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

Appendix F ECLS-K2011 Spring 4th Grade School Administrator Questionnaires

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⚠️ Notice: This form may be outdated.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 F
FOURTH-GRADE
SCHOOL ADMINISTRATOR QUESTIONNAIRES

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
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.

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

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 60 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 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. The Early Childhood Longitudinal Study,
Ki
nder
gar
t
enCl
as
sof2010‐
2011﴾
ECLS‐
K:
2011﴿is collecting information from schools attended by children
who are in the study to investigate the relationship between children's academic progress and various school,
classroom, teacher, and child characteristics. 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
﴿Sc
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i
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ami
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ommuni
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c
﴿Sc
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esandpr
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d﴿Sc
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ogr
amsf
orpa
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a
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at
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e﴿F
eder
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ams
:
Ti
t
l
eI
,Adequat
eYea
r
l
yPr
ogr
es
s﴾
AYP﴿
,
andTi
t
l
eI
I
I
﴿
f Staffing and teacher characteristics
g﴿Sc
hooladmi
ni
s
t
r
at
orc
ha
r
ac
t
er
i
s
t
i
c
s
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
pr
ot
ec
t
edf
r
om di
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os
ur
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ot
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or
m Ac
tof2002,
20U.
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§9573﴿
.I
nf
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om mul
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epor
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s
;
noi
nf
or
mat
i
on
that identifies you will be included in any reports or provided to students, their parents, or other school staff.
Pl
eas
er
ec
or
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ourans
wer
sdi
r
ec
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yont
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onna
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t
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mat
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ept
abl
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answers.

DEFINITIONS
For the purposes of this study, the following definitions apply:
 Kindergarten:
Tr
adi
t
i
onaly
earofs
c
hoolpr
i
ma
r
i
l
yf
or5‐
y
ear
‐
ol
dspr
i
ort
of
i
r
s
tgr
ade.
 Tr
ans
i
t
i
onal﴾
orr
eadi
nes
s
﴿k
i
nder
gar
t
en:
E
x
t
r
ay
earofs
c
hoolf
ork
i
nder
gar
t
en‐
a
geel
i
gi
bl
ec
hi
l
dr
enwho
are judged not ready for kindergarten.
 Tr
ans
i
t
i
onalf
i
r
s
t﴾
orpr
ef
i
r
s
t
﴿gr
a
de: 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
bygr
ade﴾
s
﴿
.

Draft

Special programs. Reference is made in this questionnaire to Title I and Title III programs, individualized
educ
a
t
i
onpr
ogr
ams﴾
I
E
P﴿
,
Sec
t
i
on504pl
ans
,
andRes
pons
et
oI
nt
er
v
ent
i
on﴾
Rt
I
﴿
.
F
ort
hi
ss
t
udy
,
t
hef
ol
l
owi
ng
definitions apply:
 Title I: "Improving the Academic Achievement of the Disadvantaged." Title I is a program of the
El
ement
ar
yandSec
onda
r
yEduc
a
t
i
onAc
t﴾
ESEA﴿of1965,
asr
ea
ut
hor
i
z
edundert
heNoChi
l
dL
ef
t
Behind Act of 2001. The purpose of this program is to ensure that all children have a fair, equal, and
s
i
gni
f
i
c
antoppor
t
uni
t
yt
oobt
ai
nahi
gh‐
qual
i
t
yeduc
a
t
i
onandr
eac
h,
atami
ni
mum,
pr
of
i
c
i
enc
yon
state academic achievement standards and state academic assessments.
 Title III: "Language Instruction for Limited English Proficient and Immigrant Students." Title III is a
pr
ogr
am oft
heEl
ement
a
r
yandSec
ondar
yE
duc
at
i
onAc
t﴾
ESEA﴿of1965,
asr
ea
ut
hor
i
z
edundert
he
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.
 I
ndi
v
i
dual
i
z
edE
duc
at
i
onPr
ogr
am ﴾
I
EP﴿
: A written statement of the educational program designed to
meett
hei
ndi
v
i
dualneedsofas
c
hool
‐
agedc
hi
l
dwi
t
hadi
s
abi
l
i
t
yt
hati
sj
udgedt
oa
f
f
ec
tt
hec
hi
l
d'
s
educational performance. Children who receive special education services under the Individuals with
Di
s
abi
l
i
t
i
esEduc
at
i
onAc
t﴾
I
DE
A﴿ar
eex
pec
t
edt
ohav
eanI
EP.
 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.
 Res
pons
et
oI
nt
er
v
ent
i
on﴾
Rt
I
﴿
:
Amul
t
i
‐
s
t
epappr
oac
ht
opr
ov
i
di
ngear
l
yandpr
ogr
es
s
i
v
el
yi
nt
ens
i
v
e
intervention and monitoring within the general education setting. In principle, RtI begins with
r
es
ea
r
c
h‐
bas
edi
ns
t
r
uc
t
i
onandbeha
v
i
or
als
uppor
tpr
ov
i
dedt
os
t
udent
si
nt
hegener
aleduc
at
i
on
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. Ref
er
enc
ei
smadet
oE
ngl
i
s
hl
anguagel
ear
ner
s﴾
E
L
L
﴿
,
a
swel
last
oi
ns
t
r
uc
t
i
ona
lpr
ogr
a
msf
orEL
L
students in this questionnaire. For this study, the following definitions apply:
:
As
t
udenti
nwhos
ehomeanon‐
E
ngl
i
s
hl
a
nguaget
y
pi
c
al
l
yi
ss
pok
en.
 L
a
nguage‐
mi
nor
i
t
y﴾
L
M﴿s
t
udent
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.
 Engl
i
s
hl
a
ngua
gel
ear
ner﴾
EL
L
﴿
: 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.

