Early Childhood Longitudinal Study Kindergarten Class of 2010-11 (ECLS-K:2011) Spring 3rd Grade School Contact for Hearing Evaluation

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

Appendix_D_E_&_F_ECLS-K2011_Spring_3rd_Teacher_&_School_Administrator_Questionnaires

Early Childhood Longitudinal Study Kindergarten Class of 2010-11 (ECLS-K:2011) Spring 3rd Grade School Contact for Hearing Evaluation

OMB: 1850-0750

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APPENDIX D
SPRING THIRD-GRADE
GENERAL CLASSROOM TEACHER
QUESTIONNAIRES

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

OMB Clearance Package
# 1850-0750 v.15

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

Draft

Spring 2014
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 IN THE
SEALED TYVEK® ENVELOPE 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 XXXX XXXX. Approval expires XX/XX/XXXX. The time required to complete both the
classroom and subject questionnaires 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.
3 Participation is voluntary. You may skip questions
you
do
not
wi
sh
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) Parent involvement
d) Evaluation and grading practices
e) School and staff activities
f ) Views on school climate and the school environment
g) 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
c
ombi
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 4) or by writing your responses in the space provided. Your best estimates are acceptable answers.

DEFINING "YOUR CLASS"
Most of the items in this questionnaire ask you to provide information about "your class." By the term "your
class," we generally mean the group of students who spend the majority of their school day with you--though
some or all of them may leave your classroom for certain activities, including some academic instruction.
In some schools, it may be easy for a teacher to decide which group of children to consider as his or her class,
while in other schools it may not be as easy to decide. If you are not sure what group of children to think
about when answering questions about "your class," please ask for assistance from the ECLS-K:2011
study representatives when they visit your school.

THANK YOU VERY MUCH FOR YOUR HELP.

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?
d. Are boys?
e. Are girls?

A2.

What grade levels are included in your class? MARK ALL THAT APPLY.
a. 1st grade
b. 2nd grade
c. 3rd grade
d. 4th grade
e. 5th grade or higher

A3.

During this school year have you taught the following subjects to any or all of the students in your
class? MARK ONE RESPONSE ON EACH ROW.
Yes, to all of the
students in my
class
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies

Yes, to some of
the students in
my class

No, not to any of
the students in
my class

Draft

A4.

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

A5.

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?

A6.

How many children in your class ...
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of
children
a. Are tardy, on an average day?
b. Are absent, on an average day?

A7.

How many children in your class are below grade level, about on grade level, or above grade
level in each of the following subjects?
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Below
grade level
a. English reading skills?
b. Mathematics skills?

About on
grade level

Above
grade level

A8.

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.

A9. Item on the Classroom Environment. Teachers are asked to give the percentage of children in their classroom who
demonstrate each of four types of behaviors or characteristics that either disrupt or create a challenging learning
environment. The exact wording of these items is not included here because they are copyright protected.
Source: Abry, T., Swanson, J., and Fabes, R. (2012) The Classroom Environment Difficulties Scale. Arizona State
University, unpublished. Used with permission.

A10.

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

A11.

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)

Draft

A12.

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

A13.

What languages are spoken by you or any other teacher or aide to the ELL children in your class
for academic instruction, 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)

Draft

SECTION B. CLASS ORGANIZATION AND RESOURCES

B1.

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

B2.

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

B3.

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

B4.

Theater/creative
dramatics

Foreign language
(excluding English
for ELL students)

How often do the children in your class go to the school library or media center? MARK ONE
RESPONSE.
No library or media center in this school
Once a month or less
Two or three times a month
Once or twice a week
Three or four times a week
Daily

B5.

How many days a week do children have recess? WRITE NUMBER IN BOX. IF NONE, WRITE "0"
AND SKIP TO Q B7.
Days per week

Draft

B6.

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

B7.

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 outdoors
(including recess)

B8.

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

Draft

B9.

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

Never

Rarely

Sometimes

Often

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
h. Other electronic devices
(PLEASE SPECIFY)

B10.

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 C1)
1 day
2 days
3 days
4 days
5 days

B11.

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

1 to 10
minutes

a. Reading and language arts
b. Math
c. Science

11 to 20
minutes

21 to 30
minutes

More
than 30
minutes

Draft

SECTION C. PARENT INVOLVEMENT
C1.

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

C2.

What percentage of children in your class have parents who participate in the following
activities? MARK ONE RESPONSE ON EACH ROW.
0%
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

1-25%

26-50%

51-75%

76% or
more

Draft

SECTION D. EVALUATION AND GRADING PRACTICES
D1.

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
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.

Ability to follow directions

Somewhat
important

Very
important

Extremely
important

Draft

D2.

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

Never

Once a
year

5 to 8
3 to 4
2 times times a times a
a year
year
year

1 to 2
times a
month

1 to 2
times a
week

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

D3.

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

Never

Once a
year

5 to 8
3 to 4
2 times times a times a
a year
year
year

1 to 2
times a
month

1 to 2
times a
week

Draft

SECTION E. SCHOOL AND STAFF ACTIVITIES
E1.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No (SKIP TO Q E3)
*
Pr
of
es
s
i
onal
devel
opment
may
i
ncl
ude
cont
i
nui
ng
f
or
mal
educat
i
on;
cour
s
es
,
conf
er
ences
,
wor
k
s
hops
,
or
i
n
s
er
vi
ce
t
r
ai
ni
ng;
st
af
f
meet
i
ngs
t
hat
i
ncl
ude
s
t
af
f
devel
opment
act
i
vi
t
i
es
;
and
receiving coaching or mentoring.

E2.

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
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.

How to implement the MATH curriculum

Once

2 times

3 to 4
times

More
than 4
times

Draft

E3.

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

SECTION F. VIEWS ON SCHOOL CLIMATE AND SCHOOL ENVIRONMENT
F1.

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. Parents are supportive of school staff.
d. There is a great deal of cooperative
effort among the staff members.
e. There is a consensus among
administrators and teachers on goals
and expectations.
f.

The academic standards at this
school are too low.

g. The school administrator sets
priorities, makes plans, and sees
that they are carried out.
h. The school administration's
behavior toward the staff is
supportive and encouraging.

Disagree

Neither
agree
nor
disagree

Agree

Strongly
agree

Draft

F2.

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

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

g. 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

F3.

To what extent do you agree or disagree with each of the following statements? MARK ONE
RESPONSE ON EACH ROW.
Neither
agree
Strongly
Strongly
nor
disagree Disagree disagree
Agree
agree
a. The attitudes and habits students bring
to my class greatly reduce their chances
for academic success.
b. My success or failure in teaching is due
primarily to factors beyond my control
rather than to my own effort or ability.
c. The amount a student can learn is
primarily related to family background.
d. I really enjoy my present teaching job.
e. If I could start over, I would choose
teaching again as my career.

F4.

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 third grade.
b. This school has clear,
predetermined criteria for
determining the level of
intervention third-grade
students will receive in reading.
c. This school has clear,
predetermined criteria for
determining when thirdgrade students no longer
need a reading intervention.

Agree

Strongly
agree

Don't
know

Draft

F5.

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 third grade.
b. This school has clear,
predetermined criteria for
determining the level of
intervention third-grade
students will receive in math.
c. This school has clear,
predetermined criteria for
determining when thirdgrade students no longer
need a math intervention.

Agree

Strongly
agree

Don't
know

Draft

SECTION G. TEACHER BACKGROUND
G1.

What is your gender? MARK ONE RESPONSE.
Male
Female

G2.

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

1 9
YEAR
G3.

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

G4.

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

G5.

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

G6.

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 Kindergarten
b. First grade
c. Second grade
d. Third grade
e. Fourth grade
f.

Fifth grade

g. Sixth grade or higher
h. English as a Second Language (ESL), bilingual
education, and/or dual language program

G7.

Special education program

Program for gifted children

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)

G8.

Is this school year the first year you have taught in this school? MARK ONE RESPONSE.
Yes
No

IF YOU DO NOT HAVE A DEGREE FROM A COLLEGE OR UNIVERSITY, CHECK HERE.
(SKIP TO Q G11)

Draft

G9.

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.)

G10.

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.)

G11.

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

Draft

G12.

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.

G13.

Date Questionnaire Completed:

2 0 1 4
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 Third-Grade General Classroom Teacher
Subject-Level Questionnaire

Draft

Spring 2014
Teacher Questionnaire
Subject 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

T_ID

The collection of information in this survey is authorized by 20 U.S.
3 Participation is voluntary. You may skip questions
Code, Section 9541.
you
do
not
wi
sh
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 the ECLS-K:2011. The questionnaire includes questions about the
instructional curriculum for each of four subjects:
•
•
•
•

Reading and Language Arts (Section A)
Mathematics (Section B)
Science (Section C)
Social Studies (Section D)

IF YOU RECEIVED THIS QUESTIONNAIRE AS PART OF A PACKAGE OF OTHER STUDY MATERIALS, PLEASE
READ THE FOLLOWING:
The children listed on the Teacher Questionnaire Instruction Sheet who are participating in the ECLS-K:2011 spend
all or much of the school day in your classroom. You probably teach at least one of the above listed subjects to one
or more of these children. Please complete the sections in this questionnaire that correspond to each subject(s)
you currently teach to one or more of these children.
As indicated on the instruction sheet, if there is a subject or subjects you do not currently teach to any of the listed
children, please ask another teacher who does teach that subject to at least one of the listed children to
complete the section of questions for that subject.

