Annual Survey for MSP Institute K-12 Participants

Attachment H

OMB # 3145-0199
Expires: xxxxxx

Math and Science Partnership Program
Annual Survey for K-12 Institute Participants

Sponsored by the
National Science Foundation

Conducted by
Westat
1650 Research Boulevard
Rockville, Maryland 20850

Privacy Notice
Information from this monitoring system will be retained by the National Science Foundation, a federal agency, and
will be an integral part of its Privacy Act System of Records in accordance with the Privacy Act of 1974 and
maintained in the Education and Professional development activities System of Records 63 Fed. Reg. 264, 272
(January 5, 1998). These are confidential files accessible only to appropriate National Science Foundation (NSF)
officials, their staffs, and their contractors responsible for monitoring, assessing, and evaluating NSF programs. Only
data in highly aggregated form, or data explicitly requested as "for general use," will be made available to anyone
outside of the National Science Foundation for research purposes. Data submitted will be used in accordance with
criteria established by NSF for monitoring research and education grants, and in response to Public Law 99-383 and
42 USC 1885c.

Public Burden
Paperwork Reduction Act Notice. The Paperwork Reduction Act of 1995 says we must tell you why we are collecting
this information, how we will use it and whether you have to give it to us. The reasons and purpose of this survey are
described in the introduction and instructions for this survey and your response is voluntary. Failure to provide full and
complete information, however, may reduce the possibility of NSF continuing support for the award or project subject
to this monitoring survey. An agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control number. The OMB control number for this survey is
3145-0199. The estimated average burden associated with this collection of information is 1.33 hours per respondent,
depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions
for reducing the burden should be sent to Suzanne Plimpton, Reports Clearance Officer for OMB 3145-0199,
NSF/DAAS, 4201Wilson Boulevard, Arlington, VA 22230.

2

Annual Survey of K-12 Institute Participants
The National Science Foundation (NSF) is collecting annual information about each of its Math and
Science Partnership (MSP) projects. The purpose is to assess the overall implementation of the MSP
program and to monitor the progress of individual MSP grants.
This survey is designed to obtain information from each K-12 teacher and administrator who has
enrolled in one or more MSP Institute courses or workshops. The Principal Investigator (PI) of one of the
MSP Institutes has identified you as being an appropriate respondent. If you have any questions about the
MSP Management Information System, please contact:
Holly Bozeman
1-800-937-8281, ext. 2619
[email protected]
We estimate that it will take approximately 80 minutes of your time to complete this survey. Thank you
in advance for completing this survey.
INSTRUCTIONS FOR COMPLETING THE SURVEY
Feed-back from K-12 teachers and administrators participating in the MSP program is crucial for
understanding the strengths and weaknesses of the MSP program. We have constructed this survey to
give you the flexibility to respond in general and in detail relative to your level of involvement.
Neither NSF nor the Federal Government will maintain names or contact information associated with this
survey. However, this information is held by the awardee institution. Your responses to the questions,
however, will not be shared with the PI except in summary form.
Please answer the following questions with the most appropriate response. You may cut and paste text
into this system.
It is recommended that you review the Primer (which can be accessed electronically by clicking on
"Help" in the menu on the top of the page) before beginning the survey. The Primer provides
general instructions and navigation information.
As you are completing the survey, please click the Save & Continue button after you respond to each
item/set of items. Once an item or item set is saved, you may use the Question Guide to return to an item
and revise your response. If you exit the system without saving, you will lose any unsaved data.
When you are ready to submit your data to NSF, please click the Submit button at the end of the form.
You will no longer have access to this survey after a Final Submit has been made.
Professional Status

Professional Community Building

Continued Professional Development

Dissemination of Institute Information

[INSERT PROJECT NAME] Participation

3

Professional Status
This section obtains information on your professional status during the [INSERT SCHOOL YEAR]
school year.

