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Grade Links to Constructs

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File Type	application/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Title	Grade Links to Constructs
Author	Alberto Sorongon
Last Modified By	Calc
File Modified	2014-09-23
File Created	2026-08-25
Conversion State	complete

Extracted Text

Explanation
A

This file contains a listing of every question asked of study children, parents, reading, math, and science teachers,
special education teachers, and school administrators in the spring fourth grade data collection round (with the
exception of the direct assessment items). For each question, the question wording is provided, along with the
item source, the construct the item measures, and the specific research question in Part C of this OMB package for
which the item is intended to provide information.
Each worksheet in this file pertains to one instrument. The worksheet name notes the specific instrument, as well
as the appendix within the OMB package in which the full instrument can be found. Below is a list of the
worksheet name and a full description of the instrument to which the worksheet pertains.

2
3
4
5
6
7
8
9
10
11
12
13

Worksheet Name
App A Spring 4th Child Quex
App B Spring 4th Parent Interview
App C Spring 4th TQ
App D Spring 4th Reading TQC
App D Spring 4th Math TQC
App D Spring 4th Science TQC
App E Spring 4th SpEd A
App E Spring 4th SpEd B
App F Spring 4th School Adm A
App F Spring 4th School Adm B

Instrument
Spring Fourth-Grade Child Questionnaire, Appendix A
Spring Fourth-Grade Parent Interview, Appendix B
Spring Fourth-Grade Teacher Questionnaire, Appendix C
Spring Fourth-Grade Reading and Language Arts Teacher Questionanire, Appendix D
Spring Fourth-Grade Mathematics Teacher Questionnaire, Appendix D
Spring Fourth-Grade Science Teacher Questionnaire, Appendix D
Spring Fourth-Grade Special Education Teacher Questionnaire A, Appendix E
Spring Fourth-Grade Special Education Teacher Questionnaire B, Appendix E
Spring Fourth-Grade School Administrator Questionnaire A, Appendix F
Spring Fourth-Grade School Administrator Questionnaire B, Appendix F

Page 1 of 170

Spring Fourth-Grade Child Questionnaire, Appendix H
Section

Item #

Introduction

CLQ400

CLQ401

CLQ402

School Liking

CLQ403
CLQ405

CLQ410

CLQ415

CLQ420

CLQ425

Peer Relationships

CLQ430

CLQ435,
450, 470

CLQ440

CLQ445

CLQ455

CLQ460

CLQ465

CLQ475

CLQ480

CLQ485

CLQ486

CLQ487

CLQ488

CLQ489

Media Usage

CLQ490

CLQ495

CLQ500

Pet Relationships

CLQ505

CLQ510

CLQ515

CLQ520

CLQ525

CLQ530

CLQ535

CLQ540

CLQ545

CLQ547

CLQ549

CLQ550

CLQ555

stionnaire, Appendix H
Item Stem
PLUG HEADPHONES INTO THE COMPUTER. POSITION LAPTOP IN FRONT OF THE
CHILD.
Now, you are going to use the computer to tell us a little more about yourself. The
computer will read some sentences while you listen on the headphones. [HOLD UP
HEADPHONES]
Then you will pick the answer that best describes you by touching your answer on
the computer screen.
[TOUCH THE MIDDLE OF THE COMPUTER SCREEN WITH ONE FINGER]
You can change the volume by pressing this button [POINT TO THE RIGHT BUTTON
ABOVE STICKER] to make it louder and this button [POINT TO THE LEFT BUTTON
ABOVE STICKER] to make it softer. If you don't want the questions and answers read
to you, just turn the volume all the way down.
SHOW THE CHILD HOW TO ADJUST THE SIZE OF THE HEADPHONES.
Okay, go ahead and put these headphones on and adjust them so they fit. Then, you
will hear directions about what to do.
TURN LAPTOP AROUND. ROTATE LAPTOP SCREEN TO FACE THE CHILD.
Hello. Before you begin, please change the volume if this voice is too loud or too soft.
In a minute, sentences will appear on the screen, and they will be read to you along
with a list of answers. For
these questions, there are no right or wrong answers, and all your answers are
private. No one will be told
the answers that you pick.
To choose your answer, just touch it on the computer screen. You don't have to wait
for the computer to
finish reading all the answers before you choose your answer.
If you want to change your answer, touch the "ERASE" button and then touch the
new answer you want to
pick.
If you want to go back and change an answer, touch the "BACK" button to move to
earlier screens.
If you have any questions, or if you need help adjusting the volume or the size of your
headphones, please ask
for help now.
When you're ready to move on, please touch the "NEXT" button to move to the next
screen.

Now let's practice. Touch the answer that best describes you, and then touch the
"NEXT" button.
How often do you watch TV?

Great, thanks for practicing.
One last thing before you begin. If there is a question you do not want to answer, just
touch the "NEXT" button to skip over it. If you touch the "NEXT" button without
answering, the computer will ask you if you want to skip the question, just make sure
you didn't skip the question by accident.
Please touch the "NEXT" button to move to the next screen.
Think about yourself and your experiences this school year. How often do the
following things happen?
I try hard to do well in school.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
In class, I work as hard as I can.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
When I'm in class, I participate in class discussions.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
I pay attention in class.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
When I'm in class, I listen very carefully.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Kids in my class make me feel better if I'm having a bad day.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Social Distress. Items not included due to copyright restrictions (3 items total)
question.

I feel lonely at school.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.

Kids in my class let me play with them.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
I feel left out at school.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Kids in my class make me feel happy.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Kids in my class would help me if I hurt myself on the playground.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Kids in my class tell me that I'm their friend.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
I feel alone at school.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Kids in my class would help me if other kids were being mean to me.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Next, please think about experiences that you have had with other students.
During this school year, how often have other students teased you, made fun of you,
or called you names?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.

During this school year, how often have other students told lies or untrue stories
about you?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
During this school year, how often have other students pushed, shoved, slapped, hit,
or kicked you?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
During this school year, how often have other students left you out from playing with
them on purpose?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
How often do you send texts, messages, or emails using an app, cell phone,
computer, iPad or tablet, or other electronic device?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Does your family have rules about who you can send texts, messages, or emails to?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Does your family have rules about when you can send texts, messages, or emails?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Do you have a pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.

Have you ever had a pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
How old were you when you got your first pet? If you can't remember exactly how
old you were, please take your best guess.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
How many pets do you have right now?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
What kind of {pet/pets} do you have? You can choose more than one answer if you
have more than one pet.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Do you have a favorite pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Which pet is your favorite pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
How often do you spend time playing with {your pet/your favorite pet/any of your
pets}?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.

How often do you have {your pet/your favorite pet/any of your pets} near you when
you do homework, study, read, or watch TV?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
When you feel bad or sad, how often do you go to {your pet/your favorite pet/any of
your pets} to help you feel better?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Do you consider {your pet/your favorite pet/any of your pets} to be {a
member/members} of your family?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT"
button to skip this
question.
Thank you for working with me. You are done answering questions on the computer.
Please take off the headphones now.

TAKE THE HEADPHONES FROM THE CHILD. UNPLUG HEADPHONES FROM
COMPUTER.
TAKE THE LAPTOP FROM THE CHILD AND PLACE THE LAPTOP DIRECTLY IN FRONT OF
YOU.
SAY: Thank you. Now we are going to do something else.
TOUCH THE "NEXT" BUTTON TO CONTINUE.

Source

Construct
Introduction

Research Question
NA

Introduction

ECLS-K:2011 3rd Grade CQ (modified)

Introduction

ECLS-K:2011 3rd Grade CQ (modified)
Skinner, Ellen A., Kindermann, T. A., Behavior
and Furrer, C. J. (In press).
engagement

Skinner, Ellen A., Kindermann, T. A.,
and Furrer, C. J. (In press).

Behavior
engagement

Skinner, Ellen A., Kindermann, T. A.,
and Furrer, C. J. (In press).

Behavior
engagement

Skinner, Ellen A., Kindermann, T. A.,
and Furrer, C. J. (In press).

Behavior
engagement

Skinner, Ellen A., Kindermann, T. A.,
and Furrer, C. J. (In press).

Behavior
engagement

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

LaGreca and Stone (1993)

Social distress

C2, C3

Also used in ECLS-K:2011 Spring 3rd
grade CQ
Parker, J. G. and Asher, S. R. (1993).

Loneliness

C2, C3

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

Parker, J. G. and Asher, S. R. (1993).

Loneliness

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

Parker, J. G. and Asher, S. R. (1993).

Loneliness

SECCYD (Vandell, using Ladd items)
"Kids in My Class at School"

Peer social support C2

Espelage and Holt (2001) (modified) Peer victimization
Also used in ECLS-K:2011 Spring 3rd
grade CQ

C2, C3

Espelage and Holt (2001) (modified) Peer victimization

Also used in ECLS-K:2011 Spring 3rd
grade CQ

Espelage and Holt (2001) (modified) Peer victimization

Also used in ECLS-K:2011 Spring 3rd
grade CQ

Espelage and Holt (2001) (modified) Peer victimization

Also used in ECLS-K:2011 Spring 3rd
grade CQ

Adapted from the PEW September
Tracking Survey (2009) (modified)

Media usage

ECLS

Media usage

ECLS

Media usage

Pet relationships

Adapted from CENSHARE Pet Attachmen

Pet relationships

Adapted from CENSHARE Pet Attachmen
Pet relationships

Adapted from CENSHARE Pet Attachmen
Adapted from Lexington Attachment Pet relationships
to Pets Scale (LAPS) (John, Garrity, &
Stallones 19922)

Pet relationships

Adapted from CENSHARE Pet Attachmen
Pet relationships

Adapted from CENSHARE Pet Attachmen

Pet relationships

Adapted from CENSHARE Pet Attachmen
Pet relationships

Adapted from CENSHARE Pet Attachmen
Closing

ECLS-K:2011 3rd Grade CQ (modified)
Closing

ECLS-K:2011 3rd Grade CQ (modified)

App B Spring 4th Parent Intervi
A

Spring Fourth-Grade Parent Interview, Appendix H

Section

Item #
INQ.005

Item Stem
Source
{In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 2012/In the fall of
ECLS-K
2012/In the spring of 2013/In the spring of 2014}, we spoke with {NAME OF RESPONDENT} who
took part in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 on {DATE
OF LAST INTERVIEW}. Am I talking to the same person?

Construct
Introduction

Research Question
NA

INQ.010
INQ.015

May I please speak with {NAME OF PREVIOUS ROUND RESPONDENT}?
Are you the parent or guardian in this household who knows the most about {CHILD}'s care,
education, and health?

ECLS-K
NHES:2007 (modified)

Introduction
Introduction

NA
NA

INQ.020

May I please speak with the parent or guardian in the household who knows the most about
{CHILD}'s care, education, and health?
May I please speak with a household member who is 18 or older and knows about {CHILD}'s
care, education, and health?
May I have your name please?

NHES:2007 (modified)

Introduction

NHES:2007 (modified)

Introduction

ECLS-K

Introduction

[May I have your name, please?]
ECLS-K
[May I have your name, please?]
ECLS-K
(As I mentioned earlier), you and {CHILD} were selected to take part in the Early Childhood
ECLS-K
Longitudinal Study Kindergarten Class of 2010-2011, which is sponsored by the U.S. Department
of Education, National Center for Education Statistics. I have some questions for you that ask
about {CHILD}’s school and home experiences. The information I collect in this interview will be
extremely valuable in understanding the development of children and how their school
experiences can be improved.

Introduction
Introduction
Introduction

NA
NA
NA

Introduction
4
5

6
7
8
9
10

INQ.025
INQ.030
INQ.060
INQ.070
INQ.080/080b

All responses that relate to or describe identifiable characteristics of individuals may be used
only for statistical purposes and may not be disclosed, or used, in identifiable form for any other
purpose, except as required by law.
This call will be recorded for quality control purposes.

Page 20 of 170

App B Spring 4th Parent Intervi
A

INQ.090/090b

ECLS-K
{In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 2012/In the fall of
2012/In the spring of 2013/In the spring of 2014}, you took part in the Early Childhood
Longitudinal Study Kindergarten Class of 2010-2011, which is sponsored by the U.S. Department
of Education, National Center for Education Statistics. I have some questions for you that ask
about {CHILD}’s school and home experiences since our last interview. The information I collect
in this interview will be extremely valuable in understanding the development of young children
and how their early school experiences can be improved.

Introduction

Introduction
Introduction
Introduction

NA
NA
NA

Introduction
Country of origin for
sample child
Country of origin for
sample child
Length of residence
in U.S. for sample
child
Citizenship of child
Parent participation
in school activities

NA
PQ1, PQ3

13
14
15
16
17
18
19

INQ.130

INQ.310/312OS

Before we begin the interview, I would like to verify some information. I have recorded {CHILD's ECLS-K
FIRST, MIDDLE, AND LAST NAME} as {CHILD}'s full name. Is this correct?
I have recorded that {CHILD}'s home address is…Is this still correct?
ECLS-K
What is {CHILD}'s home address?
I have recorded that {PHONE NUMBER} is {CHILD}'s family's current home phone number. Is this ECLS-K
correct?
{What is {CHILD}'s family's current home phone number?}
ECLS-K
Next, I have a few questions about {CHILD}'s background. Was {CHILD} born in this country, that ECLS-K
is, in any of the fifty states or the District of Columbia?
In what country or territory was {CHILD} born?
ECLS-K

INQ.320

In what year did {CHILD} come to the United States to stay?

ECLS-K

INQ.330
PIQ.130

Is {CHILD} a U.S. citizen?
Now I'd like to ask you about {CHILD}'s school.

ECLS-K
ECLS-K

INQ180
INQ190
INQ.200
INQ.205
INQ.300

20
21
22

PIQ.140
23

PIQ.150

[Since the beginning of this school year, have you or the other adults in your household…] Gone ECLS-K
to a regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with
{CHILD}'s teacher?