IF YOU HAVE RECEIVED THIS QUESTIONNAIRE FROM ANOTHER TEACHER, PLEASE READ THE FOLLOWING:
Your colleague shared this questionnaire with you because you currently teach one (or more) of the above-listed
subjects to at least one of the children participating in the Early Childhood Longitudinal Study, Kindergarten
Class of 2010-11 (ECLS-K:2011), a major longitudinal study of children's early educational experiences beginning
with kindergarten and continuing through grade 5. If you are not sure which student(s) they are, please ask your
colleague who shared this questionnaire with you.
Please complete the sections in this questionnaire that correspond to each subject(s) your colleague has asked you
to complete and return the questionnaire to him or her when you are finished. If you have been asked to complete
the same section in this questionnaire by more than one of your colleagues, please complete that section in only
one questionnaire.
ALL TEACHERS:
Please record your answers directly on the questionnaire by marking the appropriate answer (as instructed on
page 4) or by writing your responses in the space provided. Your best estimates are acceptable answers.
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 the relevant portion of this questionnaire as completely and accurately as possible.
The information you provide is being collected for research purposes only and will be protected from disclosure to
the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9573). Information from
multiple individuals will be combined to produce statistical reports; no information that identifies you will be
included in any reports or provided to students, their parents, or other school staff.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

SECTION A. READING AND LANGUAGE ARTS INSTRUCTION
A1.

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 the central message, lesson,
or moral of a folk tale or fable
b. Explaining how the central message,
lesson, or moral of a story is conveyed
through key details
c. Identifying specific information in a text
that answers questions about key details
d. Identifying the main idea of an
informational text
Craft and Structure
e. Describing how words and phrases give
rhythm and/or meaning in a story, poem
or song
f. Determining the meaning of words and
phrases as they are used in a text
g. Using text features to locate key facts or
information (for example, captions, bold
print, subheadings, indexes)
h. Students taught to distinguish their own
point of view from that of the narrator, a
character, or the writer
Integration of Knowledge and Ideas
i. Comparing and contrasting the themes,
settings, and plots of two similar stories
j. Explaining how images clarify
informational text (for example, a
photograph or diagram showing how a
machine works)
k. Identifying the reasons an author gives to
support points in an opinion piece
Range of Reading and Level of Text Complexity
l. Reading and comprehending literature,
including stories, dramas, and poetry
m. Reading and comprehending
informational selections, including social
studies or science texts

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

A1.

(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.
On
On
On
On
On
more
Not
1-10
11-20
21-40
41-80 than 80
taught
days
days
days
days
days
Phonics and Word Recognition
n. Decoding multi-syllable words
o. Identifying and understanding the
meaning of many common prefixes or
suffixes
Conventions of Standard English
p. Explaining the functions of nouns,
pronouns, and adjectives
q. Distinguishing meaning among similar
verbs (for example, toss, throw, hurl)
r. Forming and using regular and irregular
verbs
s. Using capitalization appropriately
t. Consulting reference materials, including
beginning dictionaries
Writing
u. Writing an opinion piece, giving reasons
for the opinion
v. Writing an informational piece that
develops the topic with facts, definitions,
and/or details
w. Using temporal words or phrases to
signal the order of events

Draft

SECTION B. MATHEMATICS INSTRUCTION
B1.

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

Not
taught

a. Multiplying two one-digit whole numbers
to find the product
b. Dividing one whole number by another
c. Solving word problems by adding or
subtracting numbers
d. Solving word problems by multiplying or
dividing two whole numbers
e. Solving two-step word problems that use
two different operations (that is, two of
these four: addition, subtraction,
multiplication, and division)
f. Understanding the relationship between
multiplication and division
Number and Operations in Base Ten
g. Rounding whole numbers to the nearest
10 or 100
h. Identifying the numbers that represent
the hundreds, tens, and ones places in a
three-digit number
i. Multiplying two-digit whole numbers
using strategies based on place value
Number and Operations - Fractions
j. Representing a fraction on a number line
that has a starting point of 0 and an end
point of 1
k. Recognizing simple fractions (for
example, 1/4, 1/3, 1/2, 3/4)
l. Generating simple fraction equivalents
(
f
or
exampl
e,
1/
2
=
2/
4;
4/
6
=
2/
3)
m. Comparing sizes of two fractions with
different denominators

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

B1.

(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.

Measurement and Data

Not
taught

n. Telling and writing time to the nearest
minute
o. Solving word problems involving addition
and subtraction of time intervals in
minutes
p. Measuring to determine how much
longer one object is than another
q. Measuring and estimating liquid volumes
r. Measuring and estimating weights of
objects
s. Solving word problems involving
quarters, dimes, nickels, and pennies
t. Obtaining and recording data (for
example, measuring and recording the
lengths of three or more objects)
u. Drawing a scaled picture graph or a
scaled bar graph to represent a data set
with several categories
v. Solving one- or two-step "how many
more" and "how many less" problems
using information presented in scaled
bar graphs
w. Understanding relative sizes of
measurement units within one system of
units (for example, km, m, cm or hour,
minute, second)
Geometry
x. Describing portions of simple shapes
using the words halves, fourths, and
quarters
y. Measuring area by counting unit squares
(square centimeters, square inches, etc.)
z. Using multiplication or addition to find
the area of a figure
aa. Identifying points, lines, and angles in a
figure
bb. Identifying perpendicular and parallel
lines

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On
more
than 80
days

Draft

SECTION C. SCIENCE INSTRUCTION
C1.

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.
On
On
On
On
On
more
Not
1-5
6-10
11-15
16-20 than 20
taught
days
days
days
days
days
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

C2.

For this school year as a whole, please indicate if each of the following SCIENCE topics or skills
is taught in your class either 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
Not taught in my
class
class
a. Three states of matter (gas, liquid, solid)
b. Life cycles and traits of animals
c. Life cycles and traits of plants
d. Heredity: inheritance and variation of traits
e. Ecosystems
f.

Forces such as gravity, wind, tides, and magnetism

g. Impact of human activity on the earth
h. Weather and climate
i.

Nutrition/healthy foods

Draft

SECTION D. SOCIAL STUDIES INSTRUCTION
D1.

For this school year as a whole, please indicate if each of the following SOCIAL STUDIES topics
or skills is taught in your class either 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. Important figures and events in American history
b. Community resources (for example, grocery store, police)
c. Map-reading skills
d. Different cultures
e. Reasons for rules, laws, and government
f.

Community service

g. Current events in the news

THANK YOU FOR YOUR COOPERATION!

Not taught in my
class

Draft

For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

Draft

Spring Third-Grade General Classroom Teacher
Child-Level Questionnaire

Draft

Spring 2014
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 XXXX1850XXXX. Approval expires XX/XX/XXXX.
0750.
10/31/2015. The time required to complete this
information collection is estimated to average 60
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.

The collection of information in this survey is authorized by 20 U.S.
3 Participation is voluntary. You may skip questions
Code, Section 9541.
y
ou
do
not
wi
s
h
t
o
ans
wer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
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 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.
DEFINITION
For the purposes of this study, the following definition applies:
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.

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

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

SECTION A. 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

A11. Keeps belongings organized.

A14. Shows eagerness to learn new things.
A15. Works independently.

Draft

SECTION A. SOCIAL SKILLS (CONTINUED)

A21. Easily adapts to changes in routine.

A23. Persists in completing tasks.
A24. Pays attention well.
A25. Follows classroom rules.

Draft

SECTION B. CLASSROOM BEHAVIORS

Classroom Behaviors
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: Adapted from the Temperament in Middle Childhood Questionnaire. © 2004 Jennifer Simonds and Mary K. Rothbart, University of
Oregon. Used with permission.

Draft

SECTION C. STUDENT-TEACHER INTERACTIONS

Student-Teacher Interactions
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

SECTION D. PEER RELATIONSHIPS

Peer Relationships
Nine items from the Child Behavior Scale that ask teachers to assess the child’s relationships to
his or her peers. The items are not listed as they are copyright protected.

Source: Adapted from the Chi
l
dr
en’
s
Behavi
or
Scal
e. ©2010 Gary Ladd, Arizona State University. Used with permission.

Draft

SECTION D. PEER RELATIONSHIPS (CONTINUED)
D10.

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?

D11.

During this school year, how often has this student ... MARK ONE RESPONSE ON EACH ROW.
Never

Rarely

Sometimes

Often

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?

Source: Espelage, D. L. & Holt, M. (2001). Bullying and peer victimization during early adolescence: Peer influences and
psychosocial correlates. Journal of Emotional Abuse, 2, 123-142. Adapted and used with permission.

Very often

Draft

SECTION E. STUDENT INFORMATION
E1.

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

E2.

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

E3.

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. Gifted and talented program in reading/language arts
d. Gifted and talented program in mathematics
e. Gifted and talented program with no specific content focus

E4.

Is English this child's native language? MARK ONE RESPONSE.
Yes (SKIP TO Q E10)
No
Don't know

Draft

E5.

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 E10)

E6.

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:






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 this child. (SKIP TO Q E9)

E7.

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

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

1 day
a week

2 days
a week

3 days
a week

4 days
a week

5 days
a week

Draft

E8.

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
never

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

E9.

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

E10.

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

E11.

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

3 hours
or more

Draft

E12.

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

E13.

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

E14.

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

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

Social Studies

Above
grade
level

Draft

E15.

Items About Working Memory. Teachers are asked to indicate how often the child does four
different things related to working memory, such as remembering a list of chores or tasks or
needing help from adults to stay on task. The exact wording of these items is not included here
because they are copyright protected.

Source: Adapted and reproduced with special permission of the publisher, Psychological Assessment Resources, Inc., 16204
North Florida Avenue, Lutz, Florida 33549, from the Behavior Rating Inventory of Executive Function by Gerard A. Gioia, Peter
K. Isquith, Steven C. Guy and Lauren Kenworthy, Copyright 1996, 1998, 2000 by PAR, Inc. Further reproduction is prohibited
without permission from PAR, Inc.

E16.

How often does this child work to the best of her/his ability? MARK ONE RESPONSE.
Never
Seldom
Usually
Always

E17.

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 E19)
Two
Three
Four
Five or more

E18.

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

Draft

E19.

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 E21)
Two
Three
Four
Five or more

E20.

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

E21.

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

E22.

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

Draft

E23.