Draft

SECTION A. SCHOOL CHARACTERISTICS
A1.

How many instructional days will this school provide during this academic year? WRITE IN NUMBER
BE
L
OW.I
FTHI
SI
SAYE
AR‐
ROUNDS
CHOOL
,
PL
E
AS
EPROVI
DETHENUMBE
ROFI
NS
TRUCTI
ONALDAYSA
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 SINCE OCTOBER 1, WRITE
"0" ON THE APPLICABLE LINE.
Number of
children
a. Total enrollment in fourth grade in your school around October 1, 2014,
or the date nearest to that for which data are available
b. Tot
alenr
ol
l
menti
ny
ours
c
hool﴾
ac
r
os
sal
lgr
ades
﴿ar
oundOc
t
ober1,
2014,
or the date nearest to that for which data are available
c. Number of children who have enrolled in your school since October 1, 2014
d. Number of children who have left your school since October 1, 2014, 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,
OR

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

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

Tr
ans
i
t
i
onal﴾
orr
eadi
nes
s
﴿k
i
nder
gar
t
en

3rd

9th

Kindergarten

4th

10th

Tr
ans
i
t
i
onalf
i
r
s
t﴾
orpr
ef
i
r
s
t
﴿gr
ade

5th

11th

6th

12th

Which of the following characterizes your school? MARK ALL THAT APPLY.
Regul
arpubl
i
cs
c
hool﴾
noti
nc
l
udi
ngmagnets
c
hool
﴿
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
E
ar
l
yChi
l
dhoodCent
er﴾
s
c
hool
/
c
ent
eri
nc
l
udespr
es
c
hooland/
orear
l
ygr
ades
﴿
Spec
i
aleduc
at
i
ons
c
hool–pr
i
mar
i
l
ys
er
v
esc
hi
l
dr
enwi
t
hdi
s
abi
l
i
t
i
es
Year
‐
r
ounds
c
hool
Bur
ea
uofI
ndi
anEduc
at
i
on﴾
BI
E﴿ort
r
i
bals
c
hool

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
of children

Percent

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. Tot
als
c
hoolenr
ol
l
ment﴾
s
um ofat
hr
oughg﴿
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

Don't know

a
.Theyhav
es
pec
i
a
lneeds﴾
gi
f
t
eda
ndt
al
ent
ed,
c
hi
l
dr
enwi
t
h
di
s
a
bi
l
i
t
i
es
,
et
c
.
﴿andat
t
endt
or
ec
ei
v
eas
pec
i
al
i
z
edpr
ogr
a
m or
service?

b. They transferred into the school because their previous school
di
dnotmak
eadequa
t
eyear
l
ypr
ogr
es
s﴾
AYP﴿
?﴾
Adequat
ey
ea
r
l
y
progress is your state's measure of yearly progress toward
a
c
hi
ev
i
ngs
t
at
eac
ademi
cs
t
andar
ds
.
﴿

c. They attend this school under public school choice for reasons
ot
hert
hant
hei
ra
s
s
i
gneds
c
hooldi
dnotma
k
eAYP﴾
t
hati
s
,
ex
c
l
udi
ngt
hos
ewhoar
er
epor
t
edi
nb﴿
?

A11. Aboutwhatper
c
ent
ageoft
hec
hi
l
dr
enenr
ol
l
edi
nt
hi
ss
c
hoolar
eel
i
gi
bl
ef
orf
r
eeorr
educ
ed‐
price lunch? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

Draft

SECTI
ON B.SCHOOL‐
FAMI
LY‐
COMMUNI
TYCONNECTI
ONS
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,
orPar
ent
‐
Teac
her
‐
St
udent
organization meetings
b. Repor
t
s﴾
r
epor
tc
ar
ds
﴿ofc
hi
l
d'
s
performance provided to parents
c. Information on the child's standardized
assessment scores provided to parents
d. Tea
c
her
‐
par
entc
onf
er
enc
es
e. School performances to which parents
are invited
f.

