (SKIP TO Q F4)
*
Pr
of
es
s
i
onal
devel
opment
may
i
ncl
ude
c
ont
i
nui
ng
f
or
mal
educat
i
on;
c
our
s
es,
conf
er
ences
,
wor
ks
hops
,
or
i
n
s
er
vi
ce
t
r
ai
ni
ng;
s
t
af
f
meet
i
ngs
t
hat
i
nc
l
ude
s
t
af
f
devel
opment
act
i
vi
t
i
es
;
and
receiving coaching or mentoring.

F2.

During the past 12 months, how often have you participated in the following staff development
and training activities? MARK ONE RESPONSE ON EACH ROW.

Never
a. Workshops involving study groups or
small-group problem solving
b. Direct instruction from an outside
consultant on a specific topic
c. Release time for attending
professional conferences
d. College or university courses related
to your profession
e. Professional development via
distance learning (web-based, etc.)
f.

Workshops on using computers and
technology in the classroom

Once

2 times

3 to 4
times

More
than 4
times

Draft

F3.

How often did you participate in professional development activities covering the following
topics in the last 12 months? MARK ONE RESPONSE ON EACH ROW.

Never

Once

2 times

3 to 4
times

More
than 4
times

a. How to use assessment data to identify
students who are struggling or at risk of
failure in READING
b. How to use assessment data to identify
students who are struggling or at risk of
failure in MATH
c. How to use and apply assessment data
to guide READING instruction
d. How to use and apply assessment
data to guide MATH instruction
e. How to implement the READING
curriculum
f.

F4.

How to implement the MATH curriculum

Have you received support from any of the following staff members during the current
academic year? MARK ONE RESPONSE ON EACH ROW. IF THE RESOURCE IS NOT
AVAILABLE TO YOU, MARK THE LAST COLUMN.
Yes,
support
received
a. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective READING
instruction
b. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective MATH instruction
c. A school or district staff member who provides
ongoing training and support to classroom teachers
in the delivery of effective behavioral supports
d. A school or district staff member to support teachers
in collecting, organizing, and managing assessment
data
e. A school or district staff member to support teachers
in the interpretation and use of assessment data to
guide instruction

No, support
not received
but
available

Resource
not
available

Draft

F5.

How often have you been observed by a peer for the purpose of receiving instructional feedback
during the current academic year? MARK ONE RESPONSE.
Never
Once a year
2 times a year
3 or 4 times a year
More than 4 times a year

Draft

SECTION G. VIEWS ON SCHOOL CLIMATE AND SCHOOL ENVIRONMENT
G1.

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

Strongly
disagree
a. The level of child misbehavior (for
example, noise, horseplay, or fighting
in the halls or cafeteria) in this school
interferes with my teaching.
b. Many of the children I teach are not
capable of learning the material I am
supposed to teach them.
c. I feel accepted and respected as a
colleague by most staff members.
d. Teachers in this school are
continually learning and seeking
new ideas.
e. Routine administrative duties and
paperwork interfere with my job of
teaching.
f.

Parents are supportive of school staff.

g. There is a great deal of cooperative
effort among the staff members.
h. In this school, staff members are
recognized for a job well done.
i.

The academic standards at this
school are too low.

There is broad agreement among
the entire school faculty about the
central mission of the school.

k. The school administrator sets
priorities, makes plans, and sees
that they are carried out.
l.

The school administration's
behavior toward the staff is
supportive and encouraging.

Disagree

Neither
agree
nor
disagree

Agree

Strongly
agree

Draft

G2.

To what extent do you agree or disagree with the following statements? MARK ONE
RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree
a. I am adequately trained to
teach the children with
disabilities who are in my
class.
b. Inclusion of children with
disabilities in my class has
worked well.
c. I have the resources I need
to teach the children in my
class who have disabilities.
d. I am adequately trained to
teach English language
learners in my class.
e. Inclusion of English language
learners in my class has
worked well.
f.

I have the resources I need
to teach the children in my
class who are English
language learners.

g. I am adequately trained to
teach a class of students who
have a wide range of
READING skills.
h. I have the resources I need
to teach a class of students
who have a wide range of
READING skills.
i.

I am adequately trained to
teach a class of students who
have a wide range of
MATH skills.

I have the resources I need
to teach a class of students
who have a wide range of
MATH skills.

Agree

Strongly
agree

Not
applicable

Draft

G3.