PIQ.160

[Since the beginning of this school year, have you or the other adults in your household…]
Attended a school or class event, such as a play, sports event, or science fair?

Since the beginning of this school year, have you or the other adults in your household attended
an open house or a back-to-school night?
[Since the beginning of this school year, have you or the other adults in your household…]
ECLS-K
Attended a meeting of a PTA, PTO, or Parent-Teacher Organization?

Page 21 of 170

ECLS-K

PQ1, PQ3
PQ1, PQ3

PQ1, PQ3
PQ5

Parent participation PQ5
in school activities
Parent attendance at PQ5
parent-teacher
conferences and
meetings
Parent participation PQ5
in school activities

App B Spring 4th Parent Intervi
A

NHES:2007

Parent participation PQ5
in school activities

PIQ.185

During this school year, how many times have you or other adults in your household gone to
meetings or participated in activities at {CHILD}'s school?

ECLS-K

Parent participation PQ5
in school activities

PIQ.495

Do you {or your spouse/partner} use a computer or any other electronic device to communicate ELS:2002 (modified)
with or get information from {CHILD}'s school?
How often do you {or your spouse/partner} use a computer or any other electronic device in the ELS:2002 (modified)
following ways? Would you say never, less than once a year, once or twice a year, several times
a year, at lease once a month, or weekly?

PIQ.496a/b/c

Parent involvement
online

PQ5

a. To communicate with {CHILD}'s teachers and administrative staff by email about {CHILD}, for
example, about how {he/she} is performing, or about absences or tardiness?
b. To find out about homework and other school assignments and projects?
c. To find out about {CHILD}'s grades?

Parent involvement
online
PQ5
Frequency child does PQ4, PQ5
homework at home

PIQ.510

How often does {CHILD} do homework at home? Would you say…
Never,
Less than once a week,
1 to 2 times a week,
3 to 4 times a week, or
5 or more times a week?

ECLS-K

PIQ.520

During this school year, how often did you or someone else help {CHILD} with {CHILD}'s
homework? Would you say…
Never,
Less than once a week,
1 to 2 times a week,
3 to 4 times a week, or
5 or more times a week?

ECLS-K:2011

Homework
monitoring by
parents

PQ4, PQ5

PIQ.550

How often do you check that {CHILD} has completed all homework? Would you say never,
rarely, sometimes, or always?

ECLS-K

Homework
monitoring by
parents

PQ4, PQ5

[Since the beginning of this school year, have you or the other adults in your household…]
Served as a volunteer in {CHILD}’s classroom or elsewhere in the school?

PIQ.170

Page 22 of 170

App B Spring 4th Parent Intervi
A

Now I would like to ask you about {his/her} grades during this school year. Overall, across all
subjects {he/she} takes at school, does {he/she} get...
Mostly A's,
Mostly B's,
Mostly C's,
Mostly D's and lower, or
Does {his/her} school not give those grades?

NHES

Grades received at
school

PQ1, PQ2

PIQ.570

Would you describe {CHILD}'s work at school as…
Excellent,
Above average,
Average,
Below average, or
Failing?
How often would you say that {CHILD}...

NHES

Grades received at
school

PQ1, PQ2

The School Liking and
Avoidance Questionnaire
(SLAQ)

School avoidance

PQ1, PQ2

ECLS-K

Household roster:
current

PQ1, PQ3

ECLS-K

Household roster:
former household
member's status
Household roster:
current

PQ1, PQ3

PIQ.585

a. Makes up reasons to stay home from school?
b. Seems to dread going to school?
c. Becomes upset when it's time to go to school in the morning?
d. Asks to stay home from school?
e. Complains about going to school?

FSQ.010

Would you say almost never, rarely, sometimes, a lot, or almost always?
Now I have a few questions about your household. We have listed that (READ NAMES FROM
MATRIX) lived in this household at the time of our last interview.
As I read each person's name again, please tell me if he or she still lives in this household.

Does {NAME} still live in this household?

Family Structure
FSQ.015/015OS

Why is {NAME} no longer living in this household?

FSQ020

{Other than the people I just asked about, is there anyone else currently living in this household? ECLS-K
For example, anyone who has moved in or any babies born since our last interview? Please tell
me the names and ages of all the other people who normally live here. Please do not include
anyone staying here temporarily who usually lives somewhere else.}

PIQ.560

{Now I have a few questions about your household. We have noted that you and {CHILD}
currently live in this household. First I’d like to ask you some questions about yourself, then I’d
like you to please tell me the names and ages of all the other people who normally live here.
Please do not include anyone staying here temporarily who usually lives somewhere else.}

Page 23 of 170

PQ1, PQ3

App B Spring 4th Parent Intervi
A
39

FSQ.025

ENTER LAST NAME OF {NAME}.

ECLS-K

FSQ.030

How old {are you/is {NAME}}?

ECLS-K

FSQ.040

CODE IF OBVIOUS. OTHERWISE, ASK: {Are you/Is {NAME} male or female?}

ECLS-K

FSQ.045

CHECK HOUSEHOLD MATRIX.

ECLS-K

FSQ.060
FSQ.110

Have we missed anyone who usually lives here who is temporarily away from home or living in a ECLS-K
dorm at school, or any babies or small children?
Do you have a spouse or partner who lives in this household?
ECLS-K

FSQ.120

Who in the household is your spouse or partner?

FSQ.121

During our last interview with this household (or family), it was reported that you were {the
ECLS-K
girlfriend or female partner of {CHILD}’s parent or guardian}/the boyfriend or male partner of
{CHILD}’s parent or guardian/the female guardian of {CHILD}/the male guardian of
{CHILD}/{CHILD}’s relative, but not a guardian/not related to {CHILD}/{CHILD}'s {RELATIONSHIP}}.
Has there been a change in your relationship to {CHILD}?
During our last interview with this household (or family), it was reported that {NAME OF
ECLS-K
SPOUSE/PARTNER} was {the girlfriend or female partner of {CHILD}’s parent or guardian/the
boyfriend or male partner of {CHILD}’s parent or guardian/{CHILD}’s relative, but not a
guardian/the female guardian of {CHILD}/the male guardian of {CHILD}/not related to
{CHILD}/{CHILD}'s {RELATIONSHIP}}. Has there been a change in the relationship of {NAME OF
SPOUSE/PARTNER} to {CHILD}?
What is {your/{NAME}'s} relationship to {CHILD}?
ECLS-K

Household roster:
current
Household roster:
current

PQ1, PQ3

Household roster:
current
Household roster:
current
Household roster:
current
Marital status of the
primary caretakers
Marital status of the
primary caretakers
Change in family
relationship of
respondent to child

PQ1, PQ3

Change in family
relationship of
spouse/partner to
child

PQ1, PQ3

Relationship of
household member
to child
Relationship of
household member
to child

PQ1, PQ3

41
42
43
44
45

FSQ.122
47

FSQ.130

ECLS-K

FSQ.140
49

{Are you/Is {NAME}} {CHILD}'s…
Biological or birth mother,
Adoptive mother,
Step mother,
Foster mother or female guardian, or
Other female parent or guardian?

ECLS-K

Page 24 of 170

PQ1, PQ3
PQ1, PQ3
PQ1, PQ3
PQ1, PQ3
PQ1, PQ3

PQ1, PQ3

App B Spring 4th Parent Intervi
A

FSQ.150

{Are you/Is {NAME}} {CHILD}'s…
Biological or birth father,
Adoptive father,
Step father,
Foster father or male guardian, or
Other male parent or guardian?

ECLS-K

Relationship of
household member
to child

PQ1, PQ3

FSQ.160

{Are you/Is {NAME}} {CHILD}'s…
Full sister,
Half sister,
Step sister,
Adoptive sister, or
Foster sister?

ECLS-K

Relationship of
household member
to child

PQ1, PQ3

FSQ.170

{Are you/Is {NAME}} {CHILD}'s…
Full brother,
Half brother,
Step brother,
Adoptive brother, or
Foster brother?

ECLS-K

Relationship of
household member
to child

PQ1, PQ3

Page 25 of 170

App B Spring 4th Parent Intervi
A

FSQ.180/181

{Are you/Is {NAME}} {CHILD}'s…
CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE DESCRIPTIVE.

ECLS-K

Relationship of
household member
to child

PQ1, PQ3

FSQ.190

{Are you/Is {NAME}} Hispanic or Latino?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.195

What is {your/{NAME}'s} race? You may name one or more races to indicate what {you/NAME}
{consider/considers} {yourself/himself/herself} to be.

ECLS-K

Race of child, parent PQ1, PQ3
figures, respondent
and respondent's
spouse (if no mother
or father figures)

FSQ.196a

Though we may have asked you about {CHILD}'s ethnicity and race in the past, I do have a few
more questions I'd like to ask about that now. Is {CHILD} a member of a Spanish, Hispanic, or
Latino group?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.196b

Which of the following Spanish, Hispanic, or Latino groups best describes {CHILD}'s origin? Is
{he/she}…
Mexican, Mexican American or Chicano,
Puerto Rican,
Cuban, or
Other Spanish/Hispanic/Latino group?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

Page 26 of 170

App B Spring 4th Parent Intervi
A

Is {CHILD} a member of an Asian group?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.197b

Which of the following Asian groups best describes {CHILD}'s origin? Is {he/she}…
Asian Indian,
Chinese,
Filipino,
Japanese,
Korean,
Vietnamese,
Hmong, or
Other Asian?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.198a

Is {CHILD} a member of a Pacific Islander group?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.198b

Which of the following Pacific Islander groups best describes {CHILD}'s origin? Is {he/she}…
Native Hawaiian,
Guamanian or Chamarro,
Samoan, or
Other Pacific Islander?

ECLS-K

Ethnicity of child,
PQ1, PQ3
parent figures,
respondent and
respondent's spouse
(if no mother or
father figures)

FSQ.200a

{FILL 1} currently married, separated, divorced, widowed, in a domestic partnership, or {FILL 2}
never been married {FILL 3}?
See matrix.

ECLS-K

Marital status of the PQ1, PQ3
primary caretakers
Marital status of the NA
primary caretakers

62
63

FSQ.197a

FSQ.200b

Page 27 of 170

ECLS-K

App B Spring 4th Parent Intervi
A

HEQ.010a/b/c/d/ Now I'd like to talk with you about {CHILD}'s activities with family members. In a typical week,
e/f
how often do you or any other family members do the following things with {CHILD}?

ECLS-K:2011

PQ4, PQ5

a. Tell stories to {CHILD}?
b. Help {CHILD} to do arts and crafts?
c. Play games or do puzzles with {CHILD}?
d. Talk about nature or do science projects with {CHILD}?
e. Play a sport or exercise together?
f. Practice reading, writing or working with numbers?

Home
Environment,
Activities, and
Cognitive
Stimulation

Would you say not at all, once or twice a week, 3-6 times a week, or every day?
HEQ.210

HEQ.215

In the past week, how often did {CHILD} read to {himself/herself} or to others outside of school? ECLS-K
Would you say…
Never,
Once or twice a week,
3 to 6 times a week, or
Every day?
Generally, how many minutes did {CHILD} read at each of these times?
ECLS-K

Frequency of reading PQ2, PQ4
activities with child

In an average week, how often does {CHILD} use a home computer or other electronic device to ECLS-K:2011 (modified)
play with programs that teach {him/her} something, like math or reading skills? Would you say…
Never,
Once or twice a week,
3 to 6 times a week, or
Every day?

Use of
PQ4
electronic/computer
devices

HEQ.225

Frequency of home
activities with child

Page 28 of 170

Frequency of reading PQ2, PQ4
activities with child

App B Spring 4th Parent Intervi
A

ECLS-K:2011

HEQ.226

Do you monitor how many hours {CHILD} spends online?

Parental monitoring PQ4
child's use of
electronic/computer
devices

HEQ.227

ECLS-K:2011
Do you monitor what {CHILD} looks at online, or what websites and accounts {CHILD} can join
Parental monitoring PQ4
online? Include everything the child may look at online, such as websites, email, videos, movies,
child's use of
television shows, online games, chat rooms, and picture or social media sites such as Instagram,
electronic/computer
Vine, Snapchat, YouTube, Twitter, and Facebook.
devices
Robert Crosnoe from the
How many close friends does {CHILD} have?
Child's friends
PQ1, PQ2
ECLS-K:2011 Technical Review
Panel (TRP)
What kind of influence is {CHILD}'s {best} friend? Would you say always a good influence,
The National Longitudinal
Child's friends
PQ1, PQ2
usually a good influence, neither a good nor a bad influence, usually a bad influence, or always a Study of Adolescent Health
bad influence?
(Ad Health) (adapted)
Is {CHILD} tutored on a regular basis, by someone other than you or a family member, in a ECLS-K
Tutoring
PQ5
specific subject, such as reading, math, science, or a foreign language?

HEQ.228
70

HEQ.229
71

HEQ.280
72
73
74

HEQ.290/290OS
HEQ300

What is {CHILD} tutored in?
Outside of school hours in the past year, has {CHILD} participated in: Academic activities, like
science, computers, math lab, or taking a class to learn a language other than English?

Page 29 of 170

ECLS-K
NHES 2007 (modified)

Tutoring
Child activities
outside of school
hours

PQ5
PQ4

App B Spring 4th Parent Intervi
A

High School Longitudinal
Study of 2009 (HSLS:2009)
(adapted)

HEQ.301

Did {he/she} specifically learn about math, science, or technology in any of those academic
activities?

Child activities
PQ4
outside of school
hours: STEM related

HEQ305

As part of {CHILD}’s participation in that activity, did {he/she} ever take a field trip focused on
NCES
science activities, for example to a science museum or center, a science lab, a planetarium, or a
nature center?