B2.

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

During this school year, how often has your school used the following ways to communicate with
all parents? MARK ONE RESPONSE ON EACH ROW.
More
than
once a
week
a. Electronic communication to all parents,
such as group emails, electronic
newsletters, website postings,
"
r
oboc
al
l
s
"﴾
ma
s
sa
ut
oma
t
edphone
c
al
l
s
﴿
,
t
ex
tal
er
t
s
,
orot
herel
ec
t
r
oni
c
notices for all parents
b. Non‐
el
ec
t
r
oni
cc
ommuni
c
at
i
ont
oal
l
parents, such as letters, newsletters,
phonec
al
l
s
,
orot
hernon‐
el
ec
t
r
oni
c
messages for all parents

Once a
week

Several
times a
month

Once a
month

Less than
once a
month
or never

Draft

B3.

During this school year, has your school used an online tool or website that is available to the
general public and that parents can access without a login or password? MARK ONE RESPONSE.
Yes
No

B4.

Dur
i
ngt
hi
ss
c
hoolyear
,hasyours
c
hool﴾
oranyt
eac
her
﴿us
edanonl
i
net
oolorwebs
i
t
et
hatpar
ent
s
can only access with a login and password to get information about their child, the child's class, or
the school? MARK ONE RESPONSE.
Yes
SKI
PTO Q B6﴿
No ﴾

B5.

Have the following types of information been provided in the online tool or website that parents
can only access with a login and password? MARK YES OR NO ON EACH ROW.
Yes

a. Cl
as
s
r
oom‐
s
pec
i
f
i
cas
s
i
gnment
s
,
i
nc
l
udi
nghomewor
k
b. Chi
l
d‐orpa
r
ent
‐
s
pec
i
f
i
ci
nf
or
mat
i
on,s
uc
haspr
ogr
es
sr
epor
t
s
between grading periods

B6.

How much of a problem are the following in the neighborhood where this school is located? MARK
ONE RESPONSE ON EACH ROW.
Big
problem
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

Somewhat of
a problem

No
problem

Don't
know

Draft

B7.

Never
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.

B8.

Class cutting

Does your school take any of the following measures to ensure the safety of children? MARK YES
OR NO ON EACH ROW.
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. Ot
her﴾
PL
EASESPECI
F
Y﴿

Draft

B9.

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.

B10.

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
orr
educ
ed‐
pr
i
c
el
unc
hi
nc
r
ea
s
ed
e. St
udentmobi
l
i
t
yi
nc
r
ea
s
ed﴾
t
hati
s
,
t
he
number of students transferring in and
outoft
hes
c
hooli
nc
r
eas
ed﴿
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

B11.

During the past year, were salaries frozen at your school? MARK ONE RESPONSE.
Yes
No

IF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO Q C1.
IF YOUR SCHOOL IS NOT A PRIVATE, MAGNET, OR CHARTER SCHOOL, GO TO Q B12.

B12.

During the past year, were changes made to your school's assigned attendance area? MARK ONE
RESPONSE.
Yes
No

Draft

SECTION C. SCHOOL POLICIES AND PRACTICES
C1.

How manyt
hi
r
d‐
gr
adec
hi
l
dr
enwere retained at their current grade level last school year? WRITE
NUMBE
RBE
L
OW.I
FNONE,
WRI
TE"
0.
"I
FYOURS
CHOOLDOE
SNOTHAVETHI
RD‐
GRADES
TUDE
NTS
,
MARK
THE "NOT APPLICABLE" BOX.
Numberoft
hi
r
d‐
gr
adec
hi
l
dr
enretained last year

C2.

How manyf
our
t
h‐
gr
adec
hi
l
dr
enwere retained at their current grade level last school year? WRITE
NUMBE
RBE
L
OW.I
FNONE,
WRI
TE"
0.
"I
FYOURS
CHOOLDOE
SNOTHAVEF
OURTH‐
GRADES
TUDE
NTS
,
MARK
THE "NOT APPLICABLE" BOX.
Numberoff
our
t
h‐
gr
adec
hi
l
dr
enretained last year

C3.

Not applicable

I
sas
c
hool
‐
wi
depos
i
t
i
vebehavi
or
ali
nt
er
vent
i
onands
uppor
tpr
ogr
am ﴾
f
orexampl
e,Pos
i
t
i
veBehavi
or
al
Suppor
t
,Pos
i
t
i
veBehavi
or
alI
nt
er
vent
i
onSys
t
em﴿i
mpl
ement
edatyours
c
hool
?MARK ONE RESPONSE.
Yes
No

C4.

