Spring Fourth-Grade Data Collection & Recruitment for Fifth-Grade

Appendix D ECLS-K2011 Spring 4th Grade Teacher Subject-Specific Questionnaires-Redacted

Spring Fourth-Grade Data Collection & Recruitment for Fifth-Grade

OMB: 1850-0750

⚠️ Notice: This form may be outdated.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

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APPENDIX D
FOURTH-GRADE
SUBJECT-SPECIFIC CHILD-LEVELTEACHER
QUESTIONNAIRES (TQCs)

Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)

Spring Fourth-Grade National Data Collection
and Fifth-Grade Recruitment
OMB Clearance Package
#1850-0750 v.16

Draft

Spring 2015
Reading and Language Arts
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.

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED
TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR
ORAN ECL
S‐
K:
2011STAF
FMEMBER.
DONOTMAI
LTHIS
QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY
STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

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 voluntary survey is
1850‐
XXXX.Appr
ov
alex
pi
r
esXX/
XX/
XXXX.Thet
i
mer
equi
r
edt
oc
ompl
et
et
hi
s
survey is estimated to average 26 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed,
and complete and review the survey. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this survey, or
any comments or concerns regarding the status of your individual submission
of this survey, please write to: Early Childhood Longitudinal Study, National
Cent
erf
orEduc
at
i
onSt
at
i
s
t
i
c
s
,1990KSt
r
eet
,N.
W.
,Was
hi
ngt
on,D.
C.20006‐
5574.

The collection of information in this survey is authorized by 20 U.S.
Code, Section 9543. Participation is voluntary. You may skip questions
you do not wish to answer; however, we hope that you will answer as
many questions as you can. Your responses are protected from
di
s
c
l
os
ur
e by f
eder
al s
t
at
ut
e﴾
20 U.
S. Code,Sec
t
i
on 9573﴿
. Al
l
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,
Thi
s
ques
t
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
s
t
udy
of
c
hi
l
dr
en’
s
ear
l
y
educat
i
onal
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach reading and language arts to one or more of the children who are
participants in this study.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
chi
l
dr
en’
s
ac
ademi
c
pr
ogr
ess
and
v
ar
i
ous
sc
hool
,
cl
as
sr
oom,
t
eacher, 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. 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)
.
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
oduc
e
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.
This questionnaire has two parts:
 Part 1 should be completed for the child whose name is on the cover of this questionnaire.

Par
t
2
has
quest
i
ons
about
y
our
r
eadi
ng
and
l
anguage
ar
t
s
c
l
ass
–
y
ou
onl
y
need
t
o
f
i
l
l
out
Par
t
2
if there is a red dot
next
t
o
t
he
chi
l
d’
s
name
on
t
he
cover
of
t
he
ques
t
i
onnai
r
e.
The instructions preceding each part of the questionnaire will guide you.
Please record your answers directly on the questionnaire by marking the appropriate answer (as
instructed on page 5) or by writing your responses in the space provided. Your best estimates are
acceptable answers.
DEFINITIONS
For the purposes of this study, the following definitions apply:
 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
af
f
ect
t
he
chi
l
d’
s
educ
at
i
onal
per
f
or
mance.
Chi
l
dr
en
who
r
ec
ei
v
e
speci
al
educ
at
i
on
ser
v
i
c
es
under the Individuals with Disabilities Act (IDEA) are expected to have an IEP.
 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
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

PART 1:
Please answer the questions in Part 1 about the child identified on the
cover of this questionnaire.

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

k. Keeps belongings organized.

n. Shows eagerness to learn new things.
o. Works independently.

Draft

SECTION A. SOCIAL SKILLS (continued)

u. Easily adapts to changes in routine.

w. Persists in completing tasks.
x. Pays attention well.
y. Follows classroom rules.

Draft

A2.

Please indicate how often each of these items applies to the child identified on the cover of this
questionnaire. MARK ONE RESPONSE ON EACH ROW.
Doesn't apply

Sometimes applies

Certainly applies

Seldom displays
this behavior

Occasionally displays
this behavior

Often displays
this behavior

a. Likes to come to school
b. Dislikes school
c. Has fun at school
d. Likes being in school
e. Seems unhappy in school
f.

Enjoys most classroom activities

g. Groans or complains about suggested activities
Source: Teacher version of the School Liking and Avoidance Questionnaire ﴾
SL
AQ;Ada
pt
edf
r
om L
add& Pr
i
c
e,1987;L
add,1990﴿

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. PEER RELATIONSHIPS
Please answer the following questions about the child identified on the cover of this questionnaire.
C1.

For the items below, please think about the friends with whom the child identified on the cover of
this questionnaire has associated the most during the past month or two. Please indicate how
true you think each of these items is for this group of children. If you cannot answer these items
because the child has not usually associated with a group of other children in the past month or
two, then mark "Not applicable." MARK ONE RESPONSE ON EACH ROW.

Almost
always
untrue

Usually
untrue

Sometimes
true,
sometimes
untrue

Usually
true

Almost
always
true

Not
applicable

a. This is a good group of kids
b. I worry when this child is with this
group
of kids
c. Some of these kids are a bad
influence
on this child
d. These kids must be closely supervised
by an adult
e. These kids get into trouble
f.