Date Questionnaire Completed:

2 0 1 4
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

APPENDIX E
SPRING THIRD-GRADE
SPECIAL EDUCATION TEACHER
QUESTIONNAIRES

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

OMB Clearance Package
# 1850-0750 v.15

Spring Third-Grade Special Education Teacher
Teacher-Level Questionnaire

Draft

Spring 2014
Special Education Teacher
Questionnaire A
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

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 XXXX1850XXXX. Approval expires XX/XX/XXXX.
0750.
10/31/2015. The time required to complete this
information collection is estimated to average 60
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.
3 Participation is voluntary. You may skip questions
y
ou
do
not
wi
s
h
t
o
ans
wer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
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 Special Education Teacher/Related Services Provider,
This questionnaire is an important part of a major longitudinal study of children's early
educational experiences beginning with kindergarten and continuing through grade 5. The
Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) is
collecting information from the special education teachers/related service providers of
sampled children who have Individualized Education Programs (IEPs) to investigate the
relationship between the children's academic progress and various school, classroom,
teacher, and home characteristics. This questionnaire collects information about your
background and your work in this school with children with disabilities.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a
question you do not want to answer. However, only you can provide this information.
Although we realize you are very busy, we urge you to complete this questionnaire as
completely and accurately as possible. The information you provide is being collected for
research purposes only and will be protected from disclosure to the fullest extent allowable
by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 9573). Information from
mul
t
i
pl
e
i
ndi
vi
dual
s
wi
l
l
be
combi
ned
t
o
pr
oduce
st
at
i
s
t
i
c
al
r
epor
t
s;
no
i
nf
or
mat
i
on
t
hat
identifies you will be included in any reports or provided to students, their parents, or other
school staff.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

What is your gender? MARK ONE RESPONSE.
Male
Female

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

1 9
YEAR
3.

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

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
Associ
at
e’
s
degr
ee
Bachelor's degree
Master's degree
adv
anced
pr
of
essi
onal
degr
ee
bey
ond
a
mast
er
’
s
degr
ee
(
f
or
exampl
e,
Ph.
D.
,
MD)
An

Draft

Is this school year the first year you have taught in this school? MARK ONE RESPONSE.
Yes
No

Counting this school year, how many total years have you been working with children
receiving special education or related services, including years in which you worked part
time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS IS
YOUR FIRST YEAR, WRITE "1."
Year(s)

Counting this school year, how many total years have you been working with children in any
school, including years in which you worked part time? This would include other
assignments such as teaching in a regular classroom or otherwise providing services to
children. WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS
IS YOUR FIRST YEAR, WRITE "1."
Year(s)

Draft

Which of the following credentials, licenses, or certificates do you have for working with
children with disabilities? DO NOT INCLUDE ACADEMIC DEGREES, SUCH AS A BACHELOR'S
DEGREE, MASTER'S DEGREE, OR PH.D. MARK YES OR NO ON EACH ROW.
Yes

a. Emergency credential
b. Provisional or temporary credential
c. Disability-specific credential or endorsement
d. Special education credential or endorsement
(for more than one disability category)
e. General education credential
f.

Speech/language therapy state license or certification

g. Physical therapy state license or certification
h. Occupational therapy state license or certification
i.

Social work license or certification

School psychology license or certification

k. Clinical psychology license or certification
l.

Certificate of Clinical Competence

m. Other professional license, credential, or endorsement
(PLEASE SPECIFY)

10.

Have you taken the exam for National Board for Professional Teaching Standards certification?
MARK ONE RESPONSE.
Not taken
Taken and passed
Taken and have not yet passed
Taken and awaiting test results
Not applicable

Draft

11.

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

General special education

g. Learning disabilities
h. Intellectual disability *
i.

Orthopedic impairments

Serious emotional disturbance

k. Deafness and hearing
l.

Blindness and vision

m. Communication disorders
n. Infants and toddlers with disabilities
o. Physical therapy
p. Occupational therapy
q. School psychology
r.

Classroom management

* Including the condition formerly classified as mental retardation

Draft

12.

Have you ever taken a college course that addressed issues related to the following? MARK
YES OR NO ON EACH ROW.
Yes

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

13.

Which of the following best describes your current position in this school? MARK ONE
RESPONSE.
Special education teacher
Special education teacher consultant
General education teacher
Special education classroom aide
Speech-language pathologist
Physical therapist
Physical therapy assistant or aide
Occupational therapist
Occupational therapy assistant or aide
School psychologist
School counselor
School social worker
Other (PLEASE SPECIFY)

Draft

14.

How do you classify your main assignment at this school, that is, the activity at which you
spend most of your time during this school year? MARK ONE RESPONSE.
Regular full-time teacher/service provider
Regular part-time teacher/service provider
Itinerant teacher/service provider (that is, your assignment requires you to provide
instruction/related services at more than one school)
Long-term substitute (that is, your assignment requires that you fill the role of a
teacher on a long-term basis, but you are still considered a substitute)
Teacher aide
Other (PLEASE SPECIFY)

15.

During this school year, where have you worked with children with IEPs? INCLUDE ONLY
CHILDREN WHO ATTEND THIS SCHOOL. MARK YES OR NO ON EACH ROW.
Yes
a. In a general education classroom
b. In a special education classroom
c. In a non-classroom space (for example, office, therapy
room, small work space, mobile van, etc.)
d. In a location outside of the school setting (for example,
a child's home, a private clinic, etc.)
e. Other (PLEASE SPECIFY)

Draft

16.

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

Strongly
disagree

Disagree

Neither
disagree
nor agree

Agree

Strongly
agree

a. I really enjoy my present job.
b. I am certain I am making a
difference in the lives of the
children I work with.
c. If I could start over, I would
choose this career again.
d. I am satisfied with my class
size/caseload.

17.

During the school year, how many children with IEPs have you worked with or provided
services for, on average, each week? (Include children you work with directly, as well as
children for whom you consult with the general education teacher and/or another special
education teacher/service provider.) MARK ONE RESPONSE.
1-10
11-20
21-40
More than 40
Don't know

18.

Date questionnaire completed:

2 0 1 4
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

Spring Third-Grade Special Education Teacher
Child-Level Questionnaire

Draft

Spring 2014
Special Education Teacher
Questionnaire B
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 XXXX1850XXXX. Approval expires XX/XX/XXXX.
0750.
10/31/2015. The time required to complete this
20 minutes per response,
information collection is estimated to average 60
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.
3 Participation is voluntary. You may skip questions
y
ou
do
not
wi
s
h
t
o
ans
wer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
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 Special Education Teacher/Related Services Provider,
This questionnaire is an important part of a major longitudinal study of children's early
educational experiences beginning with kindergarten and continuing through grade 5. The
Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) is
collecting information from the special education teachers/related service providers of
sampled children who have Individualized Education Programs (IEPs). We are gathering
information from these children's regular classroom teachers as well. Our purpose is to
investigate the relationship between the children's academic progress and various school,
classroom, teacher, and home characteristics. This questionnaire collects information on
the special education/related services received by the child identified on the cover of this
questionnaire.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a
question you do not want to answer. However, only you can provide this information.
Although we realize you are very busy, we urge you to complete this questionnaire as
completely and accurately as possible. You may find at least some of the information we
are asking for in the child's IEP. All information you provide is being collected for research
purposes only and will be protected from disclosure to the fullest extent allowable by law
(Education Sciences Reform Act of 2002, 20 U.S.C. § 9573). Information from multiple
i
ndi
v
i
dual
s
wi
l
l
be
combi
ned
t
o
pr
oduce
st
at
i
st
i
cal
r
epor
t
s;
no
i
nf
or
mat
i
on
t
hat
i
dent
i
f
i
es
you
will be included in any reports or provided to students, their parents, or other school staff.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

Is this child currently receiving gifted/talented services through an IEP, or has the child
received such services during this school year? MARK ONE RESPONSE.
Yes
No

Is this child currently receiving special education services through an IEP due to a disability or
has the child received such services during this school year? MARK ONE RESPONSE.
Yes
No (SKIP TO Q 33)

In what capacity or capacities do you teach or provide services to this child? MARK YES OR
NO ON EACH ROW.
Yes

a. Provide instruction directly to the child
b. Provide related services directly to the child
c. Provide consultation services directly to the child
d. Provide indirect consultation services (for example, consultation
to the child's teacher)
e. Provide case management
f.

Other (PLEASE SPECIFY)

When was this child first determined eligible for special education or related services? MARK
ONE RESPONSE.
Before kindergarten
During kindergarten
During first grade
During second grade
During third grade
Other (PLEASE SPECIFY)

Don't know

Draft

Is this the first school year that the child has been receiving special education services?
MARK ONE RESPONSE.
Yes (SKIP TO Q 10)
No

When did this child first start receiving special education or related services? MARK ONE
RESPONSE.
Before kindergarten
During kindergarten
During first grade
During second grade
Other (PLEASE SPECIFY)

Don't Know

To what extent were you involved in planning the transition from last year's special education
program to this year's special education program for this child? MARK ONE RESPONSE.
Not at all
Somewhat
Extensively

To what extent did you communicate with the person(s) who provided special education for
this child last year? MARK ONE RESPONSE.
Not at all
Somewhat
Extensively
I provided special education for this child last year.

Draft

Have you reviewed this child's records related to special education services provided before
this school year? MARK ONE RESPONSE.
Yes
No, I don't have access to the records.
No, I have access to the records, but have not reviewed them.
No, I provided special education to this child last year.

10.

What is this child's primary disability as identified on the child's IEP?
PLEASE SELECT THE CATEGORY BELOW INTO WHICH THE CHILD'S PRIMARY DISABILITY
FITS BEST. MARK ONE RESPONSE.
Speech or language impairments
Specific learning disabilities
Emotional disturbance
Intellectual disability *
Developmental delay
Visual impairments (including blindness)
Hearing impairments (including deafness)
Orthopedic impairments
Other health impairments
Autism
Traumatic brain injury
Deaf-blindness
Multiple disabilities (children included in this category should be those who have more than
one primary disability which do not include deaf-blindness or developmental delay)
No classification is given

* Including the condition formerly classified as mental retardation

Draft

THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD'S SPECIAL EDUCATION
EXPERIENCE DURING THE CURRENT SCHOOL YEAR.

11.

During this school year, for which of the following disabilities has this child received
special education or related services, whether for the child's primary disability or another
of his/her disabilities? MARK YES OR NO ON EACH ROW.
Yes
a. Speech or language impairments
b. Specific learning disabilities
c. Emotional disturbance
d. Intellectual disability *
e. Developmental delay
f.