For each of the following statements about READING and MATH, indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
Strongly Don't
disagree
Disagree
disagree
Agree
agree
know
For READING
a. This school has a set of clear,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
elbenc
hmar
k
s
﴾
t
hati
s
,
c
uts
c
or
es
,
goal
s
/
t
a
r
get
s
,
or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
odet
er
mi
ne
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,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
elbenc
hmar
k
s
﴾
t
hati
s
,
c
uts
c
or
es
,
goal
s
/
t
a
r
get
s
,
or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
odet
er
mi
ne
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.

Draft

C5.

I
sRes
pons
et
oI
nt
er
vent
i
on﴾
Rt
I
﴿c
ur
r
ent
l
yus
edatyours
c
hooli
nf
our
t
hgr
ade, either partially or
fully implemented? MARK ONE RESPONSE.
RE
S
PONS
ETOI
NTE
RVE
NTI
ON(
RTI
)I
SAMUL
TI
‐
S
TEPAPPROACHTO PROVI
DI
NGE
ARL
YAND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION
SETTING. SEE PAGE 4 FOR A COMPLETE DEFINITION OF RTI.
Yes
No ﴾
SKI
PTO Q C9﴿

C6.

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

Yes, partially
implemented
in fourth grade

No, not
implemented
in fourth grade

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

C7.

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

C8.

Fort
he2014‐
2015s
c
hoolyear
,how hasyours
c
hoolmadei
nf
or
mat
i
onavai
l
abl
et
opar
ent
s
/
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

C9.

Hasyours
c
hooli
mpl
ement
edt
heCommonCor
eSt
at
eSt
andar
dsatanygr
ade﴾
s
﴿
?MARK ONE
RESPONSE.
Yes
No ﴾
SKI
PTO QD1﴿

C10.

Are the Common Core State Standards currently implemented at your school in fourth grade in the
following areas? MARK ONE RESPONSE ON EACH ROW.
Yes, fully
implemented
in fourth grade

Yes, partially
implemented
in fourth grade

No, not
implemented
in fourth grade

a. Reading and Language Arts
b. Mathematics

C11.

Approximately how many years ago did your school begin implementing the Common Core
State Standards in any grade or subject? MARK ONE RESPONSE.
Less than 1 year ago
1 to 2 years ago
More than 2 years ago

Draft

SECTION D. SCHOOL PROGRAMS FOR PARTICULAR POPULATIONS
L
anguage‐
Mi
nor
i
t
ySt
udent
sandFami
l
i
es
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 ﴾
SKI
PTO QD5﴿

PLEASE NOTE THE FOLLOWING DEFINITION
THAT IS RELEVANT TO QUESTIONS D2 & D3 BELOW:
Engl
i
s
hl
anguagel
ear
ner
s﴾
ELL﴿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.

D2.

Whatper
c
ent
ageofc
hi
l
dr
eni
nt
hi
ss
c
hoolar
eEngl
i
s
hl
anguagel
ear
ner
s﴾
ELL﴿
?WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

D3.

What percentage of children in fourth grade are English language learners? WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

D4.

ELL among all students in school

ELL among all students in fourth grade

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
t
hepar
ent
s
'non‐
Engl
i
s
hl
anguage.
b. Translations of written communications are provided to these
families.
c. Home visits are made to families of these children.

Draft

Children with Special Needs
D5.

Si
nc
et
hebegi
nni
ngoft
hi
ss
c
hoolyear﴾
2014‐
2015﴿
,how manys
t
udent
shavebeenNEWLY
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

D6.

Oft
hos
es
t
udent
swhohavebeenNEWLYeval
uat
edatyours
c
hoolt
hi
ss
choolyear﴾
2014‐2015﴿
,
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

D7.

Whatmet
hod﴾
s
﴿ar
eus
edi
nyours
c
hoolt
odet
er
mi
nes
pec
i
aleduc
at
i
onELI
GI
BI
LI
TYf
ors
t
udent
s
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.
RE
S
PONS
ETOI
NTE
RVE
NTI
ON(
RTI
)I
SAMUL
TI
‐
S
TEPAPPROACHTO PROVI
DI
NGE
ARL
YAND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION
SETTING. SEE PAGE 4 FOR A MORE COMPLETE DEFINITION OF RTI.
Yes
a. I
Q‐
ac
hi
ev
ementdi
s
c
r
epa
nc
ymodelwhi
c
hs
howswhet
hert
her
e
is a discrepancy between expected performance and actual
performance
b. Res
pons
et
oI
nt
er
v
ent
i
on﴾
Rt
I
﴿model

Draft

D8.