Child activities
outside of school
hours: science
related field trips

PQ4

HEQ310

Outside of school hours in the past year, has {CHILD} participated in organized athletic activities, ECLS-K
like basketball, soccer, baseball, or gymnastics?

Child activities
outside of school
hours

PQ4

HEQ320

[Outside of school hours in the past year, has {CHILD} participated in:] Organized clubs or
recreational programs, like scouts?

PQ4

HEQ325

As part of {CHILD}’s participation in that program, did {he/she} ever take a field trip focused on NCES
science activities, for example to a science museum or center, a science lab, a planetarium, or a
nature center?

HEQ330

Outside of school hours in the past year, has {CHILD} participated in music lessons, for example, ECLS-K
piano, instrumental music, or singing lessons?

Child activities
outside of school
hours
Child activities
outside of school
hours: science
related field trips
Child activities
outside of school
hours

HEQ340

[Outside of school hours in the past year, has {CHILD} participated in:] Drama classes?

PQ4

HEQ350

[Outside of school hours in the past year, has {CHILD} participated in:] Art classes or lessons, for ECLS-K
example, painting, drawing, or sculpture?

HEQ370

[Outside of school hours in the past year, has {CHILD} participated in:] Organized performing arts ECLS-K
programs, such as children's choirs, dance programs, or theater performances?

HEQ.391

[Outside of school hours in the past year, has {CHILD} participated in:] Religious activities or
instruction?

HEQ.393

Did {CHILD}’s participation in {academic activities/organized athletic activities/ organized clubs ECLS-K
or recreational programs/music lessons/drama classes /art classes or lessons/organized
performing arts programs/ religious activities or instruction/any of these activities} help to cover
the hours when you needed adult supervision for {him/her}?

Child activities
outside of school
hours
Child activities
outside of school
hours
Child activities
outside of school
hours
Child activities
outside of school
hours
Whether child
activities serve as
child care

ECLS-K

Page 30 of 170

ECLS-K

PQ4

PQ6

App B Spring 4th Parent Intervi
A

HEQ.400
86

HEQ.600a/b

Social Skills,
Problem
88
Behaviors, and
Approaches
Toward Learning

SSQ020 a/b/c/d

CCQ.376
89

Child Care
CCQ.377

NRQ.040

Now, I have a question about your neighborhood. How safe is it for children to play outside
during the day in your neighborhood? Would you say it's…
Not at all safe,
Somewhat safe, or
Very safe?

ECLS-K:2011

Youth Risk Behavior Survey Amount of sleep
(YRBS)
Behavior Rating Inventory
Child's working
of Executive Function (BRIEF) memory

On an average school night, how many hours of sleep does {CHILD} get?
(Copyrighted item)
a. (copyrighted item)
b. (copyrighted item)
c. (copyrighted item)
d. (copyrighted item)

PQ4
PQ1, PQ2

Sometimes children spend time caring for themselves, either at home or somewhere else,
without an adult or older child responsible for them. Does {CHILD} spend time caring for
{himself/herself} on a regular basis before or after school?
How many hours per week does {CHILD} take care of {himself/herself}?

ECLS-K

Time child spends in PQ6
self-care

ECLS-K

The next questions are about {CHILD}'s contact with {his/her} {biological/adoptive}
{father/mother}.

ECLS-K (modified)

Time child spends in PQ6
self-care
Current contact and PQ1, PQ3, PQ4
nature of relationship
with
biological/adoptive
parents no longer
living in household

[We understand that some of these questions may be difficult {for adoptive parents} to answer;
however, these are standard questions we ask when a child does not live with {his/her}
biological parents. Any information you can provide will be helpful.]
How long has it been since {CHILD} last had a visit, a phone call, a video call, an e-mail, a text or
other electronic message, or received a card or letter from {his/her} {biological/adoptive}
{father/mother}? Would you say...

Less than one month,
More than a month but less than a year,
More than a year, or
No contact since birth?

Non-Resident
Parents
NRQ.123
92

Neighborhood safety PQ4

How many times have {CHILD} and {his/her} {biological/adoptive} {father/ mother} talked on the ECLS-K (modified)
telephone or in a video call to each other, e-mailed, texted, or had some other type of contact
that was not in person in the past 4 weeks?

Page 31 of 170

Current contact and PQ1, PQ3, PQ4
nature of relationship
with
biological/adoptive
parents no longer
living in household

App B Spring 4th Parent Intervi
A

Country of origin for PQ1, PQ3
nonresident parents

COQ.010

How old was {CHILD’}’s biological mother when she first moved to {any of the fifty states in the ECLS-K
United States or the District of Columbia /the United States}?
Now we'd like to ask {another question} about {CHILD}'s bilogical father. {I know you mentioned ECLS-K
that {CHILD}'s biological father is deceased, and I am sorry for this loss. We understand that it
may be hard to talk about those who are no longer living, but I was hoping I could ask a couple
quick background questions about where he was from.} In what country was {his/her} biological
father born?

Country of origin for PQ1, PQ3
nonresident parents
Country of origin for PQ1, PQ3
nonresident parents

How old was {CHILD’}’s biological father when he first moved to {any of the fifty states in the
United States or the District of Columbia /the United States}?
Now I am going to read some additional statements. Please tell me whether each statement is
never true for you, sometimes true for you, often true for you, or very often true for you.

Country of origin for PQ1, PQ3
nonresident parents
Parent-child
PQ4
relationship:
communication

COQ025
DWQ070a/b/c/
d/e/f

ECLS-K
ECLS-K

a. Even if I am really busy, I make time to listen to {CHILD}.
b. I discourage {CHILD} from talking about {his/her} worries because it upsets {him/her}.
c. I encourage {CHILD} to talk about {his/her} troubles.
d. I encourage {CHILD} to tell me about {his/her} friends and activities.
e. I encourage {CHILD} to express {his/her} opinions.
f. When I lose my patience with {CHILD}’s questions and demands, I just don’t listen to {CHILD}
anymore.

DWQ.075
98

DWQ077a/b/c

ECLS-K

COQ.020/OS

Now we'd like to ask {another question} about {CHILD}'s bilogical mother. {I know you
mentioned that {CHILD}'s biological mother is deceased, and I am sorry for this loss. We
understand that it may be hard to talk about those who are no longer living, but I was hoping I
could ask a couple quick background questions about where she was from.} In what country
was {his/her} biological mother born?

Country of
Origin for Non93
Resident
Biological
Parents
94

COQ.005/OS

How often do you argue with {CHILD}? Please include major arguments as well as minor
NCES
arguments, such as over homework or chores. Would you say never, almost never, sometimes,
often, or always?
The following are a number of statements about your family. Please tell me how often each
Short form of Alabama
typically occurs in your home.
Parenting Questonnaire
a. You threaten to punish {CHILD} and then do not actually punish {him/her}. Would you say this
occurs never, almost never, sometimes, often, or always?
b. {CHILD} talks you out of being punished after {he/she} has done something wrong.
c. You let {CHILD} out of punishment early, like lift restrictions earlier than you originally said?

Page 32 of 170

Time spent arguing
with child

PQ4

Inconsistent
Discipline

PQ4

App B Spring 4th Parent Intervi
A

DWQ.081a/b

Now I’d like to ask some questions about the amount of time {CHILD} plays video games. We
ECLS-K (modified)
want you to include games played on systems like Playstation, Wii, or Xbox, or on handheld
devices such as a Nintendo DS, Sony PSP, iPod, iPad, or cellphone, or games played on the
computer.
On any given weekday, how much time does {CHILD} spend playing video games? Please do not
include time {CHILD} spends on the computer doing educational activities or homework.

Time child spent
PQ4
playing video games

CHQ.010

Now we'd like to discuss {CHILD}'s health and well-being. How long has it been since {CHILD}'s ECLS-K:2011
last visit to a dentist or dental hygienist for dental care?

Dental visits

PQ1, PQ2

CHQ.020

Doctor visits

PQ1, PQ2

CHQ.021

How long has it been since {CHILD}'s last visit to a clinic, health center, hospital, doctor's office, ECLS-K:2011
or other place for routine health care?
Has {CHILD} had an ear infection since last spring?
ECLS-K:2011 (modified)

PQ1, PQ2

CHQ.022

Has {CHILD} had an ear ache since last spring?

CHQ.023

Since last spring, how many times did a doctor, nurse, or other medical professional tell you that ECLS-K:2011 (modified)
{CHILD} had an ear infection?
How have {CHILD}’s {ear infections/ear aches} been treated by your doctor, nurse, or other ECLS-K:2011 (modified)
medical professional since last spring?
Since last spring, have ear tubes been placed in the right ear, left ear, or both ears when your ECLS-K:2011 (modified)
child had surgery to place tubes in {his/her} ears?

Ear infections since
last spring
Ear aches since last
spring
Ear infections since
last spring
Ear infections/aches
treatment since last
spring
Ear tubes since last
spring

IF NEEDED: Please consider all surgeries since last spring if {CHILD} had more than one to place
ear tubes.
Has a doctor, nurse, or other medical professional ever told you that {CHILD} has asthma?
ECLS-K
Does {he/she} receive treatment for this condition?
ECLS-K
In a typical week, on how many days does {CHILD} get exercise that causes rapid breathing, ECLS-K
perspiration, and a rapid heartbeat for 20 continuous minutes or more?

Asthma
Asthma
Exercise/physical
activities

PQ1, PQ2
PQ1, PQ2
PQ1, PQ2

100

101

Child's Health
and Well-Being
102
103
104
105

CHQ.024/024OS
106

CHQ.025

ECLS-K:2011 (modified)

PQ1, PQ2
PQ1, PQ2
PQ1, PQ2

PQ1, PQ2

107

108
109
110

CHQ.026
CHQ.027
CHQ.060

Page 33 of 170

App B Spring 4th Parent Intervi
A

CHQ.095

CHQ.110

For the next set of questions, please base your answer on how {CHILD} compares to other ECLS-K
children of the same age. {CHILD} is independent and takes care of {himself/herself} …
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Does {CHILD} pay attention…
ECLS-K
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Does {CHILD} learn, think, and solve problems…
ECLS-K
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Does {CHILD} show good coordination in moving {his/her} arms and legs? Would you say ECLS-K
{he/she} does this…
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Would you say {CHILD} behaves and relates to other children…
ECLS-K (modified)
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Would you say {CHILD} behaves and relates to adults…
ECLS-K:2011
Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Thinking about {CHILD}'s overall activity level, would you say {he/she} is…
ECLS-K
Less active than other children {his/her} age,
About as active,
Slightly more active, or
A lot more active than other children {his/her} age?
Does {CHILD} have any emotional or psychological difficulties?
ECLS-K:2011

CHQ.111

Do you think this is a mild problem, a moderate problem, or a severe problem?

111

CHQ.100
112

CHQ.105
113

CHQ.106
114

CHQ.107
115

CHQ.108
116

CHQ.109
117

118

119

Page 34 of 170

ECLS-K:2011

Behavioral
PQ1, PQ2
comparison to peers:
Independence and
ability to take care of
him/herself
Behavioral
PQ1, PQ2
comparison to peers:
Attention

Behavioral
PQ1, PQ2
comparison to peers:
Learn, think, solve
problems
Behavioral
PQ1, PQ2
comparison to peers:
Child's coordination

Behavioral
PQ1, PQ2
comparison to peers:
Relating to children

Behavioral
PQ1, PQ2
comparison to peers:
Relating to adults

Behavioral
PQ1, PQ2
comparison to peers:
Overall activity level

Emotional and
psychological
difficulties
Emotional and
psychological
difficulties

PQ1, PQ2

App B Spring 4th Parent Intervi
A

CHQ.115
120

CHQ.120
121

{Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of an ECLS-K:2011
issue with {independence and taking care of {himself/herself} {or}/paying attention
{or}/learning, thinking, and solving problems {or}/ coordination in moving {his/her} arms and
legs {or}/behaving and relating to other children {or}/ behaving and relating to adults
{or}/{his/her} overall activity level {or}/{his/her} emotional or psychological difficulties}?
{Since last spring, have you obtained/Did you obtain} a diagnosis or diagnoses of a problem from ECLS-K:2011
a professional?
ECLS-K:2011

PQ1, PQ2
Diagnoses of
disabilities and health
conditions
Diagnoses of
PQ1, PQ2
disabilities and health
conditions
Diagnoses of
PQ1, PQ2
disabilities and health
conditions: Autism
spectrum disorder

CHQ.125/125OS

What was the diagnosis or were the diagnoses?

CHQ126/126OS

What type of autism spectrum disorder does {CHILD} have? Is it autism, Asperger's Disorder, ECLS-K:2011
Pervasive Developmental Disorder, something else, or was it identified generally as Autism
Spectrum Disorder?

CHQ.130/131

How old was {CHILD} when the first diagnosis of a problem related to {a learning
disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)/a
developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder (PDD), or
other autism spectrum disorder/dyslexia/dyscalculia/an intellectual disability, severe cognitive
disability, or mental retardation/an orthopedic impairment/a serious emotional disturbance/a
traumatic brain injury/a panic disorder/separation anxiety disorder/obsessive compulsive
disorder/generalized anxiety disorder/an {other} anxiety disorder/bipolar
disorder/depression/speech/a sensory deficit disorder/oppositional defiant disorder/{TEXT
FROM OTHER
SPECIFY}} was made?
What was the month and year when the diagnosis was made?

ECLS-K:2011

Diagnoses of
PQ1, PQ2
disabilities and health
conditions

ECLS-K:2011

CHQ.140

Is {CHILD} now taking any prescription medicine for the condition related to {his/her} {learning
disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder
(ADHD)/developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder
(PDD), or other autism spectrum disorder/dyslexia/dyscalculia/intellectual disability, severe
cognitive disability, or mental retardation/orthopedic impairment/serious emotional
disturbance/traumatic brain injury/panic disorder/separation anxiety disorder/obsessive
compulsive disorder/generalized anxiety disorder/{other} anxiety disorder/bipolar
disorder/depression/speech problems/sensory deficit disorder/oppositional defiant
disorder{TEXT FROM OTHER SPECIFY}}?