These kids are excellent students

g. These kids are hard workers
h. This child has a fun time with this
group
of children
i. Most of these kids are kind to other
children
Sour
c
e:Vandel
l
,Debor
ahL
owe ﴾
2001﴿
.Relationships With Peers: Part D (Teacher). Unpublished scale, NICHD Study of Early Child Care and
Youth Development, Form FLV18G3.

Draft

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 Child Behavior Scale © Gary W. Ladd. Used with permission.

Draft

C3.

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. Told lies or untrue stories about
this student?
c. Pushed, shoved, slapped, hit, or
kicked this student?
d. Intentionally excluded or left this
student out from playing with
them?

C4.

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

Rarely

Sometimes

Often

Very often

a. Teased, made fun of, or called
other students names?
b. Told lies or untrue stories about
other students?
c. Pushed, shoved, slapped, hit, or
kicked other students?
d. Intentionally excluded or left other
students out from playing with him
or her?
Sour
c
e:Es
pel
age,D.L
.& Hol
t
,M.﴾
2001﴿
.Bul
l
y
i
ngandpeerv
i
c
t
i
mi
z
at
i
ondur
i
ngear
l
yadol
es
c
enc
e:Peeri
nf
l
uenc
esand
psychosocial correlates. Journal of Emotional Abuse,
2,123‐
142.Adapt
eda
ndus
edwi
t
hper
mi
s
s
i
on.

C5.

Thinking about the child identified on the cover of this questionnaire compared to a typical
child in his/her grade, please evaluate this child in the following areas. MARK ONE RESPONSE ON
EACH ROW.
Very
poor

Somewhat
poor

Average

Good

Very
good

a. Understands others' feelings
b. Accurately interprets what a peer is
trying to do
c. Generates good quality solutions to
interpersonal problems
d. Is aware of the effects of his/her
behavior on others
Sour
c
e:Pi
er
c
e,K.M.
,Hamm,J
.V.
,& Vandel
l
,
D.L
.﴾
1999﴿
.Ex
per
i
enc
esi
naf
t
er
‐
s
c
hoolpr
ogr
amsandc
hi
l
dr
en'
sadj
us
t
menti
n
f
i
r
s
t
‐
gr
adec
l
as
s
r
ooms
.Child Development, 70,
756‐
767.

Draft

SECTION D. STUDENT INFORMATION
Please answer the following questions about the child identified on the cover of this questionnaire..
D1.

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

D2.

How long has this child been in your reading/language arts class 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

D3.

Please indicate the total number of times this child has been absent from your reading/language
arts class during the current school year. MARK ONE RESPONSE.
No absences
1 to 4 absences
5 to 7 absences
8 to 10 absences
11 to 19 absences
20 or more absences

D4.

Doest
hi
sc
hi
l
dr
ec
ei
ve﴾
orhashe/
s
her
ec
ei
veddur
i
ngt
hi
ss
choolyear
﴿i
ns
t
r
uc
t
i
oni
nanyoft
he
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. Gifted and talented program in reading/language arts
c. Gifted and talented program with no specific content focus

Draft

D5.

Is English this child's native language? MARK ONE RESPONSE.
SKI
PTO QD11﴿
Yes ﴾
No
Don't know

D6.

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 ﴾
SKI
PTO Q D11﴿

D7.

Woul
dyous
ayt
hei
ns
t
r
uc
t
i
ont
hi
sc
hi
l
dr
ec
ei
vesi
spr
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‐
wayi
mmer
s
i
onpr
ogr
am ort
wo‐
waybi
l
i
ngua
lpr
ogr
am
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:






Shel
t
er
edEngl
i
s
hi
ns
t
r
uc
t
i
onorc
ont
ent
‐
bas
edEngl
i
s
hasaSec
ond
L
a
nguage﴾
ESL
﴿pr
ogr
am
St
r
uc
t
ur
edEngl
i
s
hI
mmer
s
i
on﴾
SE
I
﴿
Pul
l
‐
outEngl
i
s
hasaSec
ondL
anguage﴾
ESL
﴿orE
ngl
i
s
hL
a
nguageDev
el
opment﴾
EL
D﴿
Pus
h‐
i
nESLpr
ogr
am

Ot
herpr
ogr
am﴾
s
﴿(PLEASE SPECIFY)

Nos
pec
i
al
i
z
edl
anguagepr
ogr
am i
spr
ovi
dedt
ot
hi
sc
hi
l
d.﴾
SKI
PTOQ D10﴿

Draft

D8.

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

Never

Less
than
once
a week

1 day
a week

2 days
a week

3 days
a week

4 days
a week

5 days
a week

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

D9.

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
applicable/ than ½
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

D10.

During this school year, how often is this child's reading 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

3 hours
or more

Draft

D11.

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

D12.

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
. Speec
h‐
l
anguaget
her
apyf
orc
hi
l
dr
enwi
t
hs
peec
horl
a
nguage
disorders/impairments
b. Special education services, not including speech therapy, whether
pr
ov
i
dedi
nt
hec
l
as
s
r
oom ori
napul
l
‐
outs
et
t
i
ng

D13.

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

About on
grade level

Above
grade level

a. Reading
b. Writing
c. Oral language
d. Social studies

D14.

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

Draft

D15.

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 ﴾
SKI
PTO Q D17﴿
Two
Three
Four
Five or more

D16.

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

D17.