Appr
oxi
mat
el
ywhatper
c
ent
ageofyourf
our
t
h‐
gr
ader
sare in each of the following instructional
programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND INDICATE IF THE PROGRAM IS
NOT OFFERED IN FOURTH GRADE OR IN ANY GRADE IN YOUR SCHOOL.
Not offered
in fourth grade

Percent

D9.

a. Special education with an Individualized
E
duc
a
t
i
onPr
ogr
a
m﴾
I
E
P﴿

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

Wher
ear
ec
hi
l
dr
enwi
t
hI
ndi
vi
dual
i
z
edEduc
at
i
onPr
ogr
ams﴾
I
EPs
﴿t
ypi
c
al
l
ys
er
vedi
nt
hi
ss
c
hool
?
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 E. FEDERAL PROGRAMS: TITLE I, ADEQUATE YEARLY PROGRESS, AND TITLE III

The following items pertain to public schools only.
SKI
PTO Q F1﴿
IF YOURS IS A PRIVATE SCHOOL CHECK HERE. ﴾

E1.

Did your school receive Federal Title I funds for this school year? MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO 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
a
c
a
demi
cs
er
v
i
c
es﴾
us
ual
l
yi
nr
eadi
ngand/
ormat
h﴿t
os
pec
i
f
i
cs
t
udent
s
,
s
omet
i
mes
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
s
c
hool
wi
depr
ogr
a
mi
fa
tl
eas
t40per
c
entofi
t
ss
t
udent
sar
ef
r
om l
ow‐
i
nc
ome
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

E3.

Di
dyours
c
hoolr
ec
ei
veFeder
alTi
t
l
eI
I
If
undsf
ort
hi
ss
c
hoolyear
?﴾
Ti
t
l
eI
I
Ii
s"L
anguageI
ns
t
r
uc
t
i
on
f
orLi
mi
t
edEngl
i
s
hPr
of
i
c
i
entandI
mmi
gr
antSt
udent
s
.
"﴿MARK ONE RESPONSE.
Yes
No

Ti
t
l
eIandTi
t
l
eI
I
Iandt
hei
rac
c
ompany
i
ngr
equi
r
ement
sar
epr
ogr
amsoft
heEl
ement
ar
yandSec
ondar
yEduc
at
i
onAc
tof1965﴾
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

Federal Requirements
E4.

Att
heendoft
heLASTs
c
hoolyear﴾
2013‐
2014﴿
,di
dt
hi
ss
c
hoolmakeAdequat
eYear
l
yPr
ogr
es
s
﴾
AYP﴿
?﴾
Adequat
eYear
l
yPr
ogr
es
si
syours
t
at
e'
smeas
ur
eofyear
l
ypr
ogr
es
st
owar
dac
hi
evi
ng
s
t
at
eac
ademi
cs
t
andar
ds
.
﴿MARK ONE RESPONSE.
Yes ﴾
SKI
PTO Q F1﴿
No
Not applicable ﴾
SKI
PTO Q F1﴿

E5.

Att
heendoft
heLASTs
c
hoolyear﴾
2013‐
2014﴿
,wast
hi
ss
c
hooli
dent
i
f
i
edf
ori
mpr
ovementduet
o
Adequat
eYear
l
yPr
ogr
es
s﴾
AYP﴿r
equi
r
ement
s
?﴾
As
c
hooli
si
dent
i
f
i
edf
ori
mpr
ovementi
fi
tdoes
notmakeAdequat
eYear
l
yPr
ogr
es
sf
ort
woc
ons
ec
ut
i
veyear
sormor
ei
nt
hes
amec
ont
entar
ea.
﴿
MARK ONE RESPONSE.
Yes
No

Draft

SECTION F. STAFFING AND TEACHER CHARACTERISTICS
F1.

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 IN ONLY ONE STAFF CATEGORY; IF A STAFF MEMBER FITS 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."
﴾
1﴿
Number who
work full time in
your school
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
pr
ov
i
der
s﴾
f
orex
ampl
e,
s
peec
ht
her
api
s
t
,
phy
s
i
c
al
t
her
api
s
t
,
adapt
i
v
ephy
s
i
c
aleduc
a
t
i
on,
et
c
.
﴿
f.

Par
a
pr
of
es
s
i
onal
s﴾
f
orex
a
mpl
e,
c
l
as
s
r
oom ai
des
﴿

﴾
2﴿
Number who
work part time
in your school

Draft

F2.

Doesyours
c
hoolc
ur
r
ent
l
yhaveanys
t
af
fmember
s﴾
f
ul
l
‐orpar
t
‐
t
i
me﴿i
nt
hef
ol
l
owi
ng
categories? MARKYE
SORNO ONE
ACHROW.I
NCL
UDETHOSEWHO AREF
UL
L
‐ORPART‐
TI
MES
TAF
F
MEMBERS AT YOUR SCHOOL.
Yes
No
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

F3.