1. Please review and update the following item. If there are no changes, click on save and
continue:
What was the name of the K–12 school at which you were working during the [INSERT
SCHOOL YEAR] school year?
First school (district) name: (Pre-filled)1
Second school (district) name: (Pre-filled)2

2. Please review and update the following item. If there are no changes, click on save and
continue:
What was the designation of your K–12 school during the [INSERT SCHOOL YEAR] school
year: (Check one response)3








Elementary school
Middle school/junior high school
K–8 school
K-12 school
High school
Ungraded school
Other (specify): _________________________________________________

1

Response is pre-filled (Q4 from Initial). Respondent can alter text.

2

Response is pre-filled (Q4 from Initial). Respondent can alter text.

3

Response is pre-filled (Q5 from Initial).

4

3.

Please review and update the following item. If there are no changes, click on save and
continue:
Which of the following best reflects your primary position during the [INSERT SCHOOL
YEAR] school year? (Check one response.)4











Elementary school teacher
Middle school/junior high school teacher
High school teacher
Curriculum specialist
School-wide subject-specific specialist5
District-wide subject-specific specialist6
Department head
Principal
Vice Principal or Assistant Principal
Other (specify): ______________________________________________

4

Response is pre-filed (Q6 from Initial).

5

Respondent will be asked to indicate if mathematics or science specialist.

6

Respondent will be asked to indicate if mathematics or science specialist.

5

4. Did you have any instructional responsibilities with K-12 students at your school during the
[INSERT SCHOOL YEAR] school year?
 Yes
 No7

5. What grades did you teach or provide other services for a mathematics or science subject
during the [INSERT SCHOOL YEAR] school year? (Check all that apply)
















7

Pre-kindergarten
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Ungraded

If checked, skip to Q7, otherwise continue with Q5.

6

6. What subject(s) did you teach or provide other services for during the [INSERT SCHOOL
YEAR] school year? (Check all that apply)
NOTE – Please refer to the glossary for the definitions of the high school level 1 – 5 Mathematics
courses.
Mathematics
 Elementary school mathematics
 Middle school Mathematics
 Includes Algebra 1 content
 Includes Geometry content*
 Includes Algebra 2 content*










High school Level 1 Mathematics
High school Level 2 Mathematics
High school Level 3 Mathematics
High school Level 4 Mathematics
High school Level 5 Mathematics
AP Calculus (AB)
AP Calculus (BC)
AP Statistics
Other (specify): _____________________________________________

Science











Elementary school science
Middle school science
Non-AP Biology
Non-AP Chemistry
Non-AP Physics
Earth Science Integrated Science
AP Biology
AP Chemistry
AP Physics
Other (specify): _____________________________________________

Computer Science
 Non-AP computer science
 AP computer science

These items are selected only after “Middle school mathematics” is selected.

7

7. Please review and update the following item. If there are no changes, click on save and
continue:
What degrees have you earned? (Check all cells that apply)8
NOTE—Degree options do not include certifications, certificates, endorsements, or licensures. If you
have earned a degree that was a combination of several different degree fields, check all of the cells
that apply (e.g., Master’s degree in mathematics and education.)

Type of degree

Degree field9
Mathematics

Science

Education

Other

Bachelor’s degree
Master’s degree
Ph.D.
Ed.D.
Professional degree (e.g., M.D., LPN)
Specialist degree
Other (specify): ___________________

8.

Are you currently working on a degree? (Check one response)



Yes (Continue with Question 8b.)
No (Go to Question 9.)

8

Response is pre-filled (Q13 from Initial).

9

NOTE: Additional information will be requested for all degree fields checked, e.g., “Please use this list to specify the discipline of the [TYPE
OF DEGREE] you earned in [DEGREE FIELD]”

8

8a.

What degrees are you currently working on? (Check all cells that apply)

NOTE—Degree options do not include certifications, certificates, endorsements, or licensures. If you
have earned a degree that was a combination of several different degree fields, check all of the cells
that apply (e.g., Master’s degree in mathematics and education.)