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

If there is a red dot next to the child's name on the cover of this questionnaire, please continue
with Part 2.
If there is no red dot next to the child's name on the cover, skip to question H4 on page 33.

Draft

PART 2:
To be completed only if there is a red dot next to the child's name on the cover
of this questionnaire.
If there is no red dot next to the child's name on the cover, skip to question H4 on page 33.

Draft

SECTION E. READING AND LANGUAGE ARTS INSTRUCTION
Please answer the following questions for the reading class in which the child identified on the cover of this
questionnaire receives reading and language arts instruction.
E1.

From the first day of school until today, please indicate on how many days you have covered each of
the following READING AND LANGUAGE ARTS skills and concepts in this child's class. Please include
the time during which you provide direct instruction as well as the time you spend supervising
students as they work.
Please focus on the skill areas that are shown in bold text.﴾
Theunbol
dedexampl
esar
eonl
yas
ampl
e
oft
hi
ngsyoumaydoorc
overundert
hi
ss
ki
l
lar
ea.
﴿MARK ONE RESPONSE ON EACH ROW.

Literature

Not yet
taught
or not
taught
in this
grade

a. Understanding key ideas and details, for
example, identifying the main idea or theme;
summarizing; describing characters and
settings; etc.
b. Understanding craft and structure, for
example, explaining major differences between
poems, plays, and prose; comparing the point
of view from which different stories are
narrated; etc.
c. Integrating knowledge and ideas, for example,
making connections between text and a visual
or oral presentation of the text; comparing
treatment of similar themes in stories and
myths; etc.

Informational Text
d. Understanding key ideas and details, for
example, identifying important details; drawing
inferences from details in the text; explaining
events, procedures or concepts in the text; etc.
e. Understanding craft and structure, for example,
describing the chronology of events in a text;
recognizing cause and effect; comparing different
accounts of the same event or topic; etc.
f. Integrating knowledge and ideas, for
example, interpreting how charts, graphs, or
timelines relate to the text; integrating information
from two texts on the same topic; etc.

On
1‐
10
days

On
11‐
20
days

On
21‐
40
days

On
On more
41‐
80 than 80
days
days

Draft

E1.

﴾
c
ont
i
nued﴿Fr
om t
hef
i
r
s
tdayofs
c
hoolunt
i
lt
oday, please indicate on how many days you have
covered each of the following READING AND LANGUAGE ARTS skills and concepts in this child's
class. Please include the time during which you provide direct instruction as well as the time you
spend supervising students as they work.
Please focus on the skill areas that are shown in bold text.﴾
Theunbol
dedexampl
esar
eonl
yas
ampl
e
oft
hi
ngsyoumaydoorc
overundert
hi
ss
ki
l
lar
ea.
﴿MARK ONE RESPONSE ON EACH ROW.

Writing and Language

Not yet
taught
or not
taught
in this
grade

g. Writing narratives, opinion pieces, and
informational text with facts and details
h. Developing and strengthening writing by
planning, drafting, revising, and editing
i. Building vocabulary, for example, studying
words and their meanings in text; learning
about roots, prefixes, and suffixes; using context
clues to derive meaning; etc.

On
1‐
10
days

On
11‐
20
days

On
21‐
40
days

On more
On
41‐
80 than 80
days
days

Draft

E2.

How often do the children in this class engage in the following reading and language arts activities?
MARK ONE RESPONSE ON EACH ROW.
Almost
every
day
a. Read silently
b. Read books they have chosen themselves
c. Talk with others about what they have read
d. Do a group activity or project about what they
have read
e. Discuss different interpretations of what they
have read
f.

Look up vocabulary words and write
definitions

g. Demonstrate understanding of words by relating
t
hem t
ot
hei
roppos
i
t
es﴾
ant
ony
ms
﴿andt
owor
ds
wi
t
hs
i
mi
l
a
rmeani
ngs﴾
s
y
nony
ms
﴿
h. When given specific questions, write responses
that are at least 3 to 4 sentences long
i.

Gather evidence from literary or informational
t
ex
t
s﴾
i
nbook
sand/
ordi
gi
t
a
ls
our
c
es
﴿t
oi
nf
or
m
their writing

Spend extended time writing and revising text
that they have written

k. Edit their classmates' writing

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never

Draft

SECTION F. CLASSROOM AND STUDENT CHARACTERISTICS
Please answer the following questions for the reading class in which the child identified on the cover of
this questionnaire receives reading and language arts instruction.
F1.

Asoft
oday'
sdat
e,how manyc
hi
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 this class?
b. Are boys?
c.

F2.

Are girls?

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade or lower
b. 3rd grade
c.

4th grade

d. 5th grade
e. 6th grade or higher

F3.

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

Draft

F4.

How many children in this 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?

F5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,
WRITE "0."
Number of children absent on an average day

F6.

How many children in this class are below grade level, about on grade level, or above grade level
in their English reading skills and in social studies?
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
I do not teach
this subject

Below
grade level

About on
grade level

Above
grade level

a. English reading skills?
b. Social studies?

F7.

At this point in the school year, how would you rate the behavior of the children in this 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.

Draft

F8.

Approximately what percentage of the students in this class demonstrate the following problems?
MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
b.L
a
c
ks
el
f
‐
c
ont
r
ol
﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
c. Are rejected by peers
d. Do not accept authority
Sour
c
e:Abr
y
,T.
,Swans
on,J
.
,andF
abes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

F9.