Visual impairments (including blindness)

g. Hearing impairments (including deafness)
h. Orthopedic impairments
i.

Other health impairments

Autism

k. Traumatic brain injury
l.

Deaf-blindness

m. Multiple disabilities (children included in this category should
be those who have more than one primary disability which do
not include deaf-blindness or developmental delay)
n. No classification given

12.

During this school year, has this child received any special education or related
services because of a diagnosed Attention Deficit Disorder (ADD) or Attention Deficit
Hyperactivity Disorder (ADHD)? MARK ONE RESPONSE.
Yes
No

* Including the condition formerly classified as mental retardation

Draft

13.

During this school year, which of the following describe(s) the IEP goals for this child?
MARK YES OR NO ON EACH ROW.

Academics

Yes

Reading

Mathematics

Language Arts

Science

Speech and language
e.

Auditory processing

Listening comprehension

Oral expression

Voice/speech articulation

Language pragmatics

Social skills

General appropriateness of behavior

Social

Life skills
l.

Adaptive behavior or self-help skills

Physical/Mobility
m.

Fine motor skills

Gross motor skills

Orientation and mobility

Other (PLEASE SPECIFY)

Other

Draft

14.

During this school year, which of the following related services have been provided
through the school to this child? MARK YES OR NO ON EACH ROW.
Yes
a. Audiology
b. Counseling services
c. Occupational therapy
d. Physical therapy
e. Psychological services
f.

Health services

g. Social work services
h. Special transportation
i.

Speech or language therapy

Orientation services

k. Mobility services
l.

Rehabilitation services

m. Other (PLEASE SPECIFY)

Draft

15.

During this school year, has this child received any of the following? MARK YES OR
NO ON EACH ROW.
Yes

a. Adaptive physical education
b. Assistance from classroom aides (for example, teacher aide,
behavioral assistant, special education aide)
c. Interpreter for the deaf or hard of hearing (oral or sign)
d. Teacher used Braille to provide instruction
e. Child was taught how to use Braille
f.

Teacher used American Sign Language to provide instruction

g. Child was taught how to use American Sign Language
h. Teacher used Manual English to provide instruction
i.

Child was taught how to use Manual English

Teacher used Cued Speech to provide instruction

k. Child was taught how to use Cued Speech
l.

Mental health services, personal/group counseling, therapy, or
psychiatric care provided to the child

m. Tutoring/remediation from special education teacher
n. Training, counseling, and other supports/services provided to
this child's family

16.

During this school year, has this child's primary placement been a general education
classroom? MARK ONE RESPONSE.
Yes
No

Draft

17.

During this school year, approximately how many hours per week of direct special education
and related services (that is, service provided directly to the child, from a teacher or another
adult) has this child received? WRITE NUMBER IN BOX.
Hours per week

18.

Of the hours of direct special education and related services reported above, approximately
how many of those hours per week were the instruction/services provided outside of a general
education classroom but within the school setting? WRITE NUMBER IN BOX.
Hours per week

19.

During this school year, what teaching practices and methods have you and/or other special
education service providers used with this child? MARK ONE RESPONSE ON EACH ROW.

Yes
a. One-on-one instruction
b. Small-group instruction
c. Large-group instruction
d. Cooperative learning
e. Peer tutoring
f.

Computer-based instruction

g. Direct instruction
h. Cognitive strategies
i.

Self-management

Behavior management

k. Instruction received through a sign interpreter

Don't
know

Draft

20.

During this school year, which of the following best describes the curriculum materials used
with this child in the general education classroom? MARK ONE RESPONSE.
General education curriculum materials were used without modification
General education curriculum materials were used with some modifications
General education curriculum materials were used with substantial modifications
Specially-designed commercial materials were used
Teacher-designed materials were used
Child not in this setting
Don't know

21.

During this school year, which of the following best describes the curriculum materials used
with this child in the special education classroom/program? MARK ONE RESPONSE.
General education curriculum materials were used without modification
General education curriculum materials were used with some modifications
General education curriculum materials were used with substantial modifications
Specially-designed commercial materials were used
Teacher-designed materials were used
Child not in this setting
Don't know

Draft

22.

During this school year, which of the following assistive technologies and devices has
this child used? MARK YES OR NO ON EACH ROW.

Mobility aids

Yes

Vans, vehicles

Wheelchair

Walker

White cane

Communication aids
e.

Electronic with voice output (for example, Touch Talker)

Electronic without voice output (for example, device with
visual display or printed speech output)

Nonelectronic (for example, manual printing board)

Hearing assistance
h.

Hearing aids

FM loops

TTYs/TDDs

Cochlear implants

Real-time captioning

Visual aids
m.

Braille texts

Electronic Braille devices

Digital texts

Magnifying devices

Close-captioned television (CCTV)

Learning aids (non-computer)
r.

Tape recorder

Calculator

Electronic spelling devices

Computer hardware designed or adapted for children with disabilities (for example,
alternate keyboards, switch interface)
u.

Used solely by individual child

Shared with other children

Draft

22.

(CONTINUED) During this school year, which of the following assistive technologies and
devices has this child used? MARK YES OR NO ON EACH ROW.

Computer software designed for children with disabilities
w.

Reading

Writing

Mathematics

Yes

Other assistive technologies or devices
z.

23.

Other (PLEASE SPECIFY)

Does this child have a computer, laptop, or word processing device assigned to him/her for
use full time this school year? MARK ONE RESPONSE.
Yes
No

24.

During this school year, on average, how often have you met with general education teacher(s)
to discuss this child's program or progress? MARK ONE RESPONSE.
Not applicable because I am the child's general education teacher (SKIP TO Q 26)
Not applicable to my work with this child (SKIP TO Q 26)
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year (SKIP TO Q 26)

Draft

25.

On average, how long were the meetings with the general education teacher(s) to discuss this
child's program or progress? MARK ONE RESPONSE.
1 to 15 minutes
16 to 30 minutes
31 to 45 minutes
46 to 60 minutes
More than 60 minutes

26.

During this school year, approximately how often have you communicated with this child's
parents about this child's program or progress (by phone, in person, or in writing, including email)? MARK ONE RESPONSE.
Every day or several times a week
Once a week or several times a month
Once a month
A few times over the school year
Once during this school year
Never during this school year

27.

During this school year, has this child received formal individual evaluations in any of the
following areas for purposes of developing IEP goals? MARK YES OR NO ON EACH ROW.
Yes
a. Psychological
b. Speech/language
c. Vision
d. Hearing
e. Learning style
f.

Motor skills

g. Academics
h. Other (PLEASE SPECIFY)

Draft

28.

To what extent is this child expected to achieve the same general education goals as other
children at his/her grade level this school year? MARK ONE RESPONSE.
Child is expected to attain grade level achievement for all of the academic content standards.
Child is expected to attain grade level achievement for some of the academic content
standards.
Child is expected to attain grade level achievement for only a few of the academic content
standards.
Child is not expected to attain grade level achievement for any of the academic content
standards.
There are no academic content standards at this grade level.
Don't know

29.

What percentage of this child's current IEP goals have been met or nearly met at this point in
the school year? MARK ONE RESPONSE.
76 to 100 percent
51 to 75 percent
26 to 50 percent
1 to 25 percent
0 percent

30.

Which of the following best expresses the likelihood that this child will continue to receive
some level of special education services (through an IEP) in the next school year? MARK ONE
RESPONSE.
Definitely will continue in special education
Very likely to continue in special education
Rather likely to continue in special education
Rather unlikely to continue in special education
Very unlikely to continue in special education
Definitely will not continue in special education (will be dismissed from services)

Draft

31.

During this school year, to what extent has this child participated in any grade-level
assessment administered as part of the school's testing program? MARK ONE RESPONSE.
Child did not participate in the school's testing or assessment program. (SKIP TO Q 33)
Child participated in alternate assessments and no regular assessments. (SKIP TO Q 33)
Child participated in some alternate assessments and some regular assessments.
Child participated fully in the school's regular testing or assessment program.
There is no testing or assessment program at this grade level. (SKIP TO Q 33)
Don't know (SKIP TO Q 33)

32.

Did this child receive special accommodations to participate in the school's regular testing or
assessment program this school year? MARK ONE RESPONSE.
Yes
No
Don't know

33.

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

34.

Date Questionnaire Completed:

2 0 1 4
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

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For Office Use Only
Comp
Ref

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APPENDIX F
SCHOOL ADMINISTRATOR QUESTIONNAIRES

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

OMB Clearance Package
# 1850-0750 v.15

Spring Third-Grade School Administrator
Questionnaire for New Schools

Draft

Spring 2014
School Administrator Questionnaire
Questionnaire A
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

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 XXXX1850XXXX. Approval expires XX/XX/XXXX.
0750.
10/31/2015. The time required to complete this
information collection is estimated to average 60 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.
3 Participation is voluntary. You may skip questions
Code, Section 9541.
y
ou
do
not
wi
s
h
t
o
ans
wer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
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 School Administrator,
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 one
or more of the children in your school are participants in this study.
This questionnaire contains several brief sections:
a) School characteristics
b) School facilities and resources
c) School-family-community connections
d) School policies and practices
e) School programs for particular populations
f)) Federal programs: Title I, Adequate Yearly Progress (AYP), and Title III (if applicable)
g) Staffing and teacher characteristics
h) School administrator characteristics
This information is vital to the study. Please feel free to ask other knowledgeable members of your staff to
provide the information necessary to complete various sections of the questionnaire. However, we ask that you,
yourself, please complete the final section, which is about your own background and 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
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
information that identifies you will be included in 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 described in the
instructions on page 6) 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.
Ungraded: A classroom containing children with an age span of two or more years, not formally identified by
grade(s).