Type of degree

Degree field10
Mathematics

Science

Education

Other

Bachelor’s degree
Master’s degree
Ph.D.
Ed.D.
Professional degree (e.g., M.D., LPN)
Specialist degree
Other (specify): ___________________

10

NOTE: Additional information will be requested for all degree fields checked, e.g., “Please use this list to specify the discipline of the [TYPE
OF DEGREE] you are working on in [DEGREE FIELD]”

9

9. Please review and update the following item. If there are no changes, click on save and
continue:
Which of the following state teaching certifications do you currently hold? (Check all
that apply.)11
 Elementary school: General
 Elementary school: Mathematics
 Elementary school: Science
 Middle school: General
 Middle school: Mathematics
 Middle school: Science







High school: Mathematics
High school: Science–General
High school: Biology
High school: Chemistry
High school: Physics
High school: Earth Science

 Special Education
 ESL/Bilingual
 Other subject area within state endorsements (specify): _________________________________

10. Please review and update the following item. If there are no changes, click on save and
continue:
Which of the following other certifications have you successfully completed? (Check all that
apply)12






11

National Board Certification©
Praxis13 II™
Praxis III™
Other (specify): ___________________________________________________________
None of the above

Response is pre-filled (Q15 from Initial).

12

Response is pre-filled (Q16 from Initial).

13

The Praxis was formerly called the National Teachers Exam (NTE).

10

11. Which of the following leadership roles did you hold during the [INSERT SCHOOL YEAR]
school year? (Check all that apply)
 Served on curriculum committee
 Served on textbook adoption committee
 Served on other school-wide or district-wide committee or task force
If yes, please describe: ___________________________________________________________
 Involved in peer coaching activities
 Served as Lesson Study leader/participant
 Served as officer in a local professional organization for science and/or mathematics
 Served as committee chair/officer/representative for a national professional organization (e.g.,
NSTA, NCTM)
 Served on business/industry mathematics or science task force in local area
 Served as mathematics/science supervisor
 Served as a department chair or mathematics/science leader for my grade or building
 Mentored novice teachers
 Supervised an undergraduate or graduate student on practicum
 Formed action research community in my school and/or district
 Organized a learning community for teachers in my school and/or district
 Offered an in-service workshop for other teachers
 Offered a professional development workshop in math or science
 Made a presentation to my school, administrators, school board, or other organization about
my school’s efforts to improve student achievement in math or science
 Other (specify):_________________________________________________________________
 None of the above

11

Professional Community Building
This section obtains information about the growth and development of a professional community
among teacher leaders and other [INSERT STEM] and education professionals.
1.

Using the table below, indicate how often you are in contact with the following mathematics,
science, and/or education professionals as a result of your participation in the [INSERT
PROJECT NAME] during the [INSERT SCHOOL YEAR] academic school year:
How often were you in contact with the following
professionals during the [INSERT SCHOOL YEAR]
academic school year?14

STEM and Education Professionals

14

a) Other Institute teacher leaders







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

b) University, college, or community college science,
technology, engineering, and/or mathematics faculty







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

c) University, college, and/or community college education
faculty







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

d) Post-docs, graduate students, and/or undergraduates







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

e) Non-academic mathematician/scientist







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

f). Other (specify):__________________________







Daily
Once or twice a week
Once or twice a month
Once or twice a year
Never

For each type of professional the respondent was in contact with daily, once or twice a week, once or twice a month, or once or twice a year,
he/she will be asked to complete two additional items about their interaction.