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

F10. Doyouhaveanyc
hi
l
dr
enwhoar
eEngl
i
s
hl
anguagel
ear
ner
si
nt
hi
sc
l
as
s
?﴾
Engl
i
s
hl
anguage
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
s
chooli
ns
t
r
uc
t
i
oni
nEngl
i
s
h.
﴿MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO Q G1﴿

F11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of ELL children

Draft

SECTION G. CLASSROOM INSTRUCTION AND EVALUATION
Please answer the following questions for the reading class in which the child identified on the cover of
this questionnaire receives reading and language arts instruction.
G1.

In a typical day, how much time do children in this reading and language arts class spend in the
following activities? MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS
BREAKS.
No
time

1‐
15
minutes

16‐
30
minutes

31‐
45
minutes

Longer
than 45
minutes

a. Working independently
b. Working on individual tasks under
teacher direction
c. Working with peers under teacher
direction
d. Working in small groups with
teacher
e. Teacher lecture with large group
and/or large group discussion led
by teacher

G2.

Do any of the following staff members provide direct instruction to students in this reading and
language arts class who are struggling or at risk of failure in reading? INCLUDE STAFF OTHER
THANYOURS
E
L
FWHOPROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
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 special education teacher

Draft

G3.

In this class, how frequently do you or your students use computers or the following electronic
devices for instructional purposes in reading and language arts? Please include any desktop,
l
apt
op,orot
herc
omput
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
Not
available

Never

Rarely

Sometimes

Often

a. Desktop or laptop computer or
ot
herc
omput
er
‐
t
y
pedev
i
c
e﴾
f
or
example, iPad/other tablet,
eRea
ders
uc
hasKi
ndl
eorNook
﴿
b.Cel
lphone/
s
mar
t
phone﴾
f
or
ex
a
mpl
e,i
Phone﴿
c
.I
nt
er
ac
t
i
v
ewhi
t
eboar
d﴾
f
or
example, SMART Board,
Ac
t
i
v
boar
d﴿
d. Document camera or document
pr
oj
ec
t
or﴾
f
orex
ampl
e,EL
MO,
Hov
er
Ca
m﴿
e. LCD or DLP projector
f
. Di
gi
t
alc
amer
a﴾
s
t
i
l
lorv
i
deo﴿
g. CD player, MP3 player/iPod,
cassette/tape player
h. DVD player, VCR, or video
s
t
r
eami
ngdev
i
c
e﴾
f
orex
ampl
e,
Roku﴿
i.

St
udentr
es
pons
es
y
s
t
em ﴾
f
or
example, clickers, responders,
Ac
t
i
Vot
e,Ac
t
i
v
Ex
pr
es
s
i
on﴿

k. Microphone or classroom audio
s
ounds
y
s
t
em ﴾
f
orex
ampl
e,
TopCat
,
Redc
a
t
﴿

G4.

In an average week, how many days a week is reading and language arts homework assigned in
this class? Please count homework assigned over the weekend as one day. MARK ONE RESPONSE.
0 days ﴾
SKI
PTO Q G6﴿
1 day
2 days
3 days
4 days
5 days

Draft

G5.

On days when homework is assigned, how much time do you expect children in this class to spend
on homework in reading and language arts? MARK ONE RESPONSE.
1 to 10 minutes
11 to 20 minutes
21 to 30 minutes
More than 30 minutes

G6.

In this class, how often do you use a formal assessment in READING for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

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

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

Please answer the following question about the school's practices regarding reading and language arts.
G7.

For each of the following statements about READING, indicate how strongly you agree or disagree.
MARK ONE RESPONSE ON EACH ROW.
Neither
agree nor
Strongly
disagree Disagree disagree
a. This school has a set of clear,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
el
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
reading in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
i
nt
er
v
ent
i
onf
our
t
h‐
gr
ade
students will receive in reading.
c. This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a reading intervention.

Agree

Strongly
agree

Don't
know

Draft

SECTION H. STAFF ACTIVITIES
H1.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No ﴾
SKI
PTO QH3﴿
* Professional development may include continuing formal education; courses, conferences,
wor
k
s
hops
,
ori
n‐
s
er
v
i
c
et
r
ai
ni
ng;
s
t
a
f
fmeet
i
ngst
hati
nc
l
udes
t
af
fdev
el
opmenta
c
t
i
v
i
t
i
es
;
and
receiving coaching or mentoring.

H2.

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

Never

Once

2 times

3 to 4
times

More
than 4
times

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

H3.

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

No, support
not received
but
available

Resource
not
available

Draft

H4.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

Spring 2015
Mathematics
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 voluntary survey is
1850‐
XXXX.Appr
ov
alex
pi
r
esXX/
XX/
XXXX.Thet
i
mer
equi
r
edt
oc
ompl
et
et
hi
s
survey is estimated to average 13 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed,
and complete and review the survey. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this survey, or
any comments or concerns regarding the status of your individual submission
of this survey, please write to: Early Childhood Longitudinal Study, National
Cent
erf
orEduc
at
i
onSt
at
i
s
t
i
c
s
,1990KSt
r
eet
,N.
W.
,Was
hi
ngt
on,D.
C.20006‐
5574.