Draft

Special programs. Reference is made in this questionnaire to Title I and Title III programs, individualized
education programs (IEP), individualized family service plans (IFSP), Section 504 plans, and Response to
Intervention (RtI). For this study, the following definitions apply:
Title I: "Improving the Academic Achievement of the Disadvantaged." Title I is a program of the
Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the No Child Left
Behind Act of 2001. The purpose of this program is to ensure that all children have a fair, equal, and
significant opportunity to obtain a high-quality education and reach, at a minimum, proficiency on state
academic achievement standards and state academic assessments.
Title III: "Language Instruction for Limited English Proficient and Immigrant Students." Title III is a
program of the Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the No
Child Left Behind Act of 2001. One of the main purposes of this program is to help ensure that children
who have limited proficiency in English, including immigrant children and youth, attain English
proficiency, develop high levels of academic attainment in English, and meet the same state academic
content and student academic achievement standards as all students are expected to meet.
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.
Section 504 plan: A written plan to provide appropriate services to a child with a disability, whether or
not the disability is judged to affect the child's educational performance. Speech therapy services may
often be specified as part of a Section 504 plan.
Response to Intervention (RtI): A multi-step approach to providing early and progressively intensive
intervention and monitoring within the general education setting. In principle, RtI begins with
research-based instruction and behavioral support provided to students in the general education
classroom, followed by screening of all students to identify those who may need systematic progress
monitoring, intervention, or support. Students who are not responding to the general education
curriculum and instruction are provided with increasingly intensive interventions through a "tiered"
system, and they are regularly monitored to assess their progress and inform the choice of future
interventions, including possibly special education for students determined to have a disability.
Language. Reference is made to English language learners (ELL), as well as to instructional programs for ELL
students in this questionnaire. For this study, the following definitions apply:
Language-minority (LM) student: A student in whose home a non-English language typically is spoken.
This group includes students whose English is fluent enough to benefit from instruction in academic
subjects offered in English as well as students who are English language learners.
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

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SECTION A. SCHOOL CHARACTERISTICS

A1.

How many instructional days will this school provide during this academic year? WRITE IN
NUMBER BELOW. IF THIS IS A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF
INSTRUCTIONAL DAYS A GIVEN CHILD WOULD ATTEND.
Number of instructional days

A2.

School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE
FOLLOWING. IF NO CHILDREN HAVE LEFT OR ENROLLED IN YOUR SCHOOL DURING THE
SCHOOL YEAR, WRITE "0" ON THE APPLICABLE LINE.
Number of
children
a. Total enrollment in third grade in your school around October 1, 2013, or
the date nearest to that for which data are available
b. Total enrollment in your school (across all grades) around October 1, 2013,
or the date nearest to that for which data are available
c. Number of children who have enrolled in your school since October 1, 2013
d. Number of children who have left your school since October 1, 2013, and
have not returned

A3.

Approximately what is the Average Daily Attendance for your school this year? WRITE IN
PERCENT OR NUMBER BELOW. TO CALCULATE PERCENT, DIVIDE THE NUMBER OF
STUDENTS ATTENDING ON AN AVERAGE DAY BY THE NUMBER OF STUDENTS ENROLLED
AND THEN MULTIPLY BY 100.
% Average Daily Attendance
That is,

number of students attending on an average day
number of students enrolled

OR
Average Number Attending Daily

X 100

Draft

A4.

A5.

Mark all grade levels included in your school. PLEASE SEE PAGE 3 OF THIS QUESTIONNAIRE
FOR DEFINITIONS OF DIFFERENT TYPES OF CLASSES AND GRADE LEVELS.
Ungraded

1st

7th

Prekindergarten

2nd

8th

Transitional (or readiness) kindergarten

3rd

9th

Kindergarten

4th

10th

Transitional first (or prefirst) grade

5th

11th

6th

12th

Which of the following characterizes your school? MARK ALL THAT APPLY.
Regular public school (not including magnet school)
Public magnet school
Charter school
Catholic school
Diocesan
Parish
Private order
Other private school, religious affiliation
Private school affiliated with NAIS, no religious affiliation
Other private school, no religious or NAIS affiliation
Early Childhood Center (school/center includes preschool and/or early grades)
Spec
i
al
educat
i
on
school
–
pr
i
mar
i
l
y
s
er
v
es
c
hi
l
dr
en
wi
t
h
di
sabi
l
i
t
i
es
Year-round school
Bureau of Indian Education (BIE) or tribal school

IF YOU MARKED "CHARTER SCHOOL" IN Q A5, GO TO Q A6.
IF YOU DID NOT MARK "CHARTER SCHOOL," THEN SKIP TO Q A8.
A6.

In what year did this school start providing instruction as a public CHARTER school? WRITE
IN YEAR BELOW.
Year

A7.

Which of the following characterizes your public CHARTER school? MARK ONE RESPONSE.
For profit
Not for profit

Draft

A8.

Approximately how many or what percentage of the children in your school belongs to each of
the following racial/ethnic groups? COMPLETE EITHER THE NUMBER OR PERCENT COLUMN.
ENTER "0" IF YOUR SCHOOL HAS NO CHILDREN IN THAT RACIAL/ETHNIC GROUP. THE
NUMBER COLUMN SHOULD ADD TO YOUR TOTAL SCHOOL ENROLLMENT OR THE PERCENT
COLUMN SHOULD ADD TO 100%.
Number
OR
Percent
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

White, not Hispanic or Latino

g. Two or more races, not Hispanic or Latino

1 0 0 %

h. Total school enrollment (sum of a through g)

A9.

A10.

If your school is a private, magnet, or charter school, please check here and SKIP TO Q A11.

About what percentage of the children enrolled in this school attend from outside of this school's
assigned attendance area because... WRITE IN PERCENTAGES BELOW. IF NONE, WRITE "0."
Percent

A11.

Don't know

a. They have special needs (gifted and talented, children with
disabilities, etc.) and attend to receive a specialized program
or service?

b. They transferred into the school because their previous
school did not make adequate yearly progress (AYP)?
(Adequate yearly progress is your state's measure of yearly
progress toward achieving state academic standards.)

c. They attend this school under public school choice for
reasons other than their assigned school did not make AYP
(that is, excluding those who are reported in b)?

About what percentage of the children enrolled in this school are eligible for free or reducedprice lunch? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

Draft

SECTION B. SCHOOL FACILITIES AND RESOURCES
B1.

In general, how adequate are each of the following school facilities for meeting the needs of the
children in your school? MARK ONE RESPONSE ON EACH ROW.
Do not
have

Never
adequate

a. Computer lab
b. Library/media center
c. Gymnasium
d. Playground
e. Classrooms

Often not
adequate

Sometimes
not adequate

Always
adequate

Draft

SECTION C. SCHOOL-FAMILY-COMMUNITY CONNECTIONS
C1.

Are any of the following programs or services for parents and families available at your school
site? Please include programs run by the school and those run by outside groups. MARK YES
OR NO ON EACH ROW.
Yes

a. Parenting education programs (for example, classes on child
development, education in being a parent, understanding children
with special needs)
b. Adult literacy program (including Adult Basic Education)
c. Family literacy program
d. Health or social services offered collaboratively by service
agencies such as hospitals
e. Orientation to school setting for new families
f.

Child care so that parents can attend school parent meetings or
events

g. Programs to learn English for parents or families whose native
language is not English

C2.

Please indicate how often each of the following activities is provided by your school. MARK ONE
RESPONSE ON EACH ROW.
2 to 3
4 to 6
7 or more
Once
times
times
times
Never
a year
a year
a year
a year
a. PTA, PTO, or Parent-Teacher-Student
organization meetings
b. Reports (report cards) of child's
performance provided to parents
c. Information on the child's standardized
assessment scores provided to parents
d. Teacher-parent conferences
e. School performances to which parents
are invited
f.

Classroom programs like class plays, book
nights, or family math nights

Draft

C3.

Indicate how much you agree or disagree with the following statements about the school's
community and parents. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
Strongly
agree nor
disagree Disagree disagree
agree
Agree
a. Parents are actively involved in
this school's programs.
b. The community served by this
school is supportive of its goals
and activities.
c. Parents of children in this school
are welcome to observe classes
any time they are in session.

C4.

How much of a problem are the following in the neighborhood where this school is located? MARK
ONE RESPONSE ON EACH ROW.
Big
Don't
Somewhat of
No
problem
a problem
problem
know
a. Tensions based on racial, ethnic, or
religious differences
b. Selling or using drugs or excessive
drinking in public
c. Gangs
d. Vacant houses and buildings
e. Crime in the neighborhood
f.

Violence in the neighborhood

Draft

C5.

To the best of your knowledge how often do the following types of problems occur at your school?
MARK ONE RESPONSE ON EACH ROW.
Happens Happens
at least
at least Happens
Happens once a
once a
on
Never
daily
week
month occasion happens
a. Children bringing weapons to school
b. Theft
c. Physical conflicts among students
d. Children bringing in or using alcohol at
school
e. Children bringing in or using illegal
drugs at school
f.

Vandalism of school property

g. Student bullying
h. Widespread disorder in classrooms
i.

C6.

Class cutting

Does your school take any of the following measures to ensure the safety of children? MARK
YES OR NO ON EACH ROW.
No
Yes
a. Security guards, unarmed
b. Security guards, armed
c. Metal detectors
d. Locked doors during the school day
e. A requirement that visitors sign in
f.

Intercoms or telephones in classrooms

g. Other (PLEASE SPECIFY)

Draft

C7.

Moderate
problem

Minor
problem

Not a
problem

a. Student tardiness
b. Student absenteeism
c. Student aggressive or disruptive behavior
d. Teacher absenteeism
e. Teacher turnover
f.

C8.

Overcrowding

During the past year, to what extent did any of the following changes occur at your school?
MARK ONE RESPONSE ON EACH ROW.
Not
at all
a. Funding levels decreased
b. Enrollment increased
c. Enrollment decreased
d. The number of students receiving free
or reduced-price lunch increased
e. Student mobility increased (that is, the
number of students transferring in and
out of the school increased)
f.

There has been a reduction in staffing

g. Class sizes increased
h. Class sizes decreased
i.

Salaries increased

Salaries decreased

k. Number of English language learners
increased

Small
extent

Moderate
extent

Large
extent

Draft

C9.

During the past year, did any of the following changes occur at your school? MARK YES OR
NO ON EACH ROW.
Yes
a. Salaries were frozen
b. Changes were made to the school's assigned
attendance area (IF YOURS IS A PRIVATE, CHARTER,
OR MAGNET SCHOOL, PLEASE SKIP ITEM b.)