To what extent do you agree or disagree with each of the following statements? MARK ONE
RESPONSE ON EACH ROW.
Neither
agree
Strongly
nor
disagree Disagree disagree
a. If I try really hard, I can get through even
to the most difficult or unmotivated
students.
b. If some students in my class are not
doing well, I feel that I should change my
approach to the subject.
c. By trying a different teaching method, I
can significantly affect a student's
achievement.
d. There is really very little I can do to
ensure that most of my students achieve
at a high level.
e. I work to create lessons so my students
will enjoy learning and become
independent thinkers.
f.

I feel sometimes it is a waste of my time
to try to do my best as a teacher.

g. The attitudes and habits students bring
to my class greatly reduce their chances
for academic success.
h. My success or failure in teaching is due
primarily to factors beyond my control
rather than to my own effort or ability.
i.

The amount a student can learn is
primarily related to family background.

If a student did not remember
information I gave in a previous lesson, I
would know how to increase his/her
retention in the next lesson.

k. If a student in my class becomes
disruptive and noisy, I feel assured that I
know some techniques to redirect
him/her quickly.
l.

I really enjoy my present teaching job.

m. I am certain I am making a difference in
the lives of the children I teach.
n. If I could start over, I would choose
teaching again as my career.

Agree

Strongly
agree

Draft

G4.

Indicate how much you agree or disagree with the following statements about your school and
staff. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
Strongly
agree nor
disagree Disagree disagree
Agree
agree
a. There is a consensus among
administrators and teachers on
goals and expectations.
b. We have an active professional
development program for
teachers.
c. Teachers are very active in
planning staff development
activities in this school.

G5.

For each of the following statements about READING, indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.

Neither
Strongly
agree nor
disagree Disagree disagree
a. This school has a set of clear,
predetermined, grade-level
benchmarks (that is, cut
scores, goals/targets, or
percentiles) that are used to
determine which students are
struggling or at risk of failure in
reading in second grade.
b. This school has clear,
predetermined criteria for
determining the level of
intervention second-grade
students will receive in reading.
c. This school has clear,
predetermined criteria for
determining when secondgrade students no longer
need a reading intervention.

Agree

Strongly
agree

Don't
Know

Draft

G6.

For each of the following statements about MATH, indicate how strongly you agree or disagree.
MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree
a. This school has a set of clear,
predetermined, grade-level
benchmarks (that is, cut
scores, goals/targets, or
percentiles) that are used to
determine which students are
struggling or at risk of failure in
math in second grade.
b. This school has clear,
predetermined criteria for
determining the level of
intervention second-grade
students will receive in math.
c. This school has clear,
predetermined criteria for
determining when secondgrade students no longer
need a math intervention.

Agree

Strongly
agree

Don't
Know

Draft

SECTION H. TEACHER BACKGROUND
H1.

What is your gender? MARK ONE RESPONSE.
Male
Female

H2.

In what year were you born? WRITE IN YEAR BELOW.

1 9
YEAR
H3.

Are you Hispanic or Latino? MARK ONE RESPONSE.
Yes
No

H4.

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

H5.

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)

Draft

H6.

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)

H7.

Counting this school year, how many years have you taught each of the following grades and
programs, including years in which you taught part time?
WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS IS YOUR
FIRST YEAR TEACHING, WRITE "1." WRITE "0" IF YOU HAVE NEVER TAUGHT THE GRADE OR
PROGRAM LISTED.
Total years grade
or program
taught
a. Preschool or Head Start
b. Kindergarten (including transitional/readiness kindergarten and
transitional/pre-1st grade)
c. First grade
d. Second grade
e. Third grade through fifth grade
f. Sixth grade or higher
g. English as a Second Language (ESL)
h. Bilingual education program
i.

Dual-language program

Special education program

k. Physical education program
l.

Art or music program

Draft

H8.

Counting this school year, how many years have you taught in your current school, including
years in which you taught part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL
SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR, WRITE "1."
Year(s)

H9.

Counting this school year, how many total years have you been a schoolteacher, including
years in which you taught part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL
SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR, WRITE "1."
Year(s)

H10.

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

H11a. What is the name of the college or university where you earned your highest degree?

COLLEGE OR UNIVERSITY
H11b. In what city and state is it located?

CITY

STATE

CHECK HERE IF YOU DO NOT HAVE A DEGREE FROM A COLLEGE OR UNIVERSITY.
(SKIP TO Q H14)

Draft

H12.