12

Complete the following items for each science, technology, engineering, mathematics and/or
education professional that you were in contact with daily, once or twice a week, or once or twice a
month during the [INSERT SCHOOL YEAR] academic school year:

1. What was the most frequent means of communication with this professional? (Check one
response)






In person
Email
Phone
Other (specify): __________________________________________________________

2. What was the purpose of your communication with this professional? (Check all that apply)
 To discuss successes and/or struggles of implementing knowledge learned at the [INSERT
PROJECT NAME] Institute
 To develop more challenging curriculum/lesson plans
 To plan for future activities (e.g. professional development, conferences, seminars, etc.)
 To attend colloquia/workshops/seminars together
 To attend professional development activities together
 To analyze the results of state assessments
 To participate in a learning community/study group
 To participate in [INSERT PROJECT NAME] research project
 To discuss course work
 Other (specify): __________________________________________________________

13

Continued Professional Development
This section obtains information about the type of [INSERT PROJECT NAME] supported
professional development activities you have completed during the [INSERT SCHOOL YEAR]
academic school year.
1.

Using the table below, identify the [INSERT PROJECT NAME]-related professional
development activities you completed during the [INSERT SCHOOL YEAR] academic school
year.

Professional Development Activities

Did you receive or
take part in this
activity during the
[INSERT SCHOOL
YEAR] academic
15
school year?

a) Completed a formal course(s) in mathematics, science, teacher education, educational
assessment, and/or educational leadership during the [INSERT SCHOOL YEAR]
academic school year.

Yes/No
(If yes, see page 14)

b) Received ongoing support, assistance, or mentoring from one or more [INSERT
PROJECT NAME] faculty members (e.g., a faculty member on-call to receive content
related questions, worked with Master Teachers on lesson plan development for diverse
student populations, discussed content/instructional issues in my classroom, etc)

Yes/No
(If yes, see page 16)

c) Participated in an externship/internship program (e.g., teachers spend a year or less
with a [INSERT PROJECT NAME] business or industry partner related to their field)

Yes/No
(If yes, see page 18)

d) Attended conferences, workshops, seminars and/or colloquia, gave a talk at a
meeting, or authored a publication.

Yes/No
(If yes, see page 19)

e) Other (specify): ________________________________________________________

Yes/No
(If yes, see page 21)

f) Other (specify): ________________________________________________________

Yes/No
(If yes, see page 21)

g) Other (specify): ________________________________________________________

Yes/No
(If yes, see page 21)

h) Other (specify): ________________________________________________________

Yes/No
(If yes, see page 21)

i) Other (specify): ________________________________________________________

Yes/No
(If yes, see page 21)

15

NOTE: Additional information will be requested for all activities for which the response was “Yes.”

14

If response is “Yes” to activity a) Completed a formal course(s) in mathematics, science, teacher
education, educational assessment, and/or educational leadership during the [INSERT SCHOOL
YEAR] academic school year , then complete the following item set:
1. How many courses did you take during the [INSERT SCHOOL YEAR] academic school year?
__________
2. Did you receive academic credit for the course(s) you took during the [INSERT SCHOOL
YEAR] academic school year?
 Yes, I received credits for all courses taken
 Yes, I received credit for some but not all courses taken
 No, I did not receive credit for the courses I took

3. What was the focus of the course(s)? (Check all that apply)






Mathematics, science, and/or teacher education pedagogy
Mathematics, science, and/or teacher education content
Educational assessment
Educational leadership
Other (specify): _________________________________________________________________

4. What was the educational level of the course(s)? (Check all that apply)





Undergraduate
Graduate
Certificate
Other (specify): _______________________________________________________________

5. How was the course(s) offered? (Check all that apply)






Online
In-class at a university or college campus
In-class at a K-12 school building
In-class at an other location (specify): _______________________________________________
Other (specify): _________________________________________________________________

6. When was the course(s) offered? (Check all that apply)





Not applicable – my courses are offered online
During teaching hours
Evenings
Weekends

15

7. Did you conduct or assist with any research as part of this course(s)? (Check all that apply)







No
Yes, science, technology, engineering, and/or mathematics research
Yes, education research
Yes, action research
Yes, other research (specify): ____________________________________________________