Draft

SECTION D. SCHOOL POLICIES AND PRACTICES
D1.

How many second-grade children were retained at their current grade level last school year?
WRITE NUMBER BELOW. IF NONE, WRITE "0." IF YOUR SCHOOL DOES NOT HAVE SECONDGRADE STUDENTS, MARK THE "NOT APPLICABLE" BOX.
Number of second-grade children retained last year

D2.

Not applicable

How many third-grade children were retained at their current grade level last school year?
WRITE NUMBER BELOW. IF NONE, WRITE "0."
Number of third-grade children retained last year

D3.

Is a school-wide positive behavioral intervention and support program (for example, Positive
Behavioral Support, Positive Behavioral Intervention System) implemented at your school?
MARK ONE RESPONSE.
Yes
No

D4.

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

For READING

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.
b. At this school, we use data from
screening tests to determine if core
instruction in READING is meeting
the needs of most of our students.
For MATH
c. 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.
d. At this school, we use data from
screening tests to determine if core
instruction in MATH is meeting the
needs of most of our students.

Agree

Strongly
agree

Don't
know

Draft

D5.

Is Response to Intervention (RtI) currently used at your school in third grade, either partially or
fully implemented? MARK ONE RESPONSE.
RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL
EDUCATION SETTING. SEE PAGE 4 FOR A COMPLETE DEFINITION OF RTI.
Yes
No (SKIP TO Q E1)

D6.

Is Rtl currently implemented at your school in third grade in the following areas? MARK ONE
RESPONSE ON EACH ROW.
Yes, fully
implemented
in third grade

Yes, partially
implemented
in third grade

No, not
implemented
in third grade

a. Math
b. Reading
c. Writing
d. Behavior/Social skills

D7.

Approximately how many years ago did your school begin implementing RtI in third grade
in any subject? MARK ONE RESPONSE.
Less than 1 year ago
1 to 2 years ago
More than 2 years ago

D8.

For the 2013-2014 school year, how has your school made information available to
parents/guardians to help them understand how RtI is being implemented in your school?
MARK YES OR NO ON EACH ROW.
Yes
a. Communication through written materials such as letters, email, school
website, or newsletters
b. Communication through workshops, discussion groups, or other meetings
such as PTA meetings
c. Communication through individual meetings with parents or phone calls
d. Information is not distributed on this topic

Draft

SECTION E. SCHOOL PROGRAMS FOR PARTICULAR POPULATIONS
Language-Minority Students and Families
E1.

Do any of the children in this school come from a home where a language other than English is
spoken? MARK ONE RESPONSE.
Yes
No (SKIP TO Q E5)

E2.

What percentage of children in this school and in third grade are English language learners
(ELL)?
SEE PAGES 4 AND 5 FOR DEFINITIONS RELATED TO LANGUAGE. WRITE IN THE PERCENTAGES
BELOW.

E3.

ELL among all students in school

ELL among all students in third grade

Please indicate what type(s) of specialized language instruction is provided to third-grade
English language learners in your school. MARK ALL THAT APPLY.
EXAMPLES OF THE PROGRAMS INCLUDED IN EACH CATEGORY ARE PROVIDED BELOW.
SEE PAGE 5 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 third-grade English language learners or there
are no third-grade English language learners in this school.

Draft

E4.

Are any of the following services provided to families of children from households where a
language other than English is spoken? MARK YES OR NO ON EACH ROW.
Yes

a. Translators are made available to parents for parent/teacher and
parent/school staff meetings and/or meetings are conducted in the
parents' non-English language.
b. Translations of written communications are provided to these
families.
c. Home visits are made to families of these children.
d. An outreach worker assists in enrolling these children when first
entering school.
e. The school conducts special parent meetings for families from a
non-English background.

Children with Special Needs
E5.

Since the beginning of this school year (2013-2014), how many students have been NEWLY
evaluated at your school to determine if they are eligible for an IEP? WRITE NUMBER IN BOX.
Total number of newly evaluated students at your school

E6.

Of those students who have been NEWLY evaluated at your school this school year (20132014), how many were found eligible for an IEP, including those who may have an IEP for
speech only? WRITE NUMBER IN BOX.
Total number of newly evaluated students found eligible at your school

E7.

What method(s) are used in your school to determine special education ELIGIBILITY for
students with learning disabilities? MARK YES OR NO ON EACH ROW. IF A COMBINATION
OF THESE METHODS IS USED AT YOUR SCHOOL, MARK YES FOR BOTH A AND B.
Yes
a. IQ-achievement discrepancy model which shows whether
there is a discrepancy between expected performance and
actual performance
b. Response to Intervention (RtI) model

Draft

E8.

Approximately what percentage of your third-graders are in each of the following instructional
programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND INDICATE IF THE
PROGRAM IS NOT OFFERED IN THIRD GRADE OR IN ANY GRADE IN YOUR SCHOOL.
Not offered
in third grade

Percent

E9.

a. Special education with an
Individualized Education Program
(IEP)

b. Receive accommodations through a
504 plan

c. Reading instruction for students
performing below grade level in
reading

d. Math instruction for students
performing below grade level in math

e. A gifted and talented program

Not offered
in any grade

Where are children with Individualized Education Programs (IEPs) typically served in this school?
MARK ONE RESPONSE.
Children with IEPs are not served in this school.
Children with IEPs typically spend most of their day in separate classes.
Children with IEPs typically spend most of their day in the regular classroom.

Draft

SECTION F. FEDERAL PROGRAMS: TITLE I, ADEQUATE YEARLY PROGRESS, AND TITLE III

The following items pertain to public schools only.
IF YOURS IS A PRIVATE SCHOOL CHECK HERE. (SKIP TO Q G1)

Title I Funding and Programs
F1.

Did your school receive Federal Title I funds for this school year? MARK ONE RESPONSE.
Yes
No (SKIP TO Q F4)

PLEASE NOTE THE FOLLOWING DEFINITIONS
THAT ARE RELEVANT TO QUESTION F2 BELOW:
A targeted assistance program uses Title I funds to provide supplemental
academic services (usually in reading and/or math) to specific students,
sometimes referred to as "Title I students," who have been identified as low
achieving.
A schoolwide program may use Title I funds to improve the quality of
educational programs and services throughout the school. A school may use
Title I funds for a schoolwide program if at least 40 percent of its students are
from low-income families, or if it receives a waiver permitting it to operate a
schoolwide program.

F2.

Is your school operating a Title I targeted assistance or schoolwide program? MARK ONE
RESPONSE.
Targeted assistance program
Schoolwide program

Title I and Title III and their accompanying requirements are programs of the Elementary and Secondary Education Act of 1965 (ESEA),
as reauthorized by the No Child Left Behind Act of 2001. See the introductory section of this questionnaire for more information on
these programs.

Draft

F3.

This school year, did your school use Title I funds for any of the following purposes? MARK
YES OR NO ON EACH ROW.
Yes

a. To serve children in a pull-out setting
b. To serve children in an in-class setting
c. To reduce class sizes
d. To provide extended time learning opportunities before and/or
after school for children
e. To provide professional development activities
f.

To provide family literacy services

g. To provide summer learning opportunities
h. To serve children in preschool
Title III Funding and Programs
F4.

Did your school receive Federal Title III funds for this school year? (Title III is "Language
Instruction for Limited English Proficient and Immigrant Students.") MARK ONE RESPONSE.
Yes
No (SKIP TO Q F6)

F5.

This school year, did your school use Title III funds for any of the following purposes? MARK
YES OR NO ON EACH ROW.
Yes
a. To serve children in a pull-out setting for second language
instruction
b. To serve children in an in-class setting for second language
instruction
c. To provide extended time learning opportunities before
and/or after school for children
d. To improve the entire educational program through a
schoolwide program
e. To provide professional development activities for teachers who
serve English language learners
f. To provide family literacy services (usually done out of Title III
immigrant funds)
g. To provide summer learning opportunities
h. To provide student support in the student's home language for
second language instruction

Draft

Federal Requirements
F6.

At the end of the LAST school year (2012-2013), did this school make Adequate Yearly Progress
(AYP)? (Adequate Yearly Progress is your state's measure of yearly progress toward achieving
state academic standards.) MARK ONE RESPONSE.
Yes (SKIP TO Q F9)
No
Not applicable (SKIP TO Q F9)

F7.

At the end of the LAST school year (2012-2013), was this school identified for improvement due
to Adequate Yearly Progress (AYP) requirements? (A school is identified for improvement if it
does not make Adequate Yearly Progress for two consecutive years or more in the same content
area.) MARK ONE RESPONSE.
Yes
No (SKIP TO Q F9)

Draft

F8.

Please indicate in PART 1 whether any of the following actions have taken place in your school
in the past three years. For each action that you mark as having taken place, please indicate in
PART 2 whether the action took place at your school in response to being identified for
improvement due to AYP requirements. MARK ONE RESPONSE ON EACH ROW FOR PART 1.
IF YES IS MARKED IN PART 1, MARK ONE RESPONSE IN PART 2 FOR THAT ROW.

PART 1

PART 2

Action taken place in
the past three years?
Yes

a. Developed or revised a two-year
school improvement plan
b. Offered students the choice to
transfer to another public school
c. Offered supplemental educational
services to students from low-income
families
d. Replaced school staff
e. Implemented a new curriculum based
on scientifically based research
f.

Extended the school day or school
year

g. Appointed an outside expert to advise
the school on its progress toward
making AYP
h. Reorganized the school (that is,
significant changes were made to
both the school's staffing and
governance)
i.

F9.

Offered professional development

Does this school have grade 3 students? MARK ONE RESPONSE.
Yes
No (SKIP TO Q G1)

If yes to part 1, was action
in response to being
identified for improvement?
Yes

Draft

F10.