If you have an associate's or bachelor's degree, indicate your undergraduate major field of
study. MARK YES OR NO ON EACH ROW.
Yes
No
a. Early childhood education
b. Elementary education
c. Special education
d. Other education-related major (such as secondary education,
educational psychology, education administration, music
education, etc.)
e. Non-education major (such as history, English, etc.)

H13.

If you have a graduate degree, indicate the major field of study of your highest level graduate
degree. MARK YES OR NO ON EACH ROW.
Yes
No
a. Early childhood education
b. Elementary education
c. Special education
d. Other education-related major (such as secondary education,
educational psychology, education administration, music
education, etc.)
e. Non-education major (such as history, English, etc.)

H14.

Have you ever taken a college course in the following areas? MARK YES OR NO ON EACH
ROW.
Yes
No
a. Early childhood education
b. Special education
c. English as a Second Language (ESL) or teaching English language
learners
d. Child development

Draft

H15.

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

H16.

Which of the following describes the teaching certificate you currently hold in THIS state?
MARK ONE RESPONSE.
Regular or standard state certificate or advanced professional certificate
Certificate issued after satisfying all requirements except the completion of a probationary
period
Certificate that requires some additional 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. (SKIP TO Q H19)

H17.

In what areas are you certified? MARK YES OR NO ON EACH ROW.
Yes
a. Elementary education
b. Early childhood education
c. Special education
d. English as a Second Language (ESL) or instruction for English
language learners or bilingual education
e. Other (PLEASE SPECIFY)

Draft

H18.

This school year, do you qualify as a "Highly Qualified Teacher (HQT)" according to your
state's requirements? MARK ONE RESPONSE.

Generally, to be Highly Qualified, teachers must meet requirements
related to having 1) a bachelor's degree, 2) full state certification, and
3) demonstrated competency in the subject area(s) taught. The HQT
requirement is a provision under the Elementary and Secondary
Education Act, as reauthorized by the No Child Left Behind Act of 2001.
Yes
No
I don't know

H19.

Date Questionnaire Completed:

2 0 1 3
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

Draft

Spring Second-Grade General Classroom
Teacher Child-Level Questionnaire

Draft

Spring 2013
Teacher Questionnaire
Child Level
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
Rockville, Maryland
Use a black or blue ball point pen to complete this questionnaire.

S_ID
C_ID

T_ID

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 18500750. Approval expires XX/XX/XXXX. 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. 20006-5574.

Draft

Dear Teacher,
This questionnaire is a vital part of a major longitudinal study of children's early educational experiences
beginning with kindergarten and continuing through grade 5. You have received this questionnaire because
you are the teacher of one or more of the children who are participants in this study. The child who is the
subject of this questionnaire is identified on the cover.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) is collecting
information from teachers of children who are in the study to investigate the relationship between children's
academic progress and various school, classroom, teacher, and home characteristics. 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.
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)
.
I
nf
or
mat
i
on
f
r
om
mul
t
i
pl
e
i
ndi
v
i
dual
s
wi
l
l
be
c
ombi
ned
t
o
pr
oduce
st
at
i
st
i
cal
r
epor
t
s;
no
information that identifies you will be included in any reports or provided to students, their parents, or other
school staff.
DEFINITIONS
For the purposes of this study, the following definitions apply:
Individualized Education Program (IEP): A written statement of the educational program designed to meet
the individual needs of a school-aged child with a disability that is judged to affect the child's educational
performance. Children who receive special education services under the Individuals with Disabilities
Education Act (IDEA) are expected to have an IEP or an IFSP.
Individualized Family Service Plan (IFSP): A written statement of the educational program and other
services designed to enhance the family's capacity to meet the developmental needs of an infant or toddler
(preschool-aged) with a disability. The plan includes a description of the appropriate services needed to
assist transition into elementary school.