8. How has completing a formal course(s) in mathematics, science, teacher education, educational
assessment, and/or educational leadership contributed to your development as a teacher leader
and/or enhanced understanding of your content area?
NOTE - If reporting an enhanced understanding of your content area, please specify the content area.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

16

If response is “Yes” to activity b) Received ongoing support, assistance, or mentoring from one or more
[INSERT PROJECT NAME] faculty members, then complete the following item set:

1. Which of the following [INSERT PROJECT NAME] Institute faculty members provided you
with ongoing technical support, assistance, or mentoring during the [INSERT SCHOOL
YEAR] academic school year? (Check all that apply)
NOTE – If mentored, received support, or received support from more than one faculty member,
provide information for the individual who was your primary mentor or the individual from whom
you have received the most guidance.
 University, college, or community college science, technology, engineering, and/or mathematics
faculty
 University, college, or community college education faculty
 Master teacher
 Post-doc
 Graduate student
 Undergraduate student
 Professional development consultant
 Other (specify): ____________________________________________________________

2. How often were you provided support, assistance, or mentoring during the [INSERT SCHOOL
YEAR] academic school year? (Check one response for each question)
a. In person. (Check one response)
 Daily
 Once or twice a week
 Once or twice a month
 A few times during the year
 Never
b. By internet (e.g., email, chat room). (Check one response)
 Daily
 Once or twice a week
 Once or twice a month
 A few times during the year
 Never
c. By telephone. (Check one response)
 Daily
 Once or twice a week
 Once or twice a month
 A few times during the year
 Never

17

3. Briefly describe the type of technical support, assistance, or mentoring you were provided
during the [INSERT SCHOOL YEAR] school year:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
4. How has receiving ongoing support, assistance, or mentoring from one or more [INSERT
PROJECT NAME] faculty member contributed to your development as a teacher leader and/or
enhanced understanding of your content area?
NOTE - If reporting an enhanced understanding of your content area, please specify the content area.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

18

If response is “Yes” to activity c) Participated in an externship/internship program, then complete the
following item set:

1. Where did you complete the externship/internship? (Check one response)
 An institution of higher education (specify):__________________________________________
 A private (non-institute of higher education) research institution or laboratory
(specify):__________________________
 A business (specify):____________________________________________________________
 A government agency/lab (specify):________________________________________________
 An informal science institution (e.g., a museum) (specify):______________________________
 Other (specify):_________________________________________________________________

2. How long was the externship/internship program? (Check one response)







Less than a week
1 to 2 weeks
3 to 4 weeks
One to three months
Four to six months
More than six months

3. Did you conduct or assist with any research as part of this externship/internship? (Check all that
apply)






No
Yes, science, technology, engineering, and/or mathematics research
Yes, education research
Yes, action research
Yes, other research (specify): ____________________________________________________

4. Briefly describe the types of activities that you participated in as part of your
externship/internship during the [INSERT SCHOOL YEAR] school year:
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

5. How has participating in an externship/internship program contributed to your development as
a teacher leader and/or enhanced understanding of your content area?
NOTE - If reporting an enhanced understanding of your content area, please specify the content area.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

19

If response is “Yes” to activity d) Attended conferences, workshops, seminars and/or colloquia, gave a
talk at a meeting, or authored/co-authored a publication, then complete the following item set:
1. How many publications did you author/co-author during the [INSERT SCHOOLYEAR] school
year?
 Specify number: ___________ (Continued with question 1a)
 Not applicable (Go to question 2)
1a. Using the table below, list the title of the publication(s) you have authored/co-authored
during the [INSERT SCHOOL YEAR] school year and indicate whether or not the
publication was published in a refereed journal.
Published in a
refereed journal?