Draft

Dear Teacher,
Thi
s
quest
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
st
udy
of
chi
l
dr
en’
s
ear
l
y
educ
at
i
onal
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach mathematics to one or more of the children who are participants in this
study.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K: 2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
c
hi
l
dr
en’
s
academi
c
pr
ogr
es
s
and
v
ar
i
ous
s
chool
,
cl
ass
r
oom,
t
eacher
,
and
home
c
har
act
er
i
st
i
cs.
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)
.
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.
This questionnaire has two parts:
 Part 1 should be completed for the child whose name is on the cover of this questionnaire.

Par
t
2
has
quest
i
ons
about
y
our
mat
hemat
i
c
s
cl
as
s
–
you
onl
y
need
t
o
f
i
l
l
out
Par
t
2
i
f
t
her
e
i
s
a
red dot
nex
t
t
o
t
he
chi
l
d’
s
name
on
t
he
cover
of
t
he
ques
t
i
onnai
r
e.
The instructions preceding each part of the questionnaire will guide you.
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.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

PART 1:
Please answer the questions in Part 1 about the child identified on the
cover of this questionnaire.

Draft

SECTION A. STUDENT INFORMATION
Please answer the following questions about the child identified on the cover of this questionnaire.
A1.

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

A2.

How long has this child been in your math class 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

A3.

Please indicate the total number of times this child has been absent from your math class during
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

A4.

Doest
hi
sc
hi
l
dr
ec
ei
ve﴾
orhashe/
s
her
ec
ei
veddur
i
ngt
hi
ss
c
hoolyear
﴿i
ns
t
r
uc
t
i
oni
nanyoft
he
following types of programs in your school? MARK YES OR NO ON EACH ROW.
Yes
a. Individual tutoring or remedial program in mathematics
b. Gifted and talented program in mathematics

Draft

A5.

Is English this child's native language? MARK ONE RESPONSE.
Yes ﴾
SKI
PTO QA7﴿
No
Don't know

A6.

During this school year, how often is this child's math 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

A7.

Overall, how would you rate this child's academic skills in math, based on curriculum standards for
his/her current grade level? MARK ONE RESPONSE.
Below grade level
About on grade level
Above grade level

A8.

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

A9.

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
Two
Three
Four
Five or more

﴾
SKI
PTO PART2,PAGE9﴿

Draft

A10.

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

If there is a red dot next to the child's name on the cover of this questionnaire, please
continue with Part 2.
If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

Draft

SECTION B. MATHEMATICS INSTRUCTION

Please answer the following questions for the math class in which the child on the cover of this questionnaire
receives math instruction.
B1.

From the first day of school until today, please indicate on how many days you have covered each of
the following MATHEMATICS skills and concepts in this child's class. Please include the time during
which you provide direct instruction as well as the time you spend supervising students as they work.
Please focus on the skill areas that are shown in bold text.﴾
Theunbol
dedexampl
esar
eonl
yas
ampl
e
oft
hi
ngsyoumaydoorc
overundert
hi
ss
ki
l
lar
ea.
﴿MARK ONE RESPONSE ON EACH ROW.
Not yet
taught
or not
taught
in this
grade

a. Using operations to solve problems, for example,
solving problems by multiplying or dividing
t
wowhol
enumber
s
;
s
ol
v
i
ngmul
t
i
pl
e‐
s
t
epwor
d
problems that use several different operations;
interpreting remainders; finding factor pairs; etc.
b. Using algebraic thinking, for example, solving word
problems by representing the problem as an
equation with a symbol for the unknown number; etc.
c. Understanding place value, for example, reading and
wr
i
t
i
ngmul
t
i
‐
di
gi
twhol
enumber
s
;
c
ompar
i
ngt
wo
numbers based on meanings of the digits in each place;
using understanding of place value to round whole
numbers to any place; etc.
d. Addi
ngands
ubt
r
ac
t
i
ngmul
t
i
pl
e‐
di
gi
tnumber
susing
strategies based on place value and properties of
operations
e. Understanding fractions, for example, comparing
fractions with different numerators or
denominators; adding and subtracting fractions;
multiplying fractions by whole numbers;
understanding the relationship between decimals and
fractions; etc.
f. Solving problems involving measurement, for example,
solving problems involving measures of distance,
time, volume, or money; understanding the relative size of
units of measurement; finding the area or perimeter of
rectangles; etc.
g. Representing and interpreting data, for example, making
line plots or other visuals to display fractions of a unit;
using addition and subtraction of fractions to answer
questions about a line plot; etc.
h. Drawing and identifying lines and angles, for example,
drawing points, lines, line segments, rays, angles, and
perpendicular and parallel lines; recognizing
right triangles; understanding lines of symmetry; etc.

On
1‐
10
days

On
On
On On more
11‐
20 21‐
40 41‐
80 than 80
days
days
days
days

Draft

B2.

How often do the children in this class engage in the following mathematics activities? MARK ONE
RESPONSE ON EACH ROW.
Almost
every
day
a. Solve mathematics problems from textbooks or
worksheets
b. Solve mathematics problems from the
blackboard, whiteboard/SMART Board®, or
projector
c. Solve mathematics problems in small groups or
with a partner
d. Wor
kwi
t
hmeas
ur
i
ngi
ns
t
r
ument
s﴾
f
orex
ampl
e,
r
ul
er
s
,
c
ompas
s
es
,
pr
ot
r
ac
t
or
s
﴿
e. Wor
kwi
t
hmani
pul
a
t
i
v
es﴾
f
orex
ampl
e,
geomet
r
i
c
s
ha
pes
,
f
r
ac
t
i
onbar
s
﴿
f.