Based on recent state assessments, what percentage of the grade 3 students in your school in
the PRIOR school year (2012-2013) scored "proficient" or above in the subjects in this table?
Please also indicate the percentage of students scoring proficient or above that was needed to
meet your AYP (Adequate Yearly Progress) goals for that school year. WRITE PERCENTAGES
BELOW. IF THE AYP COLUMN IS NOT APPLICABLE FOR YOUR SCHOOL OR IF GRADE 3
STUDENTS IN YOUR SCHOOL DO NOT TAKE A STATE ASSESSMENT, WRITE "NA" IN THE
APPROPRIATE COLUMN.
Percentage
of students whose
achievement level was
"proficient" or above in
2012-2013

Percentage required by
AYP goals in
2012-2013

a. Reading/Language Arts

b. Mathematics

c. Science
(WRITE NA IF NO STUDENTS
WERE ASSESSED IN SCIENCE)

Draft

SECTION G. STAFFING AND TEACHER CHARACTERISTICS
G1.

Approximately how many staff members does your school currently have in the following
categories?
PLEASE PROVIDE RESPONSES IN COLUMN (1) FOR STAFF MEMBERS WHO WORK FULL TIME
AT YOUR SCHOOL AND IN COLUMN (2) FOR STAFF WHO WORK PART TIME AT YOUR
SCHOOL. IF A STAFF MEMBER IS SHARED WITH OTHER SCHOOLS, COUNT THAT PERSON AS
"PART TIME" IN YOUR SCHOOL.
PLACE
EACH
STAFF
MEMBER
I
N
ONLY
ONE
STAFF
CATEGORY;
I
F
A
STAFF
MEMBER
FI
TS
MORE THAN ONE CATEGORY, PICK THE CATEGORY MOST DESCRIPTIVE OF HIS/HER WORK.
WRITE NUMBERS IN BOXES. IF THERE ARE NO STAFF IN YOUR SCHOOL IN A CATEGORY,
WRITE "0."

a. Regular classroom teachers
b. ESL/bilingual education/language immersion/ELL
instruction teachers
c. Drama, music, or art teachers
d. Gym/PE or health teachers
e. Special education teachers and related service
providers (for example, speech therapist, physical
therapist, adaptive physical education, etc.)
f.

Paraprofessionals (for example, classroom aides)

(1)

(2)

Number who
work full time in
your school

Number who
work part time
in your school

Draft

G2.

Does your school currently have any staff members (full- or part-time) in the following
categories? MARK YES OR NO ON EACH ROW. INCLUDE THOSE WHO ARE FULL- OR
PART-TIME STAFF MEMBERS AT YOUR SCHOOL.
Yes

a. Teachers of gifted/talented students
b. Reading specialists and interventionists
c. Math specialists and interventionists
d. School nurses or health professionals
e. School psychologists or social workers
f.

Guidance counselors

g. Library media specialists/librarians
h. Computer/technology teachers or support staff

G3.

Does your school currently have any staff members who do the following as their primary role
or one of their primary roles? MARK YES OR NO ON EACH ROW. INCLUDE THOSE WHO ARE
FULL- OR PART-TIME STAFF MEMBERS AT YOUR SCHOOL.
Yes

a. A school staff member who provides ongoing training or support to
classroom teachers in the delivery of effective READING instruction
b. A school staff member who provides ongoing training or support to
classroom teachers in the delivery of effective MATH instruction
c. A school staff member who provides ongoing training or support to
classroom teachers in the delivery of effective behavioral supports
d. A school staff member who supports teachers in collecting,
organizing, and managing assessment data
e. A school staff member who supports teachers in the interpretation
and use of assessment data to guide instruction

G4.

Please indicate the number of regular classroom teachers who have joined or left your school
since October 1, 2013. WRITE IN THE APPROXIMATE NUMBERS FOR EACH OF THE
FOLLOWING. IF NO TEACHERS HAVE LEFT OR STARTED AT YOUR SCHOOL DURING THE
SCHOOL YEAR, WRITE "0" ON THE APPLICABLE LINE.
Number
of teachers
a. Number of regular classroom teachers who have begun teaching in your
school since October 1, 2013
b. Number of regular classroom teachers who have left your school since
October 1, 2013, and have not returned

Draft

G5.

Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary
schedul
e
used
i
n
your
school
t
o
r
ewar
d
t
eacher
s
f
or
…
MARK YES OR NO ON EACH ROW.
Yes

a. Improved student performance on state tests?
b. Reaching target goals on state tests?

G6.

If a person other than the school administrator has completed the previous sections, please write
in the name and title of the person who completed the majority of the sections. PLEASE PRINT.

LAST NAME

FIRST NAME

MIDDLE INITIAL

TITLE
G7.

How long has the individual listed above been employed at this school? WRITE YEARS AND
MONTHS BELOW.

YEAR(S) MONTH(S)

The principal or head administrator should complete the remainder of
this questionnaire. If a designee is chosen to complete this in his or her
place, please be sure that the background and education characteristics
provided are about the school's principal or head administrator.

Draft

SECTION H. SCHOOL ADMINISTRATOR CHARACTERISTICS
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.

H5.

How many years of experience do you have in each of the following positions, including years
in which you worked part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL
SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR, WRITE "1."
Number
of years
a. Years as a teacher before becoming a school administrator
b. Total number of years as a school administrator
c. Number of years as school administrator at this school

Draft

H6.

Through which, if any, of the types of training programs below did you receive preparation for
fulfilling your role as a school administrator? MARK YES OR NO ON EACH ROW.
Yes

a. Traditional university-based training and certification program
b. District-based training program (for example, the Boston Principal
Fellowship, New York City Leadership Academy's Aspiring
Principals Program, Chicago's LAUNCH program)
c. City-based training program (for example, Cleveland's First Ring
Leadership Academy)
d. State-based training program (for example, New Jersey EXCEL)
e. Training and/or certification program run by a national non-profit
organization (for example, KIPP School Leadership Program,
New Leaders for New Schools)
f.

H7.

Another school administration preparation program

What is the highest level of education you have completed? MARK ONE RESPONSE.
High school diploma or equivalent/GED
Associ
at
e’
s
degr
ee
Bachel
or
’
s
degr
ee
l
east
one
y
ear
of
cour
sewor
k
bey
ond
a
Bachel
or
’
s
degr
ee
but
not
a
gr
aduat
e
degr
ee
At
Mas
t
er
’
s
degr
ee
Education specialist or professional diploma based on at least one year of coursework past a
Master's degree level
Doctorate or an advanced professional degree beyond a Master's degree (for example, MD)

H8.

What was your major field(s) of study in the highest degree you completed? MARK YES OR NO
ON EACH ROW.
Yes
a. Early childhood education
b. Elementary education
c. Education administration/management
d. Special education
e. Other education-related major (such as secondary
education, educational psychology, science education,
music education, etc.)
f.

Non-education major (such as history, English, etc.)

Draft

H9.

What is your best estimate of the percentage of children in your school you know by name?
MARK ONE RESPONSE.
Nearly every child
76% or more
51% to 75%
26% to 50%
25% or less

H10.

During school hours, do you speak a language other than English with students at your school
whose native language is not English? MARK ONE RESPONSE.
Yes
No

H11.

Do you speak a language other than English with students' families whose native language is
not English? MARK ONE RESPONSE.
Yes
No

H12.

If you do not speak a language other than English with EITHER students OR students'
families whose native language is not English, mark here and SKIP TO Q H14.

H13.

What language(s) other than English do you speak with students at your school or with their
families? MARK ALL THAT APPLY.
Spanish
Vietnamese
A Chinese language
Japanese
Korean
A Filipino language
Arabic
Other (PLEASE SPECIFY)

Draft

H14.

Date Questionnaire Completed:

2 0 1 4
MONTH

DAY

YEAR

Questionnaire completed by:

LAST NAME

FIRST NAME

MIDDLE INITIAL

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

NEW

Draft

Spring Third-Grade School Administrator
Questionnaire for Continuing Schools

Draft

Spring 2014
School Administrator Questionnaire
Questionnaire B
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

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 10/31/2015. The time required to complete this
information collection is estimated to average 60 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.
3 Participation is voluntary. You may skip questions
y
ou
do
not
wi
s
h
t
o
ans
wer
;
however
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
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 School Administrator,
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 one
or more of the children in your school are participants in this study.
This questionnaire contains several brief sections:
a) School characteristics
b) School-family-community connections
c) School policies and practices
d) School programs for particular populations
e) Federal programs: Title I, Adequate Yearly Progress (AYP), and Title III (if applicable)
f ) Staffing and teacher characteristics
g) School administrator characteristics
This information is vital to the study. Please feel free to ask other knowledgeable members of your staff to
provide the information necessary to complete various sections of the questionnaire. However, we ask that you,
yourself, please complete the final section, which is about your own background and 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
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
information that identifies you will be included in 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 described in the
instructions on page 6) or by writing your responses in the space provided. Your best estimates are acceptable
answers.

Draft

DEFINITIONS
For the purposes of this study, the following definitions apply:
Special programs. Reference is made in this questionnaire to Title I and Title III programs, individualized
education programs (IEP), individualized family service plans (IFSP), Section 504 plans, and Response to
Intervention (RtI). For this study, the following definitions apply:
Title I: "Improving the Academic Achievement of the Disadvantaged." Title I is a program of the
Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the No Child Left
Behind Act of 2001. The purpose of this program is to ensure that all children have a fair, equal, and
significant opportunity to obtain a high-quality education and reach, at a minimum, proficiency on state
academic achievement standards and state academic assessments.
Title III: "Language Instruction for Limited English Proficient and Immigrant Students." Title III is a
program of the Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the No
Child Left Behind Act of 2001. One of the main purposes of this program is to help ensure that children
who have limited proficiency in English, including immigrant children and youth, attain English
proficiency, develop high levels of academic attainment in English, and meet the same state academic
content and student academic achievement standards as all students are expected to meet.
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.
Section 504 plan: A written plan to provide appropriate services to a child with a disability, whether or
not the disability is judged to affect the child's educational performance. Speech therapy services may
often be specified as part of a Section 504 plan.
Response to Intervention (RtI): A multi-step approach to providing early and progressively intensive
intervention and monitoring within the general education setting. In principle, RtI begins with
research-based instruction and behavioral support provided to students in the general education
classroom, followed by screening of all students to identify those who may need systematic progress
monitoring, intervention, or support. Students who are not responding to the general education
curriculum and instruction are provided with increasingly intensive interventions through a "tiered"
system, and they are regularly monitored to assess their progress and inform the choice of future
interventions, including possibly special education for students determined to have a disability.
Language. Reference is made to English language learners (ELL), as well as to instructional programs for ELL
students in this questionnaire. For this study, the following definitions apply:
Language-minority (LM) student: A student in whose home a non-English language typically is spoken.
This group includes students whose English is fluent enough to benefit from instruction in academic
subjects offered in English as well as students who are English language learners.
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.