Draft
1

TYPES OF LANGUAGE INSTRUCTION EDUCATIONAL PROGRAMS (LIEPS)
Programs that focus on developing students' literacy in two languages

Two-way immersion program (TWI) or two-way bilingual program: The goal of these programs is to
develop strong skills and proficiency in both students' home language and English. These programs may
also be called dual language programs. These programs include students whose native language is not
English (but who all speak the same non-English language) and students whose native language is English.
Instruction is provided in both languages, typically starting with a smaller proportion of instruction in
English, and gradually moving to half of the instruction in each language. Students typically stay in these
programs throughout elementary school.
Developmental bilingual program, late exit transitional program, or maintenance bilingual education
program: The goal of these programs is to develop some skills and proficiency in students' home language
and strong skills and proficiency in English. Content is taught in both languages by teachers fluent in both
languages. These programs may also be called dual language programs. Instruction at lower grades is in
the students' home language with a gradual transition to English. Students typically transition into
mainstream classrooms with their English-speaking peers. The programs can vary in the focus placed on
acquiring literacy in students' home language, but students generally do continue to receive some degree
of support in their home language after the transition to English classrooms.
Transitional program, early exit bilingual program, or early exit transitional program: The goal of these
programs is to develop English proficiency skills as soon as possible, without delaying learning of
academic core content. Instruction begins in students' home language but rapidly moves to English.
Students typically are transitioned into mainstream classrooms with their English-speaking peers as soon
as possible.
Heritage language program or indigenous language program: The goal of these programs is to develop
literacy in two languages. Content is taught in both languages by teachers fluent in both languages.
These programs typically target non-English speakers with weak literacy skills in their home language.
Programs that focus on developing students' literacy solely in English
Sheltered English instruction or content-based English as a Second Language (ESL) program: The goal of
these programs is to develop proficiency in English while learning content in an all-English setting.
Students from various linguistic and cultural backgrounds can be in the same class. Instruction is adapted
to students' proficiency in English and is supported by visual aids and support in the students' home
languages as available. Fully developed prototypes of this program include Sheltered Instruction
Observational Protocol (SIOP) and Specially Designed Academic Instruction in English (SDAIE).
Structured English Immersion (SEI): The goal of SEI is to develop fluency in English. This program usually
serves only English language learners. All instruction is in English, though the instruction is adjusted to the
English proficiency level of students so subject matter is comprehensible. Teachers may have some
receptive skills in the students' home language(s) and generally use sheltered instructional techniques.
Pull-out English as a Second Language (ESL) or English Language Development (ELD): The goal of
these programs is to develop fluency in English. ELL students leave their mainstream classroom for part
of the day to receive ESL instruction, which generally focuses on grammar, vocabulary, and
communication skills, not academic content. There typically is no support provided for students' home
languages.
Push-in English as a Second Language (ESL) program: The goal of push-in ESL is to develop fluency in
English. Students receive ESL instruction in a mainstream classroom, with instruction in English with some
native language support if needed. The ESL teacher or an instructional aide provides clarification,
translation if needed, and uses ESL strategies.

THANK YOU VERY MUCH FOR YOUR HELP.
1

Draft

Social Skills
Social Skills
Twenty-six items ask teachers to rate children in their classroom on social skills (including their ability to
exercise self-control, interact with others, resolve conflict, and participate in group
activities); problem behaviors (e.g., fighting, bullying, arguing, anger, depression, low self-esteem,
impulsiveness, etc.); and learning dispositions or “approaches to learning” (e.g., curiosity, selfdirection, and inventiveness). The social skills items and the problem behavior items are not
listed as they are copyright protected. The learning disposition items are not copyright protected
and are listed below.
Source: Social Skills Rating System (SSRS). Copyright © 1990 NCS Pearson. Adapted with permission. All
rights reserved.

Approaches to Learning Scale items
The teacher indicated how frequently the child exhibited the following behaviors. The response
scale included four points ranging from “never” to “very often,” and there was also a “no
opportunity to observe” option.








Keeps belongings organized
Shows eagerness to learn new things
Works independently
Easily adapts to changes in routine
Follows classroom rules
Persists in completing tasks
Pays attention well

Thirteen items adapted from the Temperament in Middle Childhood Questionnaire ask teachers to assess
the attentional focusing and inhibitory control of the children in their classroom. The items are not
listed as they are copyright protected.
Source: Temperament in Middle Childhood Questionnaire. © 2004 Jennifer Simonds and Mary K. Rothbart, University of
Oregon. Adapted and used with permission.

Fifteen items from the Student-Teacher Relationship Scale that ask teachers to describe their relationship
with sampled children in their classroom. The items are not listed as they are copyright protected.
Source: Pianta, R.C. & Steinberg, M. (Eds.) (1992). Teacher-child relationships and the process of adjusting to
school. San Francisco, CA, US: Jossey-Bass. Used with permission.