ECLS-K:2011

PQ1, PQ2
Diagnoses of
disabilities and health
conditions
Prescription
PQ1, PQ2
medications

CHQ.155

Is {CHILD} medicated for ADD or ADHD at school, at home, or both?

ECLS-K:2011

122

123

124

CHQ.135a/b
125

126

127

Evaluation of
PQ1, PQ2
disabilities and health
conditions

Page 35 of 170

Prescription
medications

PQ1, PQ2

App B Spring 4th Parent Intervi
A

CHQ.173

128

How long has {CHILD} taken such prescription medicine for the condition related to {his/her} {a ECLS-K:2011
learning disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder
(ADHD)/a developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder
(PDD), or other autism spectrum disorder/dyslexia/dyscalculia/an intellectual disability, severe
cognitive disability, or mental retardation/orthopedic impairment/ a serious emotional
disturbance/a traumatic brain injury/a panic disorder/separation anxiety disorder/obsessive
compulsive disorder/generalized anxiety disorder/an {other} anxiety disorder/bipolar
disorder/depression/speech problems/a sensory deficit disorder/oppositional defiant
disorder/{TEXT FROM OTHER SPECIFY}}, in total?

Prescription
medications

PQ1, PQ2

Less than one month,
Less than a year,
1 to 2 years,
3 to 4 years, or
5 years or more?

CHQ.200

CHQ.206e

Since last spring, has {CHILD} had a problem with stuttering?

CHQ.210

{Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of ECLS-K
{his/her} ability to communicate?

CHQ.215

Did you obtain a diagnosis or diagnoses of a problem related to {his/her} ability to communicate ECLS-K
from a professional?

CHQ.216

Which best describes {CHILD}’s hearing? If {CHILD} has a hearing aid or other assistive device, ECLS-K
please consider {his/her} hearing without the hearing aid or assistive device. Would you say
{CHILD} has…
excellent hearing,
good hearing,
a little trouble hearing,
moderate trouble hearing,
a lot of trouble hearing, or
is {CHILD} deaf?

131

132

133

Communication:
PQ1, PQ2
comparison to peers

Better than other children {his/her} age,
As well as other children,
Slightly less well than other children, or
Much less well than other children?

129

130

For the next question, please base your answer on how {CHILD} compares to other children of ECLS-K:2011
the same age. Does {CHILD} pronounce words, communicate with and understand others…

ECLS-K:2011

Page 36 of 170

Communication
problems
Evaluation of
communication
problems
Diagnoses for
communication
problems
Hearing ability

PQ1, PQ2
PQ1, PQ2

PQ1, PQ2

App B Spring 4th Parent Intervi
A

PQ1, PQ2

CHQ.218

[Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a ECLS-K:2011
hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or
assistive device.] {CHILD} can usually hear and understand what a person says without seeing his
or her face if that person talks in a normal voice to {him/her} from across a quiet room.

Hearing ability

PQ1, PQ2

CHQ.219

[Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a ECLS-K:2011
hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or
assistive device.] {CHILD} can usually hear and understand what a person says without seeing
his or her face if that person shouts to {him/her} from across a quiet room.

Hearing ability

PQ1, PQ2

CHQ.220

Hearing ability

PQ1, PQ2

CHQ.221
CHQ.222

Is {CHILD}’s hearing worse in one ear?
ECLS-K:2011
ECLS-K:2011
Which best describes {CHILD}'s hearing in {his/her} worse ear? If {CHILD} has a hearing aid or
other assistive device, please consider {his/her} hearing without the hearing aid or assistive
device.
In {his/her} worse ear, would you say {CHILD} has…
Excellent hearing,
Good hearing,
A little trouble hearing,
Moderate trouble hearing,
A lot of trouble hearing, or
is {CHILD} Deaf?
{Besides the ECLS-K:2011 hearing evaluation done for this study, {Since last spring, has/Since the ECLS-K (modified)
spring of 2013, has/Since the fall of 2012, has/has}} / {Since last spring, has/Since the spring of
2013, has/Since the fall of 2012,
has/Has}} {CHILD}'s hearing {ever} been evaluated by a professional?
.

Hearing ability
Hearing ability

PQ1, PQ2
PQ1, PQ2

CHQ.245

Did you obtain a diagnosis of a problem from a professional?

ECLS-K

CHQ.246/246OS

What was the diagnosis?

ECLS-K:2011

CHQ250a/b/c

How old was {CHILD} when the first diagnosis of a problem related to {his/her} {ability to ECLS-K:2011
communicate/hearing} was made?

Diagnoses for hearing PQ1, PQ2
ability
PQ1, PQ2
Diagnoses of
disabilities and health
conditions
Diagnoses of
PQ1, PQ2
disabilities and health
conditions

136

137

139

CHQ.235
140

142

143

Hearing ability

135

141

Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a ECLS-K
hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or
assistive device. {CHILD} can usually hear and understand what a person says without seeing his
or her face if that person whispers to {him/her} from across a quiet room.

134

138

CHQ.217

Page 37 of 170

Evaluated for hearing PQ1, PQ2
ability

App B Spring 4th Parent Intervi
A

CHQ.255a/b

What was the month and year the problem with {CHILD}'s {ability to communicate/hearing} was ECLS-K:2011
diagnosed?

CHQ.256a

Since last spring, has {CHILD} worn a hearing aid?

ECLS-K:2011

PQ1, PQ2
Diagnoses of
disabilities and health
conditions
Use of hearing aid
PQ1, PQ2

CHQ.256b

Has {CHILD} ever worn a hearing aid?

ECLS-K:2011 (modified)

Use of hearing aid

PQ1, PQ2

CHQ.257a/b

At what age was the recommendation that {CHILD} wear a hearing aid first made?

ECLS-K:2011

Use of hearing aid

PQ1, PQ2

CHQ.258

How often does {CHILD} use the hearing aid(s) in school? Would you say…
All of the time,
Most of the time,
Sometimes,
Rarely, or
Never?
Please indicate whether the following statement describes {CHILD}'s hearing when wearing
{his/her} hearing aid(s). {CHILD} can usually hear and understand what a person says without
seeing his or her face if that person whispers to {him/her} from across a quiet room.

ECLS-K:2011

Use of hearing aid

PQ1, PQ2

ECLS-K:2011

Hearing ability: with PQ1, PQ2
hearing aid

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
{his/her} hearing aid(s). ] {CHILD} can usually hear and understand what a person says without
seeing his or her face if that person talks in a normal voice to {him/her} from across a quiet
room.

ECLS-K:2011

Hearing ability: with PQ1, PQ2
hearing aid

144

145

146

147

148

CHQ.259
149

CHQ.260
150

Page 38 of 170

App B Spring 4th Parent Intervi
A

155
156
157
158
159

ECLS-K:2011

Hearing ability: with PQ1, PQ2
hearing aid

CHQ.262

Hearing ability: with PQ1, PQ2
hearing aid

CHQ.264a/b
CHQ.270

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
ECLS-K:2011
{his/her} hearing aid(s).] {CHILD} can usually hear and understand what a person says without
seeing his or her face if that person speaks loudly into {his/her} {better} ear.
{Since last spring has/Has} a doctor or other health care professional {ever} recommended that ECLS-K:2011
{CHILD} wear a hearing aid?
At what age was the recommendation that {CHILD} wear a hearing aid first made?
ECLS-K:2011
Does {CHILD} have a cochlear implant?
ECLS-K

CHQ.271

In what year was it implanted?

ECLS-K

CHQ.272a/b

How old was {CHILD} when it was implanted?

ECLS-K:2011

CHQ.273

In what years were they implanted?

ECLS-K

CHQ.274

[In what years were they implanted?]

ECLS-K

CHQ.275a/b

{How old was {CHILD} when it was implanted in the left ear?}{How old was {CHILD} when they ECLS-K:2011
were implanted?}

CHQ.276a/b

{How old was {CHILD} when it was implanted in the right ear?}{How old was {CHILD} when they ECLS-K:2011
were implanted?}
Please indicate whether the following statement describes {CHILD}'s hearing when wearing
ECLS-K:2011
{his/her} cochlear implant {s}. {CHILD} can usually hear and understand what a person says
without seeing his or her face if that person whispers to {him/her} from across a quiet room.

PQ1, PQ2
Use of cochlear
implant
Hearing ability: with PQ1, PQ2
cochlear implant

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
{his/her} cochlear implant {s}.]{CHILD} can usually hear and understand what a person says
without seeing his or her face if that person talks in a normal voice to {him/her} from across a
quiet room.

Hearing ability: with PQ1, PQ2
cochlear implant

152

154

151

153

CHQ.261

CHQ.263

Use of hearing aid

PQ1, PQ2

Use of hearing aid
Use of cochlear
implant
Use of cochlear
implant
Use of cochlear
implant
Use of cochlear
implant
Use of cochlear
implant
Use of cochlear
implant

PQ1, PQ2
PQ1, PQ2
PQ1, PQ2
PQ1, PQ2
PQ1, PQ2
PQ1, PQ2
PQ1, PQ2

160

161

CHQ.277
162

CHQ.278

163

Page 39 of 170

ECLS-K:2011

App B Spring 4th Parent Intervi
A

CHQ.279

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
{his/her} cochlear implant {s}.] {CHILD} can usually hear and understand what a person says
without seeing his or her face if that person shouts to {him/her} from across a quiet room.

ECLS-K:2011

Hearing ability: with PQ1, PQ2
cochlear implant

CHQ.280

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
{his/her} cochlear implant {s}.] {CHILD} can usually hear and understand what a person says
without seeing his or her face if that person speaks loudly into {his/her} {better} ear.

ECLS-K:2011

Hearing ability: with PQ1, PQ2
cochlear implant

CHQ.285

Now I want to ask you about {CHILD}’s vision. Without the use of eyeglasses or contact lenses, ECLS-K
does {CHILD} have difficulty seeing objects in the distance or letters on paper?

Vision ability

PQ1, PQ2

CHQ.286

Vision ability

PQ1, PQ2

CHQ.290

Is {CHILD}’s difficulty with seeing objects in the distance, things up close (like letters on paper), ECLS-K:2011
or both?
{Since last spring has/Has} {CHILD}'s vision {ever} been evaluated by an eye care professional? ECLS-K (modified)

CHQ.300

Did you obtain a diagnosis of a vision-related problem from an eye care professional?

ECLS-K (modified)

CHQ.301/301OS

What was the diagnosis?

ECLS-K:2011

164

165

166

167
168
169

170

Page 40 of 170

Evaluated for vision PQ1, PQ2
ability
Diagnoses for vision- PQ1, PQ2
related problems
Diagnoses of
PQ1, PQ2
disabilities and health
conditions

App B Spring 4th Parent Intervi
A

CHQ.305a/b

How old was {CHILD} when the first diagnosis of a problem was made?

ECLS-K:2011

Diagnoses of
PQ1, PQ2
disabilities and health
conditions

CHQ.310a/b

What was the month and year the diagnosis was made?

ECLS-K:2011

Diagnoses of
PQ1, PQ2
disabilities and health
conditions

CHQ.311

Has {CHILD} been prescribed glasses or contact lenses to improve {his/her} vision?

ECLS-K:2011

Use of glasses or
contact lenses

PQ1, PQ2

CHQ.312

How often does {CHILD} wear glasses or contact lenses?
All of the time,
Most of the time,
Sometimes,
Rarely, or
Never?
Does {CHILD} have glasses or contact lenses?

ECLS-K:2011

Use of glasses or
contact lenses

PQ1, PQ2

ECLS-K:2011

Use of glasses or
PQ1, PQ2
contact lenses
PQ1, PQ2
Use of glasses or
contact lenses
Child's general health PQ1, PQ2

171

172

173

174

175
176

CHQ.313
CHQ.314
CHQ.330

177

178

CHQ.340
CHQ.420

Do {CHILD}’s glasses or contacts help {him/her} see things up close, see things in the distance, or ECLS-K:2011
both?
ECLS-K
Would you say {CHILD}'s health is …
Excellent,
Very good,
Good,
Fair, or
Poor?
ECLS-K
During this school year, has {CHILD} received therapy services or taken part in a program for
children with disabilities?
During this school year, did {CHILD} participate in a special education program?
ECLS-K (modified)

179

Page 41 of 170

Services for
disabilities
Participation in
school services for
disabilities

PQ1, PQ2
PQ1, PQ2

App B Spring 4th Parent Intervi
A

CHQ.430

180

PPQ.100
181 Parent's

Psychological
Well-Being and
Health

ECLS-K:2011
Overall, how satisfied are you with the progress {CHILD} has made in the special services or
special education program this school year? Are you…
Completely satisfied,
Very satisfied,
Fairly satisfied,
Somewhat dissatisfied, or
Very dissatisfied?
I'm going to read some statements that may relate to how you have felt about yourself and your ECLS-K
life during the past week. For each statement I read, please indicate how often in the past week
you felt or behaved this way. There are no right or wrong answers.

Depression and
subjective well-being

How often during the past week have you felt that you were bothered by things that don't
usually bother you? Would you say never, some of the time, a moderate amount of the time, or
most of the time?
How often during the past week have you felt that you did not feel like eating, that your appetite ECLS-K
was poor?

Depression and
subjective well-being

PPQ.120

How often during the past week have you felt that you could not shake off the blues even with
help from your family or friends?

ECLS-K

Depression and
subjective well-being

PPQ.130

How often during the past week have you felt that you had trouble keeping your mind on what
you were doing?

ECLS-K

Depression and
subjective well-being

PPQ.140

How often during the past week have you felt depressed?

ECLS-K

Depression and
subjective well-being

PPQ.150

How often during the past week have you felt that everything you did was an effort?