Use a calculator

g. Take mathematics tests/quizzes
h. Write a few sentences about how to solve a
mathematics problem
i.

Discuss solutions to mathematics problems with
other students

Work on and discuss mathematics problems that
r
ef
l
ec
tr
ea
l
‐
l
i
f
es
i
t
ua
t
i
ons

k. Us
eac
omput
erf
ormat
h﴾
bey
ondus
i
nga
c
omput
er
'
sc
a
l
c
ul
a
t
or
﴿
l
. Cr
eat
eori
nt
er
pr
etv
i
s
ua
lr
epr
es
ent
at
i
ons﴾
f
or
ex
ampl
e,
di
agr
ams
,gr
a
phs
,
t
a
bl
es
,
model
s
﴿

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never

Draft

SECTION C. CLASSROOM AND STUDENT CHARACTERISTICS
Please answer the following questions for the math class in which the child identified on the cover of this
questionnaire receives math instruction.
C1.

C2.

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade or lower
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher

C3.

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

Draft

C4.

How many children in this 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?

C5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,
WRITE "0."
Number of children absent on an average day

C6.

How many children in this class are below grade level, about on grade level, or above grade level
in mathematics skills?
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of children below grade level
Number of children about on grade level
Number of children above grade level

C7.

Draft

C8.

Approximately what percentage of the students in this class demonstrate the following problems?
MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
b.L
a
c
ks
el
f
‐
c
ont
r
ol﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
c. Are rejected by peers
d. Do not accept authority
Sour
c
e:Abr
y
,T.
,Swans
on,J
.
,andF
abes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

C9.

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

C10. Doyouhaveanyc
hi
l
dr
enwhoar
eEngl
i
s
hl
anguagel
ear
ner
si
nt
hi
sc
l
as
s
?﴾
Engl
i
s
hl
anguage
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
s
c
hooli
ns
t
r
uc
t
i
oni
nEngl
i
s
h.
﴿MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO QD1﴿

C11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of ELL children

Draft

SECTION D. CLASSROOM INSTRUCTION AND EVALUATION
Please answer the following questions for the math class in which the child identified on the cover of this
questionnaire receives math instruction.
D1.

In a typical day, how much time do children in this math class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.
No
time

1‐
15
minutes

16‐
30
minutes

31‐
45
minutes

Longer
than 45
minutes

D2.

Do any of the following staff members provide direct instruction to students in this math class
who are struggling or at risk of failure in math? INCLUDE STAFF OTHER THAN YOURSELF WHO
PROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
OUTS
E
TTI
NG.E
XCL
UDE
PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes
a. A math specialist/interventionist who has specialized
training in MATH instruction
b. A special education teacher

Draft

D3.

In this class, how frequently do you or your students use computers or the following electronic
devices for instructional purposes in math? Please include any desktop, laptop, or other
c
omput
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
Not
available

Never

Rarely

Sometimes

Often

a. Desktop or laptop computer or
ot
herc
omput
er
‐
t
y
pedev
i
c
e﴾
f
or
example, iPad/other tablet,
eRea
ders
uc
hasKi
ndl
eorNook﴿
b.Cel
lphone/
s
mar
t
phone﴾
f
or
ex
ampl
e,
i
Phone﴿
c
.I
nt
er
ac
t
i
v
ewhi
t
eboar
d﴾
f
or
example, SMART Board,
Ac
t
i
v
boar
d﴿
d. Document camera or document
pr
oj
ec
t
or﴾
f
orex
a
mpl
e,EL
MO,
Hov
er
Ca
m﴿
e. LCD or DLP projector
f
. Di
gi
t
alc
amer
a﴾
s
t
i
l
lorv
i
deo﴿
g. CD player, MP3 player/iPod,
cassette/tape player
h. DVD player, VCR, or video
s
t
r
eami
ngdev
i
c
e﴾
f
orex
a
mpl
e,
Roku﴿
i.

St
udentr
es
pons
es
y
s
t
em ﴾
f
or
example, clickers, responders,
Ac
t
i
Vot
e,Ac
t
i
v
Ex
pr
es
s
i
on﴿

k. Microphone or classroom audio
s
ounds
ys
t
em ﴾
f
orex
ampl
e,
TopCa
t
,
Redc
a
t
﴿

D4.

In an average week, how many days a week is math homework assigned in this math class? Please
count homework assigned over the weekend as one day. MARK ONE RESPONSE.
SKI
PTO Q D6﴿
0 days ﴾
1 day
2 days
3 days
4 days
5 days

Draft

D5.

On days when homework is assigned, how much time do you expect children in this class to spend
on homework in math? MARK ONE RESPONSE.
1 to 10 minutes
11 to 20 minutes
21 to 30 minutes
More than 30 minutes

D6.

In this class, how often do you use a formal assessment in MATH for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

Please answer the following question about the school's practices regarding math.
D7.

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,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
el
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
math in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
i
nt
er
v
ent
i
onf
our
t
h‐
gr
ade
students will receive in math.
c. This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a math intervention.