Draft

D. Student Information
D1.

In which grade is this child enrolled? MARK ONE RESPONSE.
Kindergarten
First grade
Second grade
Third grade or higher
This is an ungraded classroom

D2.

How long has this child been in your classroom this school year? MARK ONE RESPONSE.
Entire school year
More than one semester but less than the entire school year
More than one quarter but less than one semester
Less than one quarter of the school year

D3.

Please indicate the total number of absences for this child for the current school year. MARK ONE
RESPONSE.
No absences
1 to 4 absences
5 to 7 absences
8 to 10 absences
11 to 19 absences
20 or more absences

D4.

Has this child ever fallen 2 or more weeks behind in school work this year? MARK ONE RESPONSE.
Yes
No (SKIP TO Q D6)
Not applicable (child has been enrolled in your class less than 2 weeks) (SKIP TO Q D6)

Draft

D5.

Why has this child fallen behind in school work? MARK ALL THAT APPLY.
a. A health problem
b. A disciplinary problem
c. Lack of effort
d. Disorganized
e. Lacks pre-requisite skills
f.

Frequent absences

g. Emotional/family problems
h. Some other reason (PLEASE SPECIFY)

D6.

Does this child receive (or has he/she received during this school year) instruction in any of
the following types of programs in your school? MARK YES OR NO ON EACH ROW.
Yes

a. Individual tutoring or remedial program in reading/language
arts
b. Individual tutoring or remedial program in mathematics
c. Pull-out (that is, out of classroom) small group remedial program
in reading/language arts
d. Pull-out (that is, out of classroom) small group remedial program
in mathematics
e. Gifted and talented program in reading/language arts
f.

D7.

Gifted and talented program in mathematics

Does this child receive (or has he/she received during this school year) instruction and/or
related services in your school at any of the following times outside of the regular school day?
MARK ONE RESPONSE ON EACH ROW.
Yes
a. Instruction or services before school
b. Instruction or services after school
c. Instruction or services on weekends

Not
offered

Don't
know

Draft

D8.

Is English this child's native language? MARK ONE RESPONSE.
Yes (SKIP TO Q D14)
No
Don't know

D9.

Does this child participate in an instructional program designed to teach English language
skills to children with limited English proficiency? MARK ONE RESPONSE.
Yes
No (SKIP TO Q D14)

D10. Woul
d
you
say
t
he
i
nst
r
uct
i
on
t
hi
s
chi
l
d
r
ecei
ves
i
s
pr
i
mar
i
l
y…
MARK ONE RESPONSE.
EXAMPLES OF THE PROGRAMS INCLUDED IN EACH CATEGORY ARE PROVIDED BELOW.
SEE PAGE 4 FOR DEFINITIONS OF THESE EXAMPLES.
Programs that focus on developing students' literacy in two languages. For example:






Programs that focus on developing students' literacy solely in English. For example:


Sheltered English instruction or content-based English as a Second
Language (ESL) program



Structured English Immersion (SEI)



Pull-out English as a Second Language (ESL) or English Language Development (ELD)
Push-in ESL program



Other program(s) (PLEASE SPECIFY)

No specialized language program is provided to this child. (SKIP TO Q D13)

Draft

D11.

How often does this child usually receive specialized language instruction of the following program
types? MARK ONE RESPONSE ON EACH ROW.

Never

Less
than
once a
week

1 day a
week

2 days
a week

3 days
a week

4 days
a week

5 days
a week

a. Program that focuses on
developing students' literacy in
two languages
b. Program that focuses on
developing students' literacy
solely in English
c. Other program

D12.

On the days when this child receives specialized language instruction, for how much time does
he/she receive instruction of the following program types? MARK ONE RESPONSE ON EACH ROW.
Less
Not
than ½
applicable/ hour a
never
day

½ hour
to less 1 to less
than 1 than 1 ½
hour
hours

1 ½ to
less
than 2
hours

2 to less
than 2 ½
hours

2 ½ to
less
than 3
hours

a. Program that focuses on
developing students'
literacy in two languages
b. Program that focuses on
developing students'
literacy solely in English
c. Other program

D13.

During this school year, how often is this child's academic instruction provided in his/her
native language? MARK ONE RESPONSE.
None of the time
Less than half of the time
Half of the time
More than half of the time
Almost all the time

D14.

Does this child have an IEP/IFSP on record with the school? MARK ONE RESPONSE.
Yes
No

3 hours
or more

Draft

D15.