ECLS-K

Depression and
subjective well-being

PPQ.160

How often during the past week have you felt fearful?

ECLS-K

Depression and
subjective well-being

PPQ.170

How often during the past week have you felt your sleep was restless?

ECLS-K

Depression and
subjective well-being

PPQ.180

How often during the past week have you felt that you talked less than usual?

ECLS-K

Depression and
subjective well-being

PPQ.190

How often during the past week have you felt lonely?

ECLS-K

Depression and
subjective well-being

PPQ.200

How often during the past week have you felt sad?

ECLS-K

Depression and
subjective well-being

PPQ.110
182

183

184

185

186

187

188

189

190

191

Page 42 of 170

Rating school services PQ1, PQ2
for disabilities

PQ1, PQ3

App B Spring 4th Parent Intervi
A

ECLS-K

Depression and
subjective well-being

PPQ.220

Now, I would like to ask you about your health. In general, would you say that your health is…
Excellent,
Very good,
Good,
Fair, or
Poor?

ECLS-K

Parent health

PQ1, PQ3
PQ1, PQ3, PQ5

PPQ.225

During the past 12 months, would you say that you experienced a lot of stress, a moderate
amount of stress, relatively little stress, or almost no stress at all?

CAM

Parent health

PQ1, PQ3, PQ5

ECLS-K

Family food security PQ1, PQ3

ECLS-K

Family food security PQ1, PQ3

ECLS-K

Family food security PQ1, PQ3

193

FDQ.130a/b/c

195

FDQ.140
FDQ.150

In the last 12 months, did {you/you or other adults in your household} ever cut the size of your
meals or skip meals because there wasn't enough money for food?
How often did this happen? Would you say…
Almost every month
Some months, but not every month, or
In only 1 or 2 months?

197

FDQ.160

198

FDQ.170

199

FDQ.180
FDQ.190

200
201

FDQ.191
202

203

These next questions are about whether your family is able to afford the food that you need. I
am going to read you several statements that people have made about their food situation. For
these statements, please tell me whether the statement was often true, sometimes true, or
never true for {you/your household} in the last 12 months, that is, since last {CURRENT MONTH},
2014.
a. {I/We} worried whether {my/our} food would run out before {I/we} got money to buy more.
b. The food that {I/we} bought just didn't last, and {I/we} didn't have money to get more.
c. {I/We} couldn't afford to eat balanced meals.

Food Security
196

How often during the past week have you felt that you could not get going?

192

194

PPQ.210

Parent's
Education

PEQ.020

ECLS-K
In the last 12 months, did you ever eat less than you felt you should because there wasn't
enough money for food?
In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money ECLS-K
for food?
In the last 12 months, did you lose weight because there wasn't enough money for food?
ECLS-K
In the last 12 months, did {you/you or other adults in your household} ever not eat for a whole ECLS-K
day because there wasn't enough money for food?
How often did this happen? Would you say…
ECLS-K
Almost every month,
Some months, but not every month, or
In only 1 or 2 months?

Adult food security

PQ1, PQ3

Adult food security

PQ1, PQ3

Adult food security
Adult food security

PQ1, PQ3
PQ1, PQ3

Adult food security

PQ1, PQ3

{Now I have a few questions about education.} What is the highest grade or year of school that ECLS-K:2011 (modified)
{you/{NAME}} {have/has} completed?

Parent education

PQ1, PQ3

Page 43 of 170

App B Spring 4th Parent Intervi
A

PEQ.021

204

PEQ.030

205

PEQ.040
PEQ.050

206
207

PEQ.060

208

PEQ.062
Parent's
EMQ.020
Employment
210
Section 1 (NAEP
sample only)
211
EMQ.030
212
EMQ.040
EMQ.050
209

213

EMQ.060
214

EMQ.070
EMQ.080

215

216

EMQ.100
EMQ.120
EMQ.130
EMQ.140
EMQ.150

217
218
219
220
221

EMQ.200
222

Parent's
Employment

{Do/Does} {you/{NAME}} have a high school diploma, or its equivalent, such as a GED, or
neither?
{Are you/Is {NAME}} currently attending or enrolled in any courses from a school, college, or
university?
{Are you/Is {NAME}} currently taking courses full-time or part time?
{Are you/Is {NAME}} currently participating in a job training or on the job training program?
Please do not report participation in any vocational or technical programs taken at a college or
university that you just told me about.
About how many hours a week {do/does} {you/{NAME}} spend in that program? Please include
hours spent on homework for the training program.
What type of school or job training {are you/Is {NAME}} currently in?

ECLS-K

Parent education

PQ1, PQ3

ECLS-K:2011

Parent education

PQ1, PQ3

ECLS-K:2011
ECLS-K:2011

Parent education
Parent education

PQ1, PQ3
PQ1, PQ3

ECLS-K:2011

Parent education

PQ1, PQ3

ECLS-K:2011
ECLS-K:2011

Parent education
PQ1, PQ3
Parent employment PQ1, PQ3

ECLS-K:2011
ECLS-K:2011
ECLS-K:2011

Parent employment PQ1, PQ3
Parent employment PQ1, PQ3
Parent employment PQ1, PQ3

ECLS-K:2011

Parent employment PQ1, PQ3

ECLS-K:2011
ECLS-K:2011

Parent employment PQ1, PQ3
Parent employment PQ1, PQ3

ECLS-K:2011
ECLS-K:2011
ECLS-K:2011
ECLS-K:2011
ECLS-K:2011

Parent employment
Parent employment
Parent employment
Parent employment
Parent employment

Westat

Parent employment PQ1, PQ3

During the past week, did {you/{NAME}} work at a job for pay?
{Were you/Was {NAME}} on leave or vacation from a job?
How many jobs {do you/does {NAME}} have now?
About how many total hours per week {do you/does {NAME}} usually work for pay {counting
{all/both} {# of jobs from EMQ.040 IF MORE THAN TWO} jobs}?
{Have you/Has {NAME}} been actively looking for work in the past 4 weeks? By actively looking
for work, we mean activities such as checking with a public employment agency, a private
employment agency, or an employer directly; checking about jobs with friends or relatives;
placing or answering ads; sending a resume; contacting a school or university employment
center; or checking a union or professional register.
What {have you/has {NAME}} been doing in the past 4 weeks to find work?
What {were you/was {NAME}} doing most of last week? Would you say…
Keeping house, or caring for children or other family members,
Going to school,
Retired,
Unable to work, or
Something else? What was that? (SPECIFY)
Could {you/{NAME}} have taken a job last week if one had been offered?
For whom {do/does/did} {you/{NAME}} work {when {you/{he/she}}last worked}?
What kind of business or industry {is/was} this?
What kind of work {are/is/were/was} {you {NAME}} doing?
What {are/is/were/was} {your/{NAME}'s} most important activities or duties on this job? What
{do/does/did} {you/{NAME}} actually do at this job?
Which best describes {your/NAME'S} current employment situation? {Are you/Is {NAME}}…
working part-time,
working full-time,
a stay-at-home parent or guardian, or
not working?

Page 44 of 170

PQ1, PQ3
PQ1, PQ3
PQ1, PQ3
PQ1, PQ3
PQ1, PQ3

App B Spring 4th Parent Intervi
A

EMQ.210
223

EMQ.215

224

Welfare and
225 Other Public

WPQ.100

Transfers
WPQ.110
226

WPQ.170
PAQ.100

227

228

Parent Income
and Assets
PAQ.110

229

230

PAQ.120

{Since last spring/Since {CHILD} was born}, {have you/has {NAME}} served on active duty in the United States Census Bureau
U.S. Armed Forces, military Reserves, or National Guard? Active duty does not include training (modified)
for the Reserves or National Guard, but DOES include activation, for example, for the war in
Afghanistan.
{Are you/Is {NAME}} currently on active duty in the U.S. Armed Forces, military Reserves, or United States Census Bureau
National Guard?
(modified)
In the past 12 months, have you or anyone in your household received Temporary Assistance for ECLS-K:2011
Needy Families, sometimes called {TANF or} {STATE TANF PROGRAM NAME}?

Active duty military
service: since child
was born

PQ1, PQ3

Active duty military
service: current
Public assistance

PQ1, PQ3

In the past 12 months, have you or anyone in your household received food stamps, also called ECLS-K:2011
SNAP (the Supplemental Nutrition Assistance Program), or food benefits on EBT (Electronic
Benefit Transfer)?
Does {CHILD} receive complete school lunches for free or reduced price at school?
ECLS-K:2011
In studies like this, households are sometimes grouped according to income. What was the total ECLS-K
income of all persons in your household over the past year, including salaries or other earnings,
interest, retirement, and so on for all household members? Was it…
$25,000 or less, or
More than $25,000?

Public assistance

PQ1, PQ3

Was it…
$5,000 or less
$5,001 to $10,000
$10,001 to $15,000
$15,001 to $20,000
$20,001 to $25,000
$25,001 to $30,000
$30,001 to $35,000
$35,001 to $40,000
$40,001 to $45,000
$45,001 to $50,000
$50,001 to $55,000
$55,001 to $60,000
$60,001 to $65,000
$65,001 to $70,000
$70,001 to $75,000
$75,001 to $100,000
$100,001 to $200,000
$200,001 or more
What was your total household income last year, to the nearest thousand?

Page 45 of 170

PQ1, PQ3

Free/reduced lunch PQ1, PQ3
Annual family income PQ1, PQ3

ECLS-K

Annual family income PQ1, PQ3

ECLS-K

Annual family income PQ1, PQ3

App B Spring 4th Parent Intervi
A

Mobility and

ECLS-K
What is your current housing situation? Do you…
own your own house or condominium,
rent your house or apartment,
exchange services for housing,
not pay for housing,
live in temporary housing or a shelter,
live with a relative or in a dwelling owned by a relative (MAY OR MAY NOT CONTRIBUTE TO
EXPENSES OR CONTRIBUTION UNKNOWN), or
have another type of arrangement (SPECIFY)?

Housing

PQ1, PQ3

CMQ.010

Have you moved since {DATE OF LAST INTERVIEW}?

ECLS-K

Child Mobility

ECLS-K
ECLS-K

Child Mobility
Closing

NA
NA

231

232 Tracking

PAQ.140/140OS

Updates
233

CMQ.020/020OS Why did you move?
CMQ.060
Just to make sure I can reach you for the next interview, which will take place next school year,
I'd like to ask a few questions about how to find you.

234

Is there a second phone number, such as a work number, a friend or relative's number, or a
beeper or cell phone number, where you can sometimes be reached?
CMQ.100

Just to make sure I can reach you for the next interview, which will take place next school year,
I'd like to ask a few questions about how to find you. I have recorded {PHONE NUMBER} as a
second phone number where you can sometimes be reached. Is this the right number?

ECLS-K

Closing

CMQ.140
CMQ.150/155
CMQ.200

What is that telephone number?
Where is that telephone located?
I have recorded that {NAME OF RELATIVE/FRIEND}

ECLS-K
ECLS-K
ECLS-K

Closing
Closing
Closing

NA
NA
NA

ECLS-K

Closing

ECLS-K

Closing

ECLS-K
ECLS-K

Closing
Closing

NA
NA

235
236
237

at {PHONE NUMBER}
on
{STREET ADDRESS, LINE 1}
{STREET ADDRESS, LINE 2}
{CITY}
{STATE}
{ZIP CODE}

238

239
240
241
242

will always know where you are if you move. Is this still true?
Is there a relative or friend, who does not live in this household, who will always know where
you are if you move?
CMQ.210/220/23 What is the name, address, and telephone number of that person?
0/240/250/255/2
55OS/260/270
CMQ.280
What is the person's relationship to you?
CMQ.382
I have also recorded that your e-mail address is {EMAIL ADDRESS}. Is that correct?
CMQ.205

Page 46 of 170

App B Spring 4th Parent Intervi
A
243
244
245
246
247
248

CMQ.383
CMQ.384
CMQ.680
CMQ.690/690OS

Is there an e-mail address where we could reach you?
What is your e-mail address?
WAS THIS INTERVIEW CONDUCTED BY TELEPHONE OR IN-PERSON?
WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, A CHINESE LANGUAGE, VIETNAMESE,
OR ANOTHER LANGUAGE?
WHERE WAS THIS INTERVIEW CONDUCTED?
Thank you very much for your cooperation and for taking the time to participate in the Early
Childhood Longitudinal Study.
We would like to call the parent or guardian for {CHILD} at the household where {he/she} lives.
Could you please give me the name and telephone number for the home that I should call?

ECLS-K
ECLS-K
ECLS-K
ECLS-K

Closing
Closing
Closing
Closing

NA
NA
NA
NA

ECLS-K
ECLS-K

Closing
Closing

NA
NA

ECLS-K

Closing

We would like to call back when {this person/{CHILD}’s parent or guardian is available. Please
tell me when we should call back.
Thank you.
PRESS 1 AND ENTER TO SAVE AND EXIT THIS CASE.