Title of Authored/Co-Authored Publication

1. ____________________________________________________________

2. ____________________________________________________________

3. ____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

6. _____________________________________________________________

7. _____________________________________________________________

8. _____________________________________________________________

9. _____________________________________________________________

10. _____________________________________________________________

20

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

Yes/No

2. What was the focus of the conference, colloquia, workshop(s), talk, and/or seminar(s)? (Check
all that apply)











Not applicable -- Did not attend conference, colloquia, workshop, talk, and/or seminar
Science, technology, engineering, and/or mathematics content
Science, technology, engineering, and/or mathematics research
Instructional strategies
Instructional materials (e.g. technology, curriculum, etc.)
Pedagogy
Assessment
Student diversity
Leadership
Other (specify): ______________________________________________________________

3. How has attending conferences, workshops, seminars and/or colloquia, giving a talk at a
meeting, or authoring/co-authoring a publication contributed to your development as a teacher
leader and/or enhanced understanding of your content area?
NOTE - If reporting an enhanced understanding of your content area, please specify the content area.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

21

If response is “Yes” to activity e) Other (specify), then complete the following item:
1. What was this professional development activity and how has it contributed to your
development as a teacher leader and/or enhanced understanding of your content area?
NOTE – If reporting an enhanced understanding of your content area, please specify the content
area.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

22

Dissemination of Institute Information
This section obtains information about the ways in which you, as a teacher leader, during the
[INSERT SCHOOL YEAR] have disseminated the information you learned through the [INSERT
PROJECT NAME] Institute.

1. Estimate the number of teachers and administrators that you worked with on [INSERT
PROJECT NAME] during the [INSERT SCHOOL YEAR] academic school year:
Teachers

Administrators

In your school
In your school district
(excluding your school)

1a. How often did you work with the other [INSERT TEACHER OR ADMINISTRATOR] in
your [INSERT SCHOOL OR DISTRICT] on [INSERT PROJECT NAME] related
activities during the [INSERT SCHOOL YEAR] academic school year? (Check one
response)





Daily
Once or twice a week
Once or twice a month
Once or twice a year

1b. How have you disseminated [INSERT PROJECT NAME] Institute information to other
[INSERT TEACHER OR ADMINISTRATOR] in your [INSERT SCHOOL OR
DISTRICT] during the [INSERT SCHOOL YEAR] academic school year? (Check all that
apply)









Conducted classroom observations and offered feedback for improvement
Served as a mentor
Performed demonstration teaching for the other mathematics/science teachers
Led study groups or science, technology, engineering, and/or mathematics learning
communities with teachers on mathematics/science concepts and/or instructional skills
Collaborated with other teachers to develop challenging mathematics/science curriculum
Collaborated with other teachers to develop ways to promote higher student achievement
Conducted professional development workshops and activities
Other (specify): ______________________________________________________________

23

2. Did you work with any teachers or administrators on [INSERT PROJECT NAME] related
activities outside of your district or state?
 Yes
 No

(Continue with Question 2a)
(Go to Question 3)

2a. How often did you work with the other teachers and/or administrators from outside of your
district and/or state on [INSERT PROJECT NAME] related activities during the [INSERT
SCHOOL YEAR] academic school year? (Check one response)





Daily
Once or twice a week
Once or twice a month
Once or twice a year

2b. How have you disseminated [INSERT PROJECT NAME] Institute information to teachers
and/or administrators from outside of your district and/or state during the [INSERT
SCHOOL YEAR] academic school year? (Check all that apply)









Conducted classroom observations and offered feedback for improvement
Served as a mentor
Performed demonstration teaching for the other mathematics/science teachers
Led study groups or science, technology, engineering, and/or mathematics learning
communities with teachers on mathematics/science concepts and/or instructional skills
Collaborated with other teachers to develop challenging mathematics/science curriculum
Collaborated with other teachers to develop ways to promote higher student achievement
Conducted professional development workshops and activities
Other (specify): ______________________________________________________________