Does this child receive instruction in any of the following types of programs in your school?
MARK YES OR NO ON EACH ROW.
Yes

a. Speech-language therapy for children with speech or language
disorders/impairments
b. Special education services, not including speech therapy, whether
provided in the classroom or in a pull-out setting

D16.

Does this child receive special accommodations (for example, for a disability or limited
English proficiency) to participate in the school's testing or assessment program? MARK
ONE RESPONSE.
Yes
No
Don't know
Child does not participate in the school's testing or assessment program
There is no testing or assessment program at this grade level

D17.

During structured play time, how does this child compare with other children in the class in
terms of physical activity? MARK ONE RESPONSE.
A lot less active than most
A little less active than most
About the same as most
A little more active than most
A lot more active than most

D18.

During unstructured play time, how does this child compare with other children in the class
in terms of physical activity? MARK ONE RESPONSE.
A lot less active than most
A little less active than most
About the same as most
A little more active than most
A lot more active than most

Draft

D19.

Overall, how would you rate this child's academic skills in each of the following areas, based
on curriculum standards for his/her current grade level? MARK ONE RESPONSE ON EACH ROW.
Below
grade
level

About on
grade
level

Above
grade
level

a. Reading
b. Writing
c. Oral language
d. Mathematics
e. Science
f.
D20.

Social Studies

How many instructional groups based on achievement or ability levels in READING do you
currently have in this child's class? MARK ONE RESPONSE.
I do not use instructional groups for reading (SKIP TO Q D22)
Two
Three
Four
Five or more

D21.

In which reading instructional group is this child currently placed? USE "1" FOR THE
HIGHEST INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL
GROUP BELOW.
Instructional Group

D22.

How many instructional groups based on achievement or ability levels in MATHEMATICS do
you currently have in this child's class? MARK ONE RESPONSE.
I do not use instructional groups for mathematics (SKIP TO Q D24)
Two
Three
Four
Five or more

Draft

D23.

In which mathematics instructional group is this child currently placed? USE "1" FOR THE
HIGHEST INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL
GROUP BELOW.
Instructional Group

D24.

During this school year, how often have other students ... MARK ONE RESPONSE ON EACH ROW.
Never

Rarely

Sometimes

Often

Very often

a. Teased, made fun of, or called
this student names?
b. Pushed, shoved, slapped, hit, or
kicked this student?
c. Told lies or untrue stories about
this student?
d. Intentionally excluded or left this
student out from playing with
them?

D25.

During this school year, how often has this student ... MARK ONE RESPONSE ON EACH ROW.
Never
a. Teased, made fun of, or called
other students names?
b. Pushed, shoved, slapped, hit, or
kicked other students?
c. Told lies or untrue stories about
other students?
d. Intentionally excluded or left other
students out from playing with him
or her?

Rarely

Sometimes

Often

Very often

Draft

D26.

During this school year, have this child's parents/guardians participated in the following
activities? MARK ONE RESPONSE ON EACH ROW.

Yes

Not
applicable/
not offered

a. Attended regularly-scheduled conferences at
your school
b. Attended parent/teacher informal meetings that
you initiated to talk about the child's progress
c. Returned your telephone calls or e-mails
d. Initiated contact with you
e. Volunteered to help in your classroom or school

D27.

How involved at the school would you say this child's parents/guardians are? MARK ONE
RESPONSE.
Not involved at all
Somewhat involved
Very involved
Don't know

D28.

During this school year, besides regular teacher conferences, have you communicated with
this child's parents/guardians? MARK ONE RESPONSE.
Yes
No (SKIP TO Q D30)

D29.

Was the purpose of the communication with this child's parents/guardians to discuss ...
MARK YES OR NO ON EACH ROW.
Yes
a. Behavior problems the child is having in school?
b. Any problems the child is having with school work?
c. Anything the child is doing particularly
well in or better in at school?

Draft

D30.

Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON
EACH ROW.
Yes

a. Reading/Language Arts
b. Mathematics
c. Science
d. Social Studies

D31.

How far in school do you think this child will go? Would you say you think he/she will ...
MARK ONE RESPONSE.
Receive less than a high school diploma?
Graduate from high school?
Finish a four- or five-year college degree?
Earn an advanced degree?

D32.

Date Questionnaire Completed:

2 0 1 3
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

File Type	application/pdf
File Modified	2012-08-31
File Created	2012-08-23