Does your school currently have any staff members who do the following as their primary role or
one of their primary roles? MARKYE
SORNOONEACHROW.I
NCL
UDETHOSEWHO AREF
UL
L
‐OR
PART‐
TI
MES
TAF
FME
MBE
RSATYOURS
CHOOL
.
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

F4.

Please indicate the number of regular classroom teachers who have joined or left your school
since October 1, 2014. WRITE IN THE APPROXIMATE NUMBERS FOR EACH OF THE FOLLOWING. IF
NO TEACHERS HAVE LEFT OR STARTED AT YOUR SCHOOL SINCE OCTOBER 1, 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, 2014
b. Number of regular classroom teachers who have left your school since
October 1, 2014, and have not returned

Draft

F5.

Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary
s
c
hedul
eus
edi
nyours
c
hoolt
or
ewar
dt
eacher
sf
or
… MARK YES OR NO ON EACH ROW.
Yes

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

F6.

Di
dt
hi
ss
c
hool
'
spr
i
nc
i
pal﴾
orheadadmi
ni
s
t
r
at
or
﴿c
ompl
et
et
hemaj
or
i
t
yoft
hepr
evi
ouss
ec
t
i
ons
or was the majority completed by someone else? MARK ONE RESPONSE.
SKI
PTO Q G1﴿
Principal ﴾
Someone else

F7.

I
faper
s
onot
hert
hant
hes
c
hool
'
spr
i
nc
i
pal﴾
orheadadmi
ni
s
t
r
at
or
﴿hasc
ompl
et
edt
hepr
evi
ous
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

F8.

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

YE
AR﴾
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 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.

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.

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

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

a. Tr
adi
t
i
onaluni
v
er
s
i
t
y
‐
bas
edt
r
a
i
ni
ngandc
er
t
i
f
i
c
at
i
onpr
ogr
am
b. Di
s
t
r
i
c
t
‐
bas
edt
r
ai
ni
ngpr
ogr
a
m﴾
f
orex
ampl
e,
t
heBos
t
onPr
i
nc
i
pal
Fellowship, New York City Leadership Academy's Aspiring Principals
Pr
ogr
am,
Chi
c
ago'
sL
AUNCHpr
ogr
am﴿
c. Ci
t
y
‐
bas
edt
r
ai
ni
ngpr
ogr
a
m﴾
f
orex
a
mpl
e,
Cl
ev
el
and'
sF
i
r
s
tRi
ng
L
eader
s
hi
pAc
a
demy
﴿
at
e‐
bas
edt
r
ai
ni
ngpr
ogr
am ﴾
f
orex
ampl
e,
NewJ
er
s
eyEXCEL
﴿
d. St
e. Tr
ai
ni
ngand/
orc
er
t
i
f
i
c
a
t
i
onpr
ogr
am r
unbyana
t
i
onalnon‐
pr
of
i
t
or
gani
z
at
i
on﴾
f
orex
ampl
e,
KI
PPSc
hoolL
eader
s
hi
pPr
ogr
am,
New
L
eader
sf
orNewSc
hool
s
﴿
f.

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
As
s
oc
i
a
t
e’
sdegr
ee
Ba
c
hel
or
’
sdegr
ee
Atl
eas
toney
earofc
our
s
ewor
kbey
ondaBa
c
hel
or
’
sdegr
eebutnotagr
a
duat
edegr
ee
Mas
t
er
’
sdegr
ee
Education specialist or professional diploma based on at least one year of coursework past a
Master's degree level
Doc
t
or
at
eoranadv
a
nc
edpr
of
es
s
i
onaldegr
eebey
ondaMas
t
er
'
sdegr
ee﴾
f
orex
ampl
e,
MD,
E
dD﴿

G8.

Whatwasyourmaj
orf
i
el
d﴾
s
﴿ofs
t
udyi
nt
hehi
ghes
tdegr
eeyouc
ompl
et
ed?MARK YES OR NO ON
EACH ROW.
Yes
No
a. Early childhood education
b. Elementary education
c. Education administration/management
d. Special education
e. Ot
hereduc
a
t
i
on‐
r
el
at
edmaj
or﴾
s
uc
hass
ec
ondar
y
education, educational psychology, science education,
mus
i
ceduc
at
i
on,
et
c
.
﴿
f.

Non‐
educ
a
t
i
onma
j
or﴾
s
uc
hashi
s
t
or
y
,
Engl
i
s
h,
et
c
.
﴿

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. Whatl
anguage﴾
s
﴿ot
hert
hanEngl
i
s
hdoyous
peakwi
t
hs
t
udent
satyours
c
hoolorwi
t
ht
hei
r
families? MARK ALL THAT APPLY.
Spanish
Vietnamese
A Chinese language
Japanese
Korean
A Filipino language
Arabic
Ot
her﴾
PL
EASESPECI
F
Y﴿

Draft

G14.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

Questionnaire completed by:

LAST NAME

FIRST NAME

THANK YOU FOR YOUR COOPERATION!