Agree

Strongly
agree

Don't
know

Draft

SECTION E. STAFF ACTIVITIES
E1.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No ﴾
SKI
PTO Q E3﴿
* Professional development may include continuing formal education; courses, conferences,
wor
k
s
hops
,
ori
n‐
s
er
v
i
c
et
r
ai
ni
ng;
s
t
af
fmeet
i
ngst
hati
nc
l
udes
t
af
fdev
el
opmentac
t
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

Once

2 times

3 to 4
times

More
than 4
times

a. How to use assessment data to identify
students who are struggling or at risk of
b.
failure in MATH
b. How to use and apply assessment data
to guide MATH instruction
c.

E3.

How to implement the MATH
curriculum

A school or district staff member who supports
teachers in collecting, organizing, and managing
assessment data
data
d. A
school or district staff member who supports
teachers in the interpretation and use of assessment
data to guide instruction

No, support
not received
but
available

Resource
not
available

Draft

E4.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

Spring 2015
Science
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 voluntary survey is
1850‐
XXXX.Appr
ov
alex
pi
r
esXX/
XX/
XXXX.Thet
i
mer
equi
r
edt
oc
ompl
et
et
hi
s
survey is estimated to average 12 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed,
and complete and review the survey. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this survey, or
any comments or concerns regarding the status of your individual submission
of this survey, please write to: Early Childhood Longitudinal Study, National
Cent
erf
orEduc
at
i
onSt
at
i
s
t
i
c
s
,1990KSt
r
eet
,N.
W.
,Was
hi
ngt
on,D.
C.20006‐
5574.

The collection of information in this survey is authorized by 20 U.S.
Code, Section 9543. Participation is voluntary. You may skip questions
you do not wish to answer; however, we hope that you will answer as
many questions as you can. Your responses are protected from
di
s
c
l
os
ur
e by f
eder
als
t
at
ut
e﴾
20 U.
S.Code, Sec
t
i
on 9573﴿
. Al
l
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,
Thi
s
quest
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
st
udy
of
chi
l
dr
en’
s
ear
l
y
educat
i
onal
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach science to one or more of the children who are participants in this
study.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K: 2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
c
hi
l
dr
en’
s
academi
c
pr
ogr
ess
and
v
ar
i
ous
s
chool
,
cl
as
sr
oom,
t
eacher
,
and
home
c
har
ac
t
er
i
st
i
cs.
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)
.
I
nf
or
mat
i
on
f
r
om
mul
t
i
pl
e
i
ndi
vi
dual
s
wi
l
l
be
c
ombi
ned
t
o
pr
oduce
st
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.
This questionnaire has two parts:
 Part 1 should be completed for the child whose name is on the cover of this questionnaire.

Par
t
2
has
quest
i
ons
about
y
our
sci
ence
cl
as
s
–
y
ou
onl
y
need
t
o
f
i
l
l
out
Par
t
2
i
f
t
her
e
i
s
a
red
dot
next
t
o
t
he
chi
l
d’
s
name
on
t
he
cover
of
t
he
ques
t
i
onnai
r
e.
The instructions preceding each part of the questionnaire will guide you.
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.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

PART 1:
Please answer the questions in Part 1 about the child identified on the
cover of this questionnaire.

Draft

SECTION A. STUDENT INFORMATION
Please answer the following questions about the child identified on the cover of this questionnaire.
A1.

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

A2.

How long has this child been in your science class 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

A3.

Please indicate the total number of times this child has been absent from your science class during
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

A4.

Is English this child's native language? MARK ONE RESPONSE.
SKI
PTO Q A6﴿
Yes ﴾
No
Don't know

Draft

A5.

During this school year, how often is this child's science 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

A6.

Overall, how would you rate this child's academic skills in SCIENCE, based on curriculum standards
for his/her current grade level? MARK ONE RESPONSE.
Below grade level
About on grade level
Above grade level

A7.

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

If there is a red dot next to the child's name on the cover of this questionnaire, please
continue with Part 2.
If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

Draft

SECTION B. SCIENCE INSTRUCTION

Please answer the following questions for the science class in which the child identified on the cover of this
questionnaire receives science instruction.
B1.

From the first day of school until today, please indicate on how many days you have covered each of
the following SCIENCE skills and concepts in this child's class. Please include the time during which
you provide direct instruction as well as the time you spend supervising students as they work.
Please focus on the skill areas that are shown in bold text.﴾
Theunbol
dedexampl
esar
eonl
yas
ampl
e
oft
hi
ngsyoumaydoorc
overundert
hi
ss
ki
l
lar
ea.
﴿MARK ONE RESPONSE ON EACH ROW.

Fields of Science

Not yet
taught
or not
taught
in this
grade

a. Physical science, for example, understanding
electricity, magnetism, energy, waves, chemistry,
etc.
b. Life science, for example, learning about
organisms, life cycles, food chains,
ecosystems, etc.
c. Earth science, for example, learning about
rocks and minerals, weather, erosion, water,
volcanoes, earthquakes, etc.

Scientific Method
d. Observations and hypotheses, for example,
understanding the difference between
observations and inferences, formulating
predictions that can be tested, etc.
e. Scientific testing, for example, planning and
conducting investigations, measuring using
appropriate tools, demonstrating safe behavior, etc.
f. Analysis and conclusions, for example,
analyzing the results of a scientific
investigation and determining whether the
results support the initial prediction, etc.