ECLS-K

Closing

ECLS-K
ECLS-K

Closing
Closing

NA
NA

CMQ.695
CMQ.700
CMQ.701

249
250
251
252

CMQ.702
CMQ.703
CMQ.720

Page 47 of 170

Spring Fourth-Grade General Classroom Teacher Questionnaire, Appendix H
Section
Item #
Student, School, A1 a-d
and Staff Activities

A2 a-j

A3 a -j

Item Stem
Source
Which of the following subjects do you teach during ECLS-K:2011
this school year?
Grade 3

a. Reading/language arts
b. Mathematics
c. Science
d. Social studies
How often does the typical child in your class(es)
ECLS-K
usually work on lessons or projects in the following
general subject areas, whether as a whole class, in
small groups, or in individualized arrangements?
a. Reading and language arts
b. Mathematics
c. Social studies
d. Science
e. Music
f. Art
g. Physical education
h. Dance/creative movement
i. Theatre/creative dramatics
j. Foreign language (excluding English for ELL
students)

On days when children have work in these areas,
how much time does the typical child in your
class(es) usually work on lessons or projects in the
following general subject areas?
a. Reading and language arts
b. Mathematics
c. Social studies
d. Science
e. Music
f. Art
g. Physical education
h. Dance/creative dramatics
i. Theatre/creative dramatics
j. Foreign language (excluding English for ELL
students)

ECLS-K

A6 a-d

A7 a-i

Views on School
Climate and School
Environment

B1 a-h

How many days a week do children have recess?
ECLS-K
Zero; One; Two; Three; Four; Five; Other/Varies by
week
On days when children have recess, between the
ECLS-K
school day starting time and the dismissal time,
how many times a day do children have recess?
One; Two; Three; Four; Five; Other/Varies by day
What percentage of children in your class(es) have ECLS-K
parents who participate in the following activities?
a. Attend teacher-parent conferences
b. Volunteer regularly to help in your
classroom or another part of the school
c. Attend open houses or parties
d. Attend art/music events or demonstrations

How important is each of the following in
evaluating the children in your class(es) for
reporting to parents?
a. Individual child's achievement relative
to the rest of the class
b. Individual child's achievement relative
to local, state, or professional standards
c. Individual improvement or progress
over past performance
d. Effort
e. Class participation
f. Daily attendance
g. Classroom behavior or conduct
h. Cooperativeness with other children
i. Ability to follow directions

ECLS-K

ECLS-K
Please indicate the extent to which you agree or
disagree with each of the following statements
about your school.
a. The level of child misbehavior ) for example,
noise, horseplay, or fighting in the halls or cafeteria)
in this school interferers with my teaching.
b. Many of the children I teach are not capable of
learning the material I am supposed to teach them.
c. Parents are supportive of school staff.
d. There is a great deal of cooperative effort among
the staff members.
e. There is a consensus among administrators and
teachers on goals and expectations.
f. The academic standards at this school are too
low.

B2 a-e

Teacher
Background

g. The school administrator sets priorities, makes
plans, and sees that they are carried out.
h. The school administration's behavior toward the
staff is supportive and encouraging.
To what extent do you agree or disagree with the ECLS-K
following statements?
a. The attitudes and habits students bring
to my class﴾es﴿ greatly reduce their
chances for academic success.
b. My success or failure in teaching is due
primarily to factors beyond my control
rather than to my own effort or ability.
c. The amount a student can learn is
primarily related to family background.
d. I really enjoy my present teaching job.
e. If I could start over, I would choose
teaching again as my career.

What is your gender?

ECLS-K

In what year were you born?

ECLS-K

Are you Hispanic or Latino?

ECLS-K

Which best describes your race? MARK ONE OR
ECLS-K
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
ECLS-K
Counting this school year, how many years have
you taught each of the following grades and
programs, including years in which you taught part
time?
a. Preschool or kindergarten
b. First grade
c. Second grade
d. Third grade
e. Fourth grade
f. Fifth grade
g. Sixth grade or higher
h. English as a Second Language (ESL), bilingual
education, and/or dual language program
i. Special education program
j. Program for gifted children
Counting this school year, how many total years
ECLS-K
have you been a school teacher, including years in
which you taught part-time?

C5 a-j

C7
C8

C9 a-n

C10 a-n

Is this school year the first year you have taught in New
this school?
What is the highest level of education you have
ECLS-K
completed?
Did not complete high school; High school diploma
or equivalent/GED; Some college or technical or
vocational school; Associate's degree; Bachelor's
degree; Master's degree; An advanced professional
degree beyond a master's degree (for example,
Ph.D, MD)
If you have an associate's or bachelor's degree,
ECLS-K
indicate your undergraduate major field of study.
a. Early childhood education
b. Elementary education
c. English
d. Reading and/or language arts
e. Curriculum and instruction
f. Mathematics education
g. Mathematics
h. Science education
i. Life science
j. Physical science
k. Earth science
l. Special education
m. Other education-related major (for example,
secondary education, educational psychology,
administration, music education, etc.)
n. Non-education major (for example, history, etc.)
If you have a graduate degree, indicate the major ECLS-K
field of study of your highest level graduate degree.
a. Early childhood education
b. Elementary education
c. English
d. Reading and/or language arts
e. Curriculum and instruction
f. Mathematics education
g. Mathematics
h. Science education
i. Life science
j. Physical science
k. Earth science
l. Special education
m. Other education-related major (for example,
secondary education, educational psychology,
administration, music education, etc.)
n. Non-education major (for example, history, etc.)

C11 a-d

C12

C13

Have you ever taken a college course that
addressed issues related to the following?
a. Using published research evidence to identify
and select effective interventions and supports for
students
b. Using formal assessment data to inform the
choice of READING interventions and supports for
students
c. Using formal assessment data to inform the
choice of MATH interventions and supports for
students
d. Using data to inform the choice of behavioral
interventions and supports for students
Which of the following describes the teaching
ECLS-K
certificate you currently hold in THIS state?
Regular or standard certificate or advanced
professional certificate; Certificate issued after
satisfying all requirements except the completion of
a probationary period; Certificate that requires
some additional coursework, student teaching, or
passage of a test before regular certification can be
obtained; Certificate issued to persons who must
complete a certification program in order to
continue teaching; I do not hold any of the above
certifications in THIS state.

Date questionnaire completed

dix H
Construct
Subjects taught

Research
Question
TQ3

6/10/14 Comments

Use of class time, by subject area TQ1

added (es) in item stem.

Use of class time, by subject area TQ1

added (es) in item stem.

Class activities (outside of class)/
recess

TQ1

Class activities (outside of class)/
recess

TQ1

Parent involvement in school

TQ2

added (es) in item stem.

Methods of assessing children's
progress

TQ1

added (es) in item stem.

School climate

TQ4

Teacher’s sense of efficacy; Job
satisfaction

TQ4

Teacher demographic information TQ4
Teacher demographic information TQ4
Teacher demographic information TQ4
Teacher demographic information TQ4

Teaching experience, by grade and TQ4
program

Teaching experience, total years

TQ4

First year teaching in this school

TQ4

Teacher's education

TQ4

Teacher's education: major field of TQ4
study

Teacher's education: coursework ; TQ4
Response to Intervention-related
practices

Type of teaching certification held TQ4

N/A

Spring Fourth-Grade Reading and Language Arts Teacher Questionnaire, Appendix H
Section
Item #
Item Stem
Source
Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.
Social Skills
A1 a-z
Items focusing on general social skills in the
SSRS Elementary
classroom. Items not included due to copyright
Scale A; ECLS-K
restrictions (26 items total)
Please indicate how often each of these items
A2 a-g
Adapted from
applies to the child identified on the cover of this
Ladd & Price,
questionnaire.
1987; Ladd, 1990
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
Classroom
Behaviors

B1 a-m

Peer Relationships C1 a-i

TMCQ
Item about classroom behaviors. Items not
included due to copyright restrictions (13 items
total)
For the items below, please think about the friends Adapted from
with whom the child identified on the cover of this Vandell, 2001.
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."

a. This is a good group of kids
b. I worry when this child is with this group
c. Some of these kids are a bad influence
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
i. Most of these kids are kind to other children

C2 a-I

Items asking how often certain statements related
to the child's relationships with peers apply to the
child. Items not included due to copyright
restrictions (9 items total)

Adapted from the
Child Behavior
Scale. Gary W.
Ladd, 2010

C3 a-d

During this school year, how often have other
students…

Source: Adapted
from Espelage
and Holt, 2011

C4 a-d

C5 a-d

Student
Information

D1 a-d

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?
During this school year, how often has this
student…
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?

Source: Adapted
from Espelage
and Holt, 2001

Thinking about the child identified on the cover of Source: Pierce,
this questionnaire compared to a typical child in
Hamm, and
his/her grade, please evaluate this child in the
Vandell, 1999.
following areas.
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
Are you this child's primary teacher in the following ECLS-K
subject areas?
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies

How long has this child been in your
ECLS-K
reading/language arts class this school year until
now?
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

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

D4 a-c

Does this child receive (or has he/she received
ECLS-K
during this school year) instruction in any of the
following types of programs in your school?
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
ECLS-K
Is English this child's native language?

D5
D6

Does this child participate in an instructional
ECLS-K
program designed to teach English language skills to
children with limited English proficiency?

D8 a-c

D9 a-c

D10

D11

Would you say the instruction this child receives is Adapted from the
primarily …
"Types of
Programs that focus on developing students'
language
literacy in two languages. For example:
instruction
Two‐way immersion program or two‐way bilingual educational
program;
programs,"
Developmental bilingual program, late exit
provided by the
transitional program, or maintenance bilingual
National
education program;
Clearinghouse for
Transitional program, early exit bilingual program, English Language
or early exit transitional program;
Acquisition.
Heritage language program or indigenous language
program
Programs that focus on developing students'
literacy solely in English. For example:
Sheltered English instruction or content-based
English as a Second Language (ESL) program;
Structured English Immersion (SEI);
Pull-out English as a Second Language (ESL) or
English Language Development (ELD);
Push-in ESL program
Other program(s) (PLEASE SPECIFY);
No specialized language program is provided to
this child.
How often does this child usually receive specialized ECLS-K
language instruction of the following program
types?
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
ECLS-K
On the days when this child receives specialized
language instruction, for how much time does
he/she receive instruction of the following program
types?
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
During this school year, how often is this child's
reading instruction provided in his/her native
language?
None of the time; Less than half of the time;
Half of the time; More than half of the time;
Almost all the time
Does this child have an IEP on record with the
school?

ECLS-K

D12 a-b

D13 a-d

D14

Does this child receive instruction in any of the
ECLS-K
following types of programs in your school?
a. Speech‐language therapy for children with
speech or language disorders/impairments
b. Special education services, not including speech
therapy, whether provided in the classroom or in a
pull‐out setting
Overall, how would you rate this child’s academic ECLS-K
skills in each of the following areas, based on
curriculum standards for his/her current grade
level?
a. Reading
b. Writing
c. Oral language
d. Social studies
How often does this child work to the best of
ECLS-K
her/his ability in READING AND LANGUAGE ARTS?
Never; Seldom; Usually; Always

D15

How many instructional groups based on
achievement or ability levels in READING do you
currently have in this child's class?
I do not use instructional groups for reading; Two;
Three; Four; Five or more

ECLS-K

D16

In which reading instructional group is this child
currently placed? USE "1" FOR THE HIGHEST
INSTRUCTIONAL GROUP.
How involved at the school would you say this
child’s parents/guardians are?
Not involved at all; Somewhat involved; Very
involved; Don't know

ECLS-K

D17

ECLS-K

Part 2: To be completed only if there is a red dot next to the child's name on the cover of this questionnaire.

Reading and
Language Arts
Instruction

E1 a-i

From the first day of school until today, please
ECLS-K, updated
indicate on how many days you have covered each
to reflect
of the following READING AND LANGUAGE ARTS
"Common Core
skills and concepts in this child's class. Please
State Standards,"
include the time during which you provide direct
corestandards.org
instruction as well as the time you spend
supervising students as they work.
Literature
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. 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.
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.
Writing and Language
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.

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.

E2 a-k

Classroom and
Student
Characteristics

F1 a-c

f. Integrating knowledge and ideas, for example,
interpreting how charts, graphs, or timelines relate
to the text; integrating information from two texts
onb the same topic; etc.
Writing and Language
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.
How often do the children in this class engage in the ECLS-K, updated
following reading and language arts activities?
to reflect
a. Read silently
"Common Core
b. Read books they have chosen themselves
State Standards,"
c. Talk with others about what they have read
corestandards.org
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
them to their opposites ﴾antonyms﴿ and to words
with similar meanings ﴾synonyms﴿
h. When given specific questions, write responses
that are at least 3 to 4 sentences long
i. Gather evidence from literary or informational
texts ﴾in books and/or digital sources﴿ to inform
their writing
j. Spend extended time writing and revising text
that they have written
k. Edit their classmates' writing

As of today’s date, how many children…
a. Are currently enrolled in this class?
b. Are boys?
c. Are girls?

ECLS-K

F2 a-e

F3
F4 a-b

F5
F6 a-b

What grade levels are included in this class?
ECLS-K
a. 2nd grade or lower
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher
How many of the children in this class are repeating ECLS-K
their grade this year?
ECLS-K
How many children in this class…
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented
program?
ECLS-K
How many children in this class are absent on an
average day?
How many children in this class are below grade
ECLS-K
level, about on grade level, or above grade level in
their English reading skills and in social studies?
a. English reading skills?
b. Social studies?

At this point in the school year, how would you rate ECLS-K
the behavior of the children in this class?
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.

F8 a-d

Approximately what percentage of the students in New. From Abry,
this class demonstrate the following problems?
Swanson, & Fabes
a. Have difficulty paying attention in class
(2012)
b. Lack self‐control ﴾disruptive behavior﴿
c. Are rejected by peers
d. Do not accept authority

How many children in this class have a diagnosed ECLS-K
disability?
Do you have any children who are English language ECLS-K
learners in this class? (English language learners are
children whose native language is one other than
English and whose skills in listening, speaking,
reading, or writing English are such that they have
difficulty understanding school instruction in
English.)
How many English language learners (ELLs) do you ECLS-K
have in this class?