24

3. Did you present at a professional conference or workshop during the [INSERT SCHOOL
YEAR] school year to disseminate information that you’ve learned through your participation
in the [INSERT PROJECT NAME] Institute? (Check one response)
 Yes
 No

(Continue with Question 3a)
(Section complete)

3a. Please list the professional conference(s)/workshop(s) you presented at during the [INSERT
SCHOOL YEAR] school year:
___________________________________________________________________________
__________________________________________________________________________
________________________________________________________________________

3b. What was the topic of your presentation(s)? (Check all that apply)










Science, technology, engineering, and/or mathematics content
Science, technology, engineering, and/or mathematics research
Instructional strategies
Instructional materials (e.g. technology, curriculum, etc.)
Pedagogy
Assessment
Student diversity
Leadership
Other (specify): ______________________________________________________________

25

[INSERT PROJECT NAME] Participation
This section obtains information about your involvement in the [INSERT PROJECT NAME]
Institute during the [INSERT SCHOOL YEAR] school year.

1. How much time did you spend at the [INSERT PROJECT NAME] 2005 Summer Institute?
(Check one response)







Less than 2 weeks (Skip to Q2)
2 to 3 weeks (Skip to Q2)
4 to 5 weeks (Skip to Q2)
6 weeks or more (Skip to Q2)
Not applicable – No Summer Institute, entire program was offered online (Continue to Q1a)
Did not attend

1a. What support did you receive for participating in the [INSERT PROJECT NAME]? (Skip
to Q4 after completing this item)








No support provided
Release time, constituting _____% of my daily schedule
Administrative support
Financial support
Additional recognition/rewards
Tuition reimbursement
Other (specify)

2. What support did you receive for participating in the [INSERT PROJECT NAME] 2005
Summer Institute? (Check all that apply)








No support provided
Release time, constituting _____ % of my daily schedule
Administrative support
Financial support
Additional recognition/rewards
Tuition reimbursement
Other (specify): _____________________________________

26

3. What support did you receive from [INSERT PROJECT NAME] during the [INSERT
SCHOOL YEAR] academic year to fulfill your teacher leader responsibilities and/or to
participate in project related activities? (Check all that apply)








No support provided
Release time, constituting _____ % of my daily schedule
Administrative support
Financial support
Additional recognition/rewards
Tuition reimbursement
Other (specify): ______________________________________________________________

4. To what extent did each of the following facilitate or hinder your ability to fulfill your teacher
leader responsibilities AND/OR participate in [INSERT PROJECT NAME] during the
[INSERT SCHOOL YEAR] academic school year? (Check one response for each question)
Facilitate
1
2
a. Total amount of financial assistance that I
received
b. The total amount of release time that I
received
c. Level of cooperation provided by the
principal at your school
d. Level of cooperation provided by other
administrators in your school or district
e. Level of cooperation provided by
other teachers in your school or district
f. Level of ongoing support provided by
faculty or others at post-secondary
institutions
g. Level of ongoing support (other than
financial) provided by your school or
district

Neutral
3
4

Hinder
5

Not
Applicable





















































































5. Were there any other factors that facilitated or hindered your ability to fulfill your teacher
leader responsibilities AND/OR participate in [INSERT PROJECT NAME] during the
[INSERT SCHOOL YEAR] academic school year?
_________________________________________________________________________________
_________________________________________________________________________________

6. Briefly describe how your teaching practices changed over the course of your involvement with
the [INSERT PROJECT NAME]. Your response may include changes to your approach to
planning lessons and/or classroom practices. Your response should also include what aspect of
your involvement brought about this change.
_________________________________________________________________________________

27

_________________________________________________________________________________

7. What has been your own most significant contribution to your school, district, or state as a
result of your involvement with the [INSERT PROJECT NAME]?
_________________________________________________________________________________
_________________________________________________________________________________

8. How has your role within your school and/or district changed over the course of your
involvement with the [INSERT PROJECT NAME]?
_________________________________________________________________________________
_________________________________________________________________________________

28