Science, Engineering and Technology
g. Interdependence of science, technology and
engineering, for example, exploring how
scientific discoveries lead to the development
of new technologies, new technologies lead to
new scientific discoveries, etc.
h. Engineering concepts, for example, identifying
a simple design problem that can be solved
through the development of an object, tool,
process, or system; etc.

On
1‐
10
days

On
11‐
20
days

On
21‐
40
days

On more
On
41‐
80 than 80
days
days

Draft

B2.

How often do the children in this class engage in the following science activities? MARK ONE
RESPONSE ON EACH ROW.
Almost
every
day
a. Read a science textbook
b. Discuss science in the news
c. Generate and test hypotheses
d. Work with other children on a science activity or
project
e. Us
es
c
i
enc
eequi
pment﴾
e.
g.
,
magni
f
y
i
nggl
a
s
s
,
s
c
al
es
,
t
her
momet
er
s
﴿
f.

Prepare a written science report

g. E
ngagei
nhands
‐
onac
t
i
v
i
t
i
esori
nv
es
t
i
gat
i
ons
in science
h. Talk about measurements and results from
c
hi
l
dr
en’
shands
‐
onac
t
i
v
i
t
i
es
i.

Take a science test or quiz

Use library resources for science

k. Use computers for science
l.

Use the Internet for science

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never

Draft

SECTION C. CLASSROOM AND STUDENT CHARACTERISTICS
Please answer the following questions for the science class in which the child identified on the cover of
this questionnaire receives science instruction.
C1.

C2.

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade or lower
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher

C3.

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

Draft

C4.

How many children in this 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?

C5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,
WRITE "0."
Number of children absent on an average day

C6.

How many children in this class are below grade level, about on grade level, or above grade level
in science?
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of children below grade level
Number of children about on grade level
Number of children above grade level

C7.

Draft

C8.

Approximately what percentage of the students in this class demonstrate the following problems?
MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
b.L
a
c
ks
el
f
‐
c
ont
r
ol﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
c. Are rejected by peers
d. Do not accept authority
Sour
c
e:Abr
y
,T.
,Swans
on,J
.
,andF
abes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

C9.

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

C11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of ELL children

Draft

SECTION D. CLASSROOM INSTRUCTION AND EVALUATION
Please answer the following questions for the science class in which the child identified on the cover of this
questionnaire receives science instruction.
D1.

In a typical day, how much time do children in this science class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.
No
time

1‐
15
minutes

16‐
30
minutes

31‐
45
minutes

Longer
than 45
minutes

a. Working independently
b. Working on individual tasks under
teacher direction
c.

Working with peers under teacher
direction

d. Working in small groups with
teacher
e. Teacher lecture with large group
and/or large group discussion led
by teacher

D2.

Do any of the following staff members provide direct instruction to students in this science class
who are struggling or at risk of failure in science? INCLUDE STAFF OTHER THAN YOURSELF WHO
PROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
OUTS
E
TTI
NG.E
XCL
UDE
PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes
a. A SCIENCE specialist/interventionist who has specialized
training in science instruction
b. A special education teacher

Draft

D3.

In this class, how frequently do you or your students use computers or the following electronic
devices for instructional purposes in science? Please include any desktop, laptop, or other
c
omput
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
Not
available

Never

Rarely

Sometimes

Often

udentr
es
pons
es
y
s
t
em ﴾
f
or
St
example, clickers, responders,
Ac
t
i
Vot
e,Ac
t
i
v
Ex
pr
es
s
i
on﴿

k. Microphone or classroom audio
s
ounds
y
s
t
em ﴾
f
orex
ampl
e,
TopCat
,
Redc
a
t
﴿

D4.

In an average week, how many days a week is science homework assigned in this class? Please
count homework assigned over the weekend as one day. MARK ONE RESPONSE.
0 days ﴾
SKI
PTO Q D6﴿
1 day
2 days
3 days
4 days
5 days

Draft

D5.

On days when homework is assigned, how much time do you expect children in this class to spend
on homework in science? MARK ONE RESPONSE.
1 to 10 minutes
11 to 20 minutes
21 to 30 minutes
More than 30 minutes

D6.

In this class, how often do you use a formal assessment in SCIENCE for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

Please answer the following question about the school's practices regarding science.
D7.

For each of the following statements about SCIENCE 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,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
el
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
science in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
i
nt
er
v
ent
i
onf
our
t
h‐
gr
ade
students will receive in science.
c. This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a science intervention.

Agree

Strongly
agree

Don't
know

Draft

SECTION E. STAFF ACTIVITIES
E1.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No ﴾
SKI
PTO QE3﴿
* Professional development may include continuing formal education; courses, conferences,
wor
k
s
hops
,
ori
n‐
s
er
v
i
c
et
r
ai
ni
ng;
s
t
a
f
fmeet
i
ngst
hati
nc
l
udes
t
af
fdev
el
opmenta
c
t
i
v
i
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

Once

2 times

3 to 4
times

More
than 4
times

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

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

No, support
not received
but
available

Resource
not
available

Draft

E4.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Draft

For Office Use Only
Comp
Ref

Draft

File Type	application/pdf
File Modified	2014-08-26
File Created	2014-07-01