F10

F11

Classroom
Instruction and
Evaluation

G1 a-e

G2 a-b

G3 a-h

In a typical day, how much time do children in this
reading and language arts class spend in the
following activities?
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
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 THAN
YOURSELF WHO PROVIDE DIRECT INSTRUCTION
EITHER IN THIS CLASS OR IN A PULL-OUT SETTING.
EXCLUDE PARAPROFESSIONALS/AIDES.
a. A READING specialist/interventionist who has
specialized training in reading instruction
b. A special education teacher

ECLS-K:2011
Grade 1

Adapted from
Reading First
Impact Study-Teacher Survey

In this class, how frequently do you or your
ECLS-K
students use computers or the following electronic
devices for instructional purposes in reading and
language arts? Please include any desktop, laptop,
or other computer-type devices.
a. Computer ﴾desktop, laptop or
other computer‐type device
such as a tablet﴿
b. LCD or DLP projector
c. Interactive whiteboard ﴾for example, SMART
Board, Activboard﴿
d. Digital camera ﴾still or video﴿
e. CD player or MP3 player/iPod
f. DVD player or VCR
g. TV
h. Other electronic devices
(PLEASE SPECIFY)
ECLS-K
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.
0 days; 1 day; 2 days; 3 days; 4 days; 5 days
ECLS-K
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?
1 to 10 minutes; 11 to 20 minutes; 21 to 30
minutes; More than 30 minutes

Staff Activities

G6 a-e

In this class, how often do you use a formal
ECLS-K:2011
assessment in READING for the following purposes? Grade 1
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

G7 a-c

For each of the following statements about
Adapted from WA
READING, indicate how strongly you agree or
(RTI) and HB
disagree.
2136: Spring 2010
MARK ONE RESPONSE ON EACH ROW.
a. This school has a set of clear, predetermined,
grade‐level benchmarks ﴾that is, cut scores,
goals/targets, or percentiles﴿ that are used to
determine which students are struggling or at risk
of failure in reading in fourth grade.
b. This school has clear, predetermined criteria for
determining the level of intervention fourth‐grade
students will receive in reading.
c. This school has clear, predetermined criteria for
determining when fourth grade students no longer
need a reading intervention.

Did you participate in any professional
development within the the last 12 months?

H2 a-c

How often did you participate in professional
Adapted from
development activities covering the following topics Reading First
in the last 12 months?
Impact Study-a. How to use assessment data to identify students Teacher Survey
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

ECLS-K:2011
Grade 1

H3 a-d

Have you received support from any of the
ECLS-K:11 Grade 1
following staff members during the current
academic year?
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

Date Questionnaire Completed:

e, Appendix H
Construct

s questionnaire.
Social skills and approaches to
learning

Research
Question
TQ5

School liking and avoidance

TQ5

Social skills and approaches to
learning

TQ5

Peer relationships

TQ5

Peer acceptance/exclusion

TQ5

Target of victimization by other
students

TQ5

Victimization of other students by TQ5
this student

Peer relationships

TQ5

Grade/class configuration

TQ1

Family mobility

TQ3

Attendance

TQ3; TQ5

Receipt of remedial or gifted
services

TQ3; TQ7

Native language other than
English
Receipt of instruction for English
language learners

TQ2; TQ3
TQ1; TQ3

Receipt of instruction for English
language learners

TQ1; TQ3

Receipt of instruction for English
language learners

TQ1; TQ3

Receipt of instruction for English
language learners

TQ1; TQ3

Receipt of instruction for English
language learners

TQ1; TQ3

IEP status

TQ3; SEQ1

Receipt of special education
services

TQ1; TQ3; SEQ1

Comparison to peers: academic
TQ5
skills for current grade level in
reading, language arts, and social
studies

Working to the best of one's
ability

TQ5

Use of achievement grouping:
Reading

TQ1; TQ3

Placement in achievement
grouping: Reading

TQ5

Parent involvement in school
activities

TQ2

this questionnaire.

Time spent on specific activities TQ7
and skills in reading/language arts

Time spent on specific activities
TQ7
and skills in reading/language arts

Classroom characteristics:
enrollment, gender distribution

TQ1; TQ2

Classroom characteristics: grade
levels within class

TQ2

Classroom characteristics: number TQ2; TQ3
of repeaters
Classroom characteristics: number TQ3
of gifted and talented

Student absenteeism

TQ2

Students above or below grade
level in reading/social studies

TQ3

Overall behavior of the class

TQ2; TQ5

Classroom climate (student
difficulties)

TQ2; TQ5

Number of students with
disabilities
Number of English language
learners

TQ3

Number of English language
learners

TQ3

Proportion of time students spend TQ1
working independently, small
group, large group

Response to Intervention-related TQ6
policies and practices

Availability, use, and adequacy of TQ1
resources

Use of homework

TQ1

Use of homework

TQ1

Response to Intervention-related TQ6
policies and practices

Professional development
activities

TQ4

Professional development
activities; Response to
Intervention-related policies and
practices

TQ6

Response to Intervention-related TQ6
policies and practices

N/A

Spring Fourth-Grade Math Teacher Questionnaire, Appendix H
Section
Item #
Item Stem
Source
Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.
Student
A1 a-d
Are you this child's primary teacher in the following ECLS-K
Information
subject areas?
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies
A2
How long has this child been in your math class this ECLS-K
school year until now?
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

A4 a-b

A5
A6

Please indicate the total number of times this child ECLS-K
has been absent from your math class during the
current school year.
No absences; 1 to 4 absences; 5 to 7 absences;
8 to 10 absences; 11 to 19 absences; 20 or more
absences
ECLS-K
Does this child receive (or has he/she received
during this school year) instruction in any of the
following types of programs in your school?
a. Individual tutoring or remedial program in
mathematics
b. Gifted and talented program in mathematics
Is English this child's native language?
ECLS-K
During this school year, how often is this child's
ECLS-K
math instruction provided in his/her native
language?
None of the time; Less than half of the time; Half of
the time; More than half of the time; Almost all the
time
Overall, how would you rate this child’s academic ECLS-K
skills in math, based on curriculum standards for
his/her current grade level?
Below grade level; About on grade level; Above
grade level
How often does this child work to the best of
ECLS-K
her/his ability in MATH?
Never; Seldom; Usually; Always

How many instructional groups based on
achievement or ability levels in MATHEMATICS do
you currently have in this child's class?
I do not use instructional groups for mathematics;
Two; Three; Four; Five or more

ECLS-K

In which mathematics instructional group is this
ECLS-K
child currently placed? USE "1" FOR THE HIGHEST
INSTRUCTIONAL GROUP.
Part 2: To be completed only if there is a red dot next to the child's name on the cover of this questionnaire
A10

Mathematics
Instruction

B1 a-h

From the first day of school until today, please
ECLS-K, updated
indicate on how many days you have covered each
to reflect
of the following MATHEMATICS skills and concepts "Common Core
in this child's class. Please include the time during
State Standards,"
which you provide direct instruction as well as the corestandards.org
time you spend supervising students as they work.
Please focus on the skill areas that are shown in
bold text. ﴾The unbolded examples are only a
sample of things you may do or cover under this
skill area.﴿
a. Using operations to solve problems, for
example, solving problems by multiplying or
dividing two whole numbers; solving multiple‐step
word 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 writing multi‐ digit whole numbers; comparing
two numbers based on meanings of the digits in
each place; using understanding of place value to
round whole numbers to any place; etc.
d. Adding and subtracting multiple‐digit numbers
using 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.

B2 a-l

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.
How often do the children in this class engage in the ECLS-K, updated
following mathematics activities?
to reflect
a. Solve mathematics problems from textbooks or "Common Core
worksheets
State Standards,"
b. Solve mathematics problems from the
corestandards.org
blackboard, whiteboard/SMART Board®, or
projector
c. Solve mathematics problems in small groups or
with a partner
d. Work with measuring instruments ﴾for example,
rulers, compasses, protractors)
e. Work with manipulatives ﴾for example, geometric
shapes, fraction bars﴿
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
j. Work on and discuss mathematics problems that
reflect real‐life situations
k. Use a computer for math ﴾beyond using a
computer's calculator)
l. Create or interpret visual representations ﴾for
example, diagrams, graphs, tables, models﴿

Classroom and
Student
Characteristics

C1 a-c

C2 a-e

C3
C4 a-b

C5
C6

As of today’s date, how many children…
ECLS-K
a. Are currently enrolled in this class?
b. Are boys?
c. Are girls?
What grade levels are included in this class?
ECLS-K
a. 2nd grade or lower
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher
How many of the children in this class are repeating ECLS-K
their grade this year?
ECLS-K
How many children in this class…
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented
program?
ECLS-K
How many children in this class are absent on an
average day?
How many children in this class are below grade
ECLS-K
level, about on grade level, or above grade level in
mathematics skills?

At this point in the school year, how would you rate ECLS-K
the behavior of the children in this class?
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.

C8 a-d

Items asking the percentage of the students in the New. From Abry,
Swanson, & Fabes
classroom who demonstrate behaviors or
(2012)
characteristics that either disrupt or create a
challenging learning environment. Items not
included due to copyright restrictions (4 items
total).
How many children in this class have a diagnosed ECLS-K
disability?
Do you have any children who are English language ECLS-K
learners in this class? (English language learners are
children whose native language is one other than
English and whose skills in listening, speaking,
reading, or writing English are such that they have
difficulty understanding school instruction in
English.)
How many English language learners (ELLs) do you ECLS-K
have in this class?

C9
C10

C11

Classroom
Instruction and
Evaluation

D1 a-e

D2 a-b

D3 a-h

In a typical day, how much time do children in this ECLS-K:2011
math class spend in the following activities?
Grade 1
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
Do any of the following staff members provide
Adapted from
direct instruction to students in this math class who Reading First
are struggling or at risk of failure in math?
Impact Study-INCLUDE STAFF OTHER THAN YOURSELF WHO
Teacher Survey
PROVIDE DIRECT INSTRUCTION EITHER IN THIS
CLASS OR IN A PULL-OUT SETTING. EXCLUDE
PARAPROFESSIONALS/AIDES.
a. A math specialist/interventionist who has
specialized training in MATH instruction
b. A special education teacher
In this class, how frequently do you or your
ECLS-K
students use computers or the following electronic
devices for instructional purposes in math? Please
include any desktop, laptop, or other computertype devices.
a. Computer ﴾desktop, laptop or other computer‐
type device such as a tablet﴿
b. LCD or DLP projector
c. Interactive whiteboard ﴾for example, SMART
Board, Activboard﴿
d. Digital camera ﴾still or video﴿
e. CD player or MP3 player/iPod
f. DVD player or VCR
g. TV
h. Other electronic devices (PLEASE SPECIFY)
In an average week, how many days a week is math ECLS-K
homework assigned in this math class? Please count
homework assigned over the weekend as one day.
0 days; 1 day; 2 days; 3 days; 4 days; 5 days
On days when homework is assigned, how much
ECLS-K
time do you expect children in this class to spend on
homework in math?
1 to 10 minutes; 11 to 20 minutes; 21 to 30
minutes; More than 30 minutes

D6 a-e

D7 a-c

Staff Activities

E1
E2 a-c

In this class, how often do you use a formal
ECLS-K:2011
assessment in MATH for the following purposes?
Grade 1
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
For each of the following statements about MATH Adapted from WA
indicate how strongly you agree or disagree.
(RTI) and HB
a. This school has a set of clear, predetermined,
2136: Spring 2010
grade‐level benchmarks ﴾that is, cut
scores, goals/targets, or percentiles﴿ that are used
to determine which students are struggling or at
risk of failure in math in fourth grade.
b. This school has clear, predetermined criteria for
determining the level of intervention fourth‐grade
students will receive in math.
c. This school has clear, predetermined criteria for
determining when fourth-grade students no longer
need a math intervention.
Did you participate in any professional
ECLS-K:2011
development* within the last 12 months?
Grade 1
How often did you participate in professional
Adapted from
development activities covering the following topics Reading First
in the last 12 months?
Impact Study-a. How to use assessment data to identify students Teacher Survey
who are struggling or at risk of failure in MATH
b. How to use and apply assessment data
to guide MATH instruction
c. How to implement the MATH
curriculum

E3 a-d

Have you received support from any of the
ECLS-K:11 Grade 1
following staff members during the current
academic year?
a. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective MATH
instruction
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
d. A school or district staff member who supports
teachers in the interpretation and use of
assessment data to guide instruction

Date Questionnaire Completed:

Construct

Research
Question

s questionnaire.
Grade/class configuration

TQ1

Family mobility

TQ3

Attendance

TQ3; TQ5

Receipt of remedial or gifted
services

TQ3; TQ7

Native language other than
English
Receipt of instruction for English
language learners

TQ2; TQ3

Comparison to peers: academic
skills for current grade level in
math

TQ5

Working to the best of one's
ability

TQ5

TQ2; TQ3

Use of achievement grouping:
mathematics

TQ1; TQ3

Placement in achievement
grouping: mathematics

TQ5

his questionnaire

Time spent on specific activities
and skills in mathematics

TQ7

Time spent on specific activities
and skills in mathematics

TQ7

Classroom characteristics:
enrollment, gender distribution

TQ1; TQ2

Classroom characteristics: grade
levels within class

TQ2

Classroom characteristics: number TQ2; TQ3
of repeaters
Classroom characteristics: number TQ3
of gifted and talented

Students above or below grade
level
Student absenteeism

TQ3

Overall behavior of the class

TQ2; TQ5

Classroom climate (student
difficulties)

TQ2; TQ5

Number of students with
disabilities
Number of English language
learners

TQ3

Number of English language
learners

TQ3

TQ2

TQ3

Proportion of time students spend TQ1
working independently, small
group, large group

Response to Intervention-related TQ6
policies and practices

Availability, use, and adequacy of TQ1
resources

Use of homework

TQ1

Use of homework

TQ1

Response to Intervention-related TQ6
policies and practices

Professional development
TQ4
activities
Response to Intervention-related TQ6
policies and practices

Response to Intervention-related TQ6
policies and practices

N/A

Spring Fourth-Grade Science Teacher Questionnaire, Appendix H
Section
Item #
Item Stem
Source
Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.
Student
A1 a-d
Are you this child's primary teacher in the following ECLS-K
Information
subject areas?
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies
A2
How long has this child been in your science class ECLS-K
this school year until now?
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

A4
A5

Please indicate the total number of times this child ECLS-K
has been absent from your science class during the
current school year.
No absences; 1 to 4 absences; 5 to 7 absences; 8 to
10 absences; 11 to 19 absences; 20 or more
absences
Is English this child's native language?
ECLS-K
During this school year, how often is this child's
ECLS-K
science instruction provided in his/her native
language?
None of the time; Less than half of the time; Half of
the time; More than half of the time; Almost all the
time
Overall, how would you rate this child’s academic ECLS-K
skills in SCIENCE, based on curriculum standards for
his/her current grade level?
Below grade level; About on grade level; Above
grade level
ECLS-K
How often does this child work to the best of
his/her ability in SCIENCE?
Never; Seldom; Usually; Always

Part 2: To be completed only if there is a red dot next to the child's name on the
cover of this questionnaire.