MIDDLE INITIAL

Draft

For Office Use Only
C‐NoDR

C‐DRComp

C‐DRRef

Ref

NEW

Draft

Spring 2015
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

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. The Early Childhood Longitudinal Study,
Ki
nder
gar
t
enCl
as
sof2010‐
2011﴾
ECLS‐
K:
2011﴿is collecting information from schools attended by children
who are in the study to investigate the relationship between children's academic progress and various school,
classroom, teacher, and child characteristics. 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
﴿Sc
hoolc
har
ac
t
er
i
s
t
i
c
s
b﴿Sc
hool
‐
f
ami
l
y
‐
c
ommuni
t
yc
onnec
t
i
ons
c
﴿Sc
hoolpol
i
c
i
esandpr
ac
t
i
c
es
d﴿Sc
hoolpr
ogr
amsf
orpa
r
t
i
c
ul
a
rpopul
at
i
ons
e﴿F
eder
alpr
ogr
ams
:
Ti
t
l
eIa
ndTi
t
l
eI
I
I
f ﴿Staffing and teacher characteristics
g﴿Sc
hooladmi
ni
s
t
r
at
orc
ha
r
ac
t
er
i
s
t
i
c
s
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
pr
ot
ec
t
edf
r
om di
s
c
l
os
ur
et
ot
hef
ul
l
es
tex
t
ental
l
owabl
ebyl
aw﴾
Educ
a
t
i
onSc
i
enc
esRef
or
m Ac
tof2002,
20U.
S.
C.
§9573﴿
.I
nf
or
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onf
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om mul
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ombi
nedt
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oduc
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t
a
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i
s
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i
c
alr
epor
t
s
;
noi
nf
or
mat
i
on
that identifies you will be included in any reports or provided to students, their parents, or other school staff.
Pl
eas
er
ec
or
dy
ourans
wer
sdi
r
ec
t
l
yont
heques
t
i
onna
i
r
ebyma
r
k
i
ngt
heappr
opr
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a
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r
uc
t
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onsonpage5﴿orbywr
i
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ourr
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esi
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hes
pa
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epr
ov
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ded.Yourbes
tes
t
i
mat
esar
eac
c
ept
abl
e
answers.

Draft

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

SECTION A. SCHOOL CHARACTERISTICS
A1.

A2.

A3.

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

X 100

Average Number Attending Daily

A4.

Aboutwhatper
c
ent
ageoft
hec
hi
l
dr
enenr
ol
l
edi
nt
hi
ss
c
hoolar
eel
i
gi
bl
ef
orf
r
eeorr
educ
ed‐
price lunch? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

Draft

SECTI
ON B.SCHOOL‐
FAMI
LY‐
COMMUNI
TYCONNECTI
ONS
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

B2.

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

Once a
week

Several
times a
month

Once a
month

Less than
once a
month
or never

Draft

B3.

During this school year, has your school used an online tool or website that is available to the
general public and that parents can access without a login or password? MARK ONE RESPONSE.
Yes
No

B4.

B5.

Have the following types of information been provided in the online tool or website that parents
can only access with a login and password? MARK YES OR NO ON EACH ROW.
Yes

a. Cl
as
s
r
oom‐
s
pec
i
f
i
cas
s
i
gnment
s
,
i
nc
l
udi
nghomewor
k
b. Chi
l
d‐orpa
r
ent
‐
s
pec
i
f
i
ci
nf
or
mat
i
on,s
uc
haspr
ogr
es
sr
epor
t
s
between grading periods

B6.

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
on
once a
once a
daily
week
month occasion
a. Children bringing weapons to school
b. Physical conflicts among students
c. Student bullying
d. Widespread disorder in classrooms

Never
happens

Draft

B7.

Does your school take any of the following measures to ensure the safety of children? MARK YES
OR NO ON EACH ROW.
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. Ot
her﴾
PL
EASESPECI
F
Y﴿

B8.

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

B9.

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
orr
educ
ed‐
pr
i
c
el
unc
hi
nc
r
ea
s
ed
c. There has been a reduction in staffing
d. Class sizes increased
e. Class sizes decreased
f.

Salaries increased

g. Salaries decreased

B10.

During the past year, were salaries frozen at your school? MARK ONE RESPONSE.
Yes
No

IF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO Q C1.
IF YOUR SCHOOL IS NOT A PRIVATE, MAGNET, OR CHARTER SCHOOL, GO TO Q B11.

B11.