THANK YOU VERY MUCH FOR YOUR HELP.
4

Draft

SECTION A. SCHOOL CHARACTERISTICS

A1.

A2.

A3.

number of students attending on an average day
number of students enrolled

X 100

OR
Average Number Attending Daily

A4.

About what percentage of the children enrolled in this school are eligible for free or reducedprice lunch? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

Draft

SECTION B. SCHOOL-FAMILY-COMMUNITY CONNECTIONS
B1.

Please indicate how often each of the following activities is provided by your school. MARK ONE
RESPONSE ON EACH ROW.

Never

Once
a year

2 to 3
times
a year

4 to 6
times
a year

7 or more
times
a year

a. PTA, PTO, or Parent-Teacher-Student
organization meetings
b. Reports (report cards) of child's
performance provided to parents
c. Information on the child's standardized
assessment scores provided to parents
d. Teacher-parent conferences
e. School performances to which parents
are invited
f.

B2.

Classroom programs like class plays,
book nights, or family math nights

Indicate how much you agree or disagree with the following statements about the school's
community and parents. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree
a. Parents are actively involved in
this school's programs.
b. The community served by this
school is supportive of its goals
and activities.
c. Parents of children in this school
are welcome to observe classes
any time they are in session.

Agree

Strongly
agree

Draft

B3.

To the best of your knowledge how often do the following types of problems occur at your
school? MARK ONE RESPONSE ON EACH ROW.
Happens Happens
at least
at least Happens
Happens once a
once a
on
Never
daily
week
month occasion happens
a. Children bringing weapons to school
b. Physical conflicts among students
c. Student bullying
d. Widespread disorder in classrooms

B4.

Does your school take any of the following measures to ensure the safety of children? MARK
YES OR NO ON EACH ROW.
Yes
No
a. Security guards, unarmed
b. Security guards, armed
c. Metal detectors
d. Locked doors during the school day
e. A requirement that visitors sign in
f.

Intercoms or telephones in classrooms

g. Other (PLEASE SPECIFY)

B5.

To what extent is each of the following matters a problem in this school? Indicate whether each
is a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a problem in this
school. MARK ONE RESPONSE ON EACH ROW.
Serious
problem
a. Student tardiness
b. Student absenteeism
c. Student aggressive or disruptive behavior
d. Teacher absenteeism
e. Teacher turnover
f.

Overcrowding

Moderate
problem

Minor
problem

Not a
problem

Draft

B6.

During the past year, to what extent did any of the following changes occur at your school?
MARK ONE RESPONSE ON EACH ROW.
Not
at all

Small
extent

Moderate
extent

Large
extent

a. Funding levels decreased
b. The number of students receiving free
or reduced-price lunch increased
c. There has been a reduction in staffing
d. Class sizes increased
e. Class sizes decreased
f.

Salaries increased

g. Salaries decreased

B7.

Draft

SECTION C. SCHOOL POLICIES AND PRACTICES
C1.

C2.

Not applicable

How many third-grade children were retained at their current grade level last school year?
WRITE NUMBER BELOW. IF NONE, WRITE "0."
Number of third-grade children retained last year

C3.

C4.

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

For READING
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.

Neither
agree nor
Strongly
disagree Disagree disagree

b. At this school, we use data from
screening tests to determine if core
instruction in READING is meeting
the needs of most of our students.
For MATH
c. 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.
d. At this school, we use data from
screening tests to determine if core
instruction in MATH is meeting the
needs of most of our students.

Agree

Strongly
agree

Don't
know

Draft

C5.

C6.

Is RtI currently implemented at your school in third grade in the following areas? MARK ONE
RESPONSE ON EACH ROW.
Yes, fully
implemented
in third grade

Yes, partially
implemented
in third grade

No, not
implemented
in third grade

a. Math
b. Reading
c. Writing
d. Behavior/Social skills

C7.

Approximately how many years ago did your school begin implementing RtI in third grade
in any subject? MARK ONE RESPONSE.
Less than 1 year ago
1 to 2 years ago
More than 2 years ago

C8.

For the 2013-2014 school year, how has your school made information available to
parents/guardians to help them understand how RtI is being implemented in your school?
MARK YES OR NO ON EACH ROW.
No
Yes
a. Communication through written materials such as letters, email, school
website, or newsletters
b. Communication through workshops, discussion groups, or other meetings
such as PTA meetings
c. Communication through individual meetings with parents or phone calls
d. Information is not distributed on this topic

Draft

SECTION D. SCHOOL PROGRAMS FOR PARTICULAR POPULATIONS
Language-Minority Students and Families
D1.

Do any of the children in this school come from a home where a language other than English is
spoken? MARK ONE RESPONSE.
Yes
No (SKIP TO Q D3)

D2.

What percentage of children in this school and in third grade are English language learners (ELL)?
SEE PAGES 4 AND 5 FOR DEFINITIONS RELATED TO LANGUAGE. WRITE IN THE PERCENTAGES
BELOW.

ELL among all students in school

ELL among all students in third grade

Children with Special Needs
D3.

D4.

Draft

D5.

a. IQ-achievement discrepancy model which shows whether
there is a discrepancy between expected performance and
actual performance
b. Response to Intervention (RtI) model

D6.

Percent
a. Special education with an
Individualized Education Program
(IEP)

b. Receive accommodations through a
504 plan

c. Reading instruction for students
performing below grade level in
reading

d. Math instruction for students
performing below grade level in math

e. A gifted and talented program

Not offered
in any grade

Draft

SECTION E. TITLE I AND TITLE III

The following items pertain to public schools only.
IF YOURS IS A PRIVATE SCHOOL CHECK HERE. (SKIP TO Q F1)

Title I Funding and Programs
E1.

Did your school receive Federal Title I funds for this school year? MARK ONE RESPONSE.
Yes
No (SKIP TO Q E3)

PLEASE NOTE THE FOLLOWING DEFINITIONS
THAT ARE RELEVANT TO QUESTION E2 BELOW:
A targeted assistance program uses Title I funds to provide supplemental
academic services (usually in reading and/or math) to specific students,
sometimes referred to as "Title I students," who have been identified as low
achieving.
A schoolwide program may use Title I funds to improve the quality of
educational programs and services throughout the school. A school may use
Title I funds for a schoolwide program if at least 40 percent of its students are
from low-income families, or if it receives a waiver permitting it to operate a
schoolwide program.

E2.

Is your school operating a Title I targeted assistance or schoolwide program? MARK ONE
RESPONSE.
Targeted assistance program
Schoolwide program

Title III Funding and Programs
E3.

Did your school receive Federal Title III funds for this school year? (Title III is "Language
Instruction for Limited English Proficient and Immigrant Students.") MARK ONE RESPONSE.
Yes
No

Draft

SECTION F. STAFFING AND TEACHER CHARACTERISTICS
F1.

Paraprofessionals (for example, classroom aides)

(1)

(2)

Number who
work full time in
your school

Number who
work part time
in your school

Draft

F2.

Guidance counselors

g. Library media specialists/librarians
h. Computer/technology teachers or support staff

F3.

F4.

Draft

F5.

Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary
schedul
e
used
i
n
your
school
t
o
r
ewar
d
t
eacher
s
f
or
…
MARK YES OR NO ON EACH ROW.
Yes

a. Improved student performance on state tests?
b. Reaching target goals on state tests?

F6.

If a person other than the school administrator has completed the previous sections, please write
in the name and title of the person who completed the majority of the sections. PLEASE PRINT.

LAST NAME

FIRST NAME

MIDDLE INITIAL

TITLE
F7.

How long has the individual listed above been employed at this school? WRITE YEARS AND
MONTHS BELOW.

YEAR(S) MONTH(S)

Draft

SECTION G. SCHOOL ADMINISTRATOR CHARACTERISTICS
G1.

What is your gender? MARK ONE RESPONSE.
Male
Female

G2.

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

1 9
YEAR
G3.

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

G4.

G5.

Draft

G6.

Through which, if any, of the types of training programs below did you receive preparation for
fulfilling your role as a school administrator? MARK YES OR NO ON EACH ROW.
Yes

G7.

Another school administration preparation program

What is the highest level of education you have completed? MARK ONE RESPONSE.
High school diploma or equivalent/GED
at
e’
s
degr
ee
Associ
Bachel
or
’
s
degr
ee
l
east
one
y
ear
of
cour
sewor
k
bey
ond
a
Bachel
or
’
s
degr
ee
but
not
a
gr
aduat
e
degr
ee
At
Mas
t
er
’
s
degr
ee
Education specialist or professional diploma based on at least one year of coursework past a
Master's degree level
Doctorate or an advanced professional degree beyond a Master's degree (for example, MD)

G8.

Non-education major (such as history, English, etc.)

Draft

G9.

What is your best estimate of the percentage of children in your school you know by name?
MARK ONE RESPONSE.
Nearly every child
76% or more
51% to 75%
26% to 50%
25% or less

G10.

During school hours, do you speak a language other than English with students at your school
whose native language is not English? MARK ONE RESPONSE.
Yes
No

G11.

Do you speak a language other than English with students' families whose native language is
not English? MARK ONE RESPONSE.
Yes
No

G12.

If you do not speak a language other than English with EITHER students OR students'
families whose native language is not English, mark here and SKIP TO Q G14.

G13.

Draft

G14.

Date Questionnaire Completed:

2 0 1 4
MONTH

DAY

YEAR

Questionnaire completed by:

LAST NAME

FIRST NAME

MIDDLE INITIAL

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

RETURNING

Draft

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File Modified	2013-07-24
File Created	2013-07-18