During the past year, were changes made to your school's assigned attendance area? MARK ONE
RESPONSE.
Yes
No

Draft

SECTION C. SCHOOL POLICIES AND PRACTICES
C1.

C2.

C3.

Not applicable

I
sas
c
hool
‐
wi
depos
i
t
i
vebehavi
or
ali
nt
er
vent
i
onands
uppor
tpr
ogr
am ﴾
f
orexampl
e,Pos
i
t
i
ve
Behavi
or
alSuppor
t
,Pos
i
t
i
veBehavi
or
alI
nt
er
vent
i
onSys
t
em﴿i
mpl
ement
edatyours
c
hool
?MARK
ONE RESPONSE.
Yes
No

C4.

Draft

C5.

C6.

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

Yes, partially
implemented
in fourth grade

No, not
implemented
in fourth grade

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

C7.

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

C8.

Draft

C9.

Hasyours
c
hooli
mpl
ement
edt
heCommonCor
eSt
at
eSt
andar
dsatanygr
ade﴾
s
﴿
?MARK ONE
RESPONSE.
Yes
No ﴾
SKI
PTO QD1﴿

C10.

Are the Common Core State Standards currently implemented at your school in fourth grade in the
following areas? MARK ONE RESPONSE ON EACH ROW.
Yes, fully
implemented
in fourth grade

Yes, partially
implemented
in fourth grade

No, not
implemented
in fourth grade

a. Reading and Language Arts
b. Mathematics

C11.

Draft

SECTION D. SCHOOL PROGRAMS FOR PARTICULAR POPULATIONS
L
anguage‐
Mi
nor
i
t
ySt
udent
sandFami
l
i
es
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 ﴾
SKI
PTO QD4﴿

D2.

Whatper
c
ent
ageofc
hi
l
dr
eni
nt
hi
ss
c
hoolar
eEngl
i
s
hl
anguagel
ear
ner
s﴾
ELL﴿
?WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

D3.

ELL among all students in school

What percentage of children in fourth grade are English language learners? WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

ELL among all students in fourth grade

Draft

Children with Special Needs
D4.

D5.

Oft
hos
es
t
udent
swhohavebeenNEWLYeval
uat
edatyours
c
hoolt
hi
ss
c
hoolyear﴾
2014‐2015﴿
,
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

D6.

Whatmet
hod﴾
s
﴿ar
eus
edi
nyours
c
hoolt
odet
er
mi
nes
pec
i
aleduc
at
i
onELI
GI
BI
L
I
TYf
ors
t
udent
s
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.
RE
S
PONS
ETOI
NTE
RVE
NTI
ON(
RTI
)I
SAMUL
TI
‐
S
TEPAPPROACHTO PROVI
DI
NGE
ARL
YAND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION
SETTING. SEE PAGE 4 FOR A MORE COMPLETE DEFINITION OF RTI.
Yes

a. I
Q‐
ac
hi
ev
ementdi
s
c
r
epa
nc
ymodelwhi
c
hs
howswhet
hert
her
e
is a discrepancy between expected performance and actual
performance
pons
et
oI
nt
er
v
ent
i
on﴾
Rt
I
﴿model
b. Res

D7.

Percent
a. Special education with an Individualized
E
duc
a
t
i
onPr
ogr
a
m﴾
I
E
P﴿

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

%
15

Not offered
in any grade

Draft
1

SECTION E. FEDERAL PROGRAMS: TITLE I AND TITLE III
The following items pertain to public schools only.
SKI
PTOQF1﴿
IF YOURS IS A PRIVATE SCHOOL CHECK HERE. ﴾

E1.

Did your school receive Federal Title I funds for this school year? MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO Q E3﴿

E2.

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

E3.

Draft

SECTION F. STAFFING AND TEACHER CHARACTERISTICS
F1.

Par
a
pr
of
es
s
i
onal
s﴾
f
orex
a
mpl
e,
c
l
as
s
r
oom ai
des
﴿

﴾
2﴿
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
s
c
hedul
eus
edi
nyours
c
hoolt
or
ewar
dt
eacher
sf
or
… MARK YES OR NO ON EACH ROW.
Yes

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

F6.

F7.

LAST NAME

FIRST NAME

MIDDLE INITIAL

TITLE

F8.

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

YE
AR﴾
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

G8.

Non‐
educ
a
t
i
onma
j
or﴾
s
uc
hashi
s
t
or
y
,
Engl
i
s
h,
et
c
.
﴿

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.

Draft

G14.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

Questionnaire completed by:

LAST NAME

FIRST NAME

THANK YOU FOR YOUR COOPERATION!

MIDDLE INITIAL

Draft

For Office Use Only
C‐NoDR

C‐DRComp

C‐DRRef

Ref

RETURNING

Draft

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Author	nickey_z
File Modified	2014-06-19
File Created	2014-06-09