Science Instruction

B1 a-h

From the first day of school until today, please
ECLS-K, updated to
indicate on how many days you have covered each reflect "Common
of the following SCIENCE skills and concepts in this Core State
child's class. Please include the time during which Standards,"
you provide direct instruction as well as the time
corestandards.org
you spend supervising students as they work.
Please focus on the skill areas that are shown in
bold text. ﴾The unbolded examples are only a
sample of things you may do or cover under this
skill area.﴿
Fields of Science
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.

Classroom and
Student
Characteristics

B2 a-l

How often do the children in this class engage in the ECLS-K, updated to
following science activities?
reflect "Common
a. Read a science textbook
Core State
b. Discuss science in the news
Standards,"
c. Generate and test hypotheses
corestandards.org
d. Work with other children on a science activity or
project
e. Use science equipment ﴾e.g., magnifying glass,
scales, thermometers﴿
f. Prepare a written science report
g. Engage in hands‐on activities or investigations
in science
h. Talk about measurements and results from
children’s hands‐on activities
i. Take a science test or quiz
j. Use library resources for science
k. Use computers for science
l. Use the Internet for science

C1 a-c

ECLS-K
As of today’s date, how many children…
a. Are currently enrolled in this class?
b. Are boys?
c. Are girls?
ECLS-K
What grade levels are included in this class?
a. 2nd grade or lower
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher
How many of the children in this class are repeating ECLS-K
their grade this year?
ECLS-K
How many children in this class…
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented
program?
How many children in this class are absent on an
ECLS-K
average day?
How many children in this class are below grade
ECLS-K
level, about on grade level, or above grade level in
science skills?

C2 a-e

C3
C4 a-b

C5
C6

Items asking the percentage of the students in the New. From Abry,
classroom who demonstrate behaviors or
Swanson, & Fabes
characteristics that either disrupt or create a
(2012)
challenging learning environment. Items not
included due to copyright restrictions (4 items
total).
How many children in this class have a diagnosed ECLS-K
disability?
Do you have any children who are English language ECLS-K
learners in this class? (English language learners are
children whose native language is one other than
English and whose skills in listening, speaking,
reading, or writing English are such that they have
difficulty understanding school instruction in
English.)
How many English language learners (ELLs) do you ECLS-K
have in this class?
In a typical day, how much time do children in this ECLS-K:2011 Grade
science class spend in the following activities?
1
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

C9
C10

C11
Classroom
Instruction and
Evaluation

D1 a-e

D2 a-b

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
PROVIDE DIRECT INSTRUCTION EITHER IN THIS
CLASS OR IN A PULL-OUT SETTING. EXCLUDE
PARAPROFESSIONALS/AIDES.
a. A SCIENCE specialist/interventionist who has
specialized training in science instruction
b. A special education teacher

Adapted from
Reading First
Impact Study-Teacher Survey

D3 a-h

D6 a-e

In this class, how frequently do you or your
ECLS-K
students use computers or the following electronic
devices for instructional purposes in science? Please
include any desktop, laptop, or other computertype devices.
a. Computer ﴾desktop, laptop or other computer‐
type device such as a tablet﴿
b. LCD or DLP projector
c. Interactive whiteboard ﴾for example, SMART
Board, Activboard﴿
d. Digital camera ﴾still or video﴿
e. CD player or MP3 player/iPod
f. DVD player or VCR
g. TV
h. Other electronic devices (PLEASE SPECIFY)
In an average week, how many days a week is
ECLS-K
science homework assigned in this class? Please
count homework assigned over the weekend as one
day.
0 days; 1 day; 2 days; 3 days; 4 days; 5 days;
On days when homework is assigned, how much
ECLS-K
time do you expect children in this class to spend on
homework in science?
1 to 10 minutes; 11 to 20 minutes; 21 to 30
minutes; More than 30 minutes
In this class, how often do you use a formal
ECLS-K:2011 Grade
assessment in SCIENCE for the following purposes? 1
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

Staff Activities

D7 a-c

For each of the following statements about SCIENCE Adapted from WA
indicate how strongly you agree or disagree.
(RTI) and HB 2136:
a. This school has a set of clear, predetermined,
Spring 2010
grade‐level benchmarks ﴾that is, cut scores,
goals/targets, or percentiles﴿ that are used to
determine which students are struggling or at risk
of failure in science in fourth grade.
b. This school has clear, predetermined criteria for
determining the level of intervention fourth‐grade
students will receive in science.
c. This school has clear, predetermined criteria for
determining when fourth-grade students no longer
need a science intervention.

Did you participate in any professional
ECLS-K:2011 Grade
development* within the last 12 months?
1
How often did you participate in professional
Adapted from
development activities covering the following topics Reading First
in the last 12 months?
Impact Study-a. How to use assessment data to identify students Teacher Survey
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

E2 a-c

E3 a-d

Have you received support from any of the
ECLS-K:11 Grade 1
following staff members during the current
academic year?
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
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

Date Questionnaire Completed:

Construct

Research
Question

questionnaire.
Grade/class configuration

TQ1

Family mobility

TQ3

Attendance

TQ3; TQ5

Native language other than
English
Receipt of instruction for English
language learners

TQ2; TQ3

Comparison to peers: academic
skills for current grade level in
science

TQ5

Working to the best of one's
ability

TQ5

TQ2; TQ3

Time spent on specific activities
and skills in science

TQ7

Time spent on specific activities
and skills in science

TQ7

Classroom characteristics:
enrollment, gender distribution

TQ1; TQ2

Classroom characteristics: grade
levels within class

TQ2

Classroom characteristics: number TQ2; TQ3
of repeaters
Classroom characteristics: number TQ3
of gifted and talented

Student absenteeism

TQ3

Students above or below grade
level in science

TQ2

Overall behavior of the class

TQ2; TQ5

Classroom climate (student
difficulties)

TQ2; TQ5

Number of students with
disabilities
Number of English language
learners

TQ3
TQ3

Number of English language
TQ3
learners
Proportion of time students spend TQ1
working independently, small
group, large group

Response to Intervention-related TQ6
policies and practices

Availability, use, and adequacy of TQ1
resources

Use of homework

TQ1

Use of homework

TQ1

Response to Intervention-related TQ7
policies and practices

Response to Intervention-related TQ6
policies and practices

Professional development
activities
Professional development
activities; Response to
Intervention-related policies and
practices

TQ4
TQ6

Response to Intervention-related TQ6
policies and practices

N/A

Spring Fourth-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix H
Item #
1

What is your gender?

Source
ECLS-K

In what year were you born?

ECLS-K

Are you Hispanic or Latino?

ECLS-K

Which best describes your race? MARK ONE OR MORE
ECLS-K
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
What is the highest level of education you have completed?
ECLS-K
Did not complete high school; High school diploma or
equivalent/GED; Some college or technical or vocational
school; Associate’s degree; Bachelor's degree; Master's
degree; An advanced professional degree beyond a master’s
degree ﴾for example, Ph.D., MD﴿

6
7

9 a-m

Item Stem

Is this school year the first year you have worked with children ECLSin this school?
K:2011
ECLS-K
Counting this school year, how many total years have you
been working with children receiving special education or
related services in any school, including years in which you
worked part time?
Counting this school year, how many total years have you
ECLS-K
been working with children in any school, including years in
which you worked part time? This would include other
assignments such as teaching in a regular classroom or
otherwise providing services to children.
Which of the following credentials, licenses, or certificates do ECLS-K
you have for working with children with disabilities? DO NOT
INCLUDE ACADEMIC DEGREES, SUCH AS A BACHELOR'S
DEGREE, MASTER'S DEGREE OR PH.D.
a. Emergency credential
b. Provisional or temporary credential
c. Disability‐specific credential or endorsement
d. Special education credential or endorsement ﴾for more
than one disability category﴿
e. General education credential
f. Speech/language therapy state license or certification
g. Physical therapy state license or certification
h. Occupational therapy state license or certification
i. Social work license or certification
j. School psychology license or certification
k. Clinical psychology license or certification
l. Certificate of Clinical Competence
m. Other professional license, credential, or endorsement
﴾PLEASE SPECIFY﴿

Have you taken the exam for National Board for Professional ECLS-K
Teaching Standards certification?
Not taken; Taken and passed; Taken and have not yet passed;
Taken and awaiting test results; Not applicable

11 a-r

Have you ever taken a college course in the following areas?
a. Early childhood education
b. Early childhood special education
c. Elementary education
d. Child development
e. English as a Second Language ﴾ESL﴿ or teaching English
language learners
f. General special education
g. Learning disabilities
h. Intellectual disability *
i. Orthopedic impairments
j. Serious emotional disturbance
k. Deafness and hearing
l. Blindness and vision
m. Communication disorders
n. Infants and toddlers with disabilities
o. Physical therapy
p. Occupational therapy
q. School psychology
r. Classroom management

12 a-d

ECLSHave you ever taken a college course that addressed issues
K:2011
related to the following?
Grade 1
a. Using published research evidence to identify and select
effective interventions and supports for students
b. Using formal assessment data to inform the choice of
READING interventions and supports for students
c. Using formal assessment data to inform the choice of MATH
interventions and supports for students
d. Using data to inform the choice of behavioral interventions
and supports for students
Which of the following best describes your current position in ECLS-K
this school?
Special education teacher; Special education teacher
consultant; General education teacher; Special education
classroom aide; Speech‐language pathologist; Physical
therapist; Physical therapy assistant or aide; Occupational
therapist; Occupational therapy assistant or aide; School
psychologist; School counselor; School social worker;
Other ﴾PLEASE SPECIFY﴿

ECLS-K

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

15 a-e

During this school year, where have you worked with children ECLS-K
with IEPs? INCLUDE ONLY CHILDREN WHO ATTEND THIS
SCHOOL.
a. In a general education classroom
b. In a special education classroom
c. In a non‐classroom space ﴾for example, office, therapy
room, small work space, mobile van, etc.﴿
d. In a location outside of the school setting ﴾for example, a
child's home, a private clinic, etc.﴿
e. Other ﴾PLEASE SPECIFY﴿
Please indicate the extent to which you agree or disagree with ECLS-K
each of the following statements.
a. I really enjoy my present job.
b. I am certain I am making a difference in the lives of the
children I work with.
c. If I could start over, I would choose this career again.
d. I am satisfied with my class size/caseload.

16 a-d

17 During the school year, how many children with IEPs have you ECLS-K
worked with or provided services for, on average, each week?
(Include children you work with directly, as well as children for
whom you consult with the general education teacher and/or
another special education teacher/service provider?
1‐10; 11‐20; 21‐40; More than 40; Don't know
18 Date questionnaire completed:

-Level Questionnaire, Appendix H
Research
Question
Construct
Teacher demographic information SEQ4
Teacher demographic information SEQ4
Teacher demographic information SEQ4
Teacher demographic information SEQ4

Teacher’s education

SEQ4

First year teaching in current school SEQ4
Teaching experience in special
education

SEQ4

Total years teaching experience

SEQ4

Teaching certification, credentials, SEQ4
and licenses

Teacher’s education

SEQ4

Teacher’s education; Response to
Intervention-related practices

SEQ4

Teaching position and assignment

SEQ4

Teaching position and assignment

SEQ4

Locations in which teacher delivers SEQ1, SEQ3,
services
SEQ5

Teacher’s sense of efficacy; Job
satisfaction

SEQ4

Teaching student caseload

SEQ4, SEQ5

N/A

Spring Fourth-Grade Special Education Teacher Child-Level Questionnaire, Appendix H
Item #

Item Stem

Source

Is this child currently receiving gifted/talented services through an IEP, or has the
child received such services during this school year?
Is this child currently receiving special education services through an IEP due to a
disability or has the child received such services during this school year?
In what capacity or capacities do you teach or provide services to this child?
a. Provide instruction directly to the child
b. Provide related services directly to the child
c. Provide consultation services directly to the child
d.Provide indirect consultation services ﴾for example, consultation to the child's
teacher﴿
e. Provide case management
f. Other ﴾PLEASE SPECIFY﴿
When was this child first determined eligible for special education or related
services?
Before kindergarten; During kindergarten; During first grade; During second
grade; During third grade; During fourth grade; Other ﴾PLEASE SPECIFY﴿;
Don't know
Is this the first school year that the child has been receiving special education
services?
When did this child first start receiving special education or related services?
Before kindergarten; During kindergarten; During first grade; During second
grade; During third grade; Other (PLEASE SPECIFY); Don't know
To what extent were you involved in planning the transition from last year's
special education program to this year's special education program for this child?
Not at all; Somewhat; Extensively

ECLS-K

To what extent did you communicate with the person(s) who provided special
education for this child last year?
Not at all; Somewhat; Extensively; I provided special education for this child last
year.
Have you reviewed this child’s records related to special education services
provided before this school year?
Yes; No, I don't have access to the records; No, I have access to the records, but
have not reviewed them; No, I provided special education to this child last year

ECLS-K

2
3 a-f

5
6

ECLS-K
ECLS-K

ECLS-K

ECLS-K
ECLS-K

ECLS-K

What is this child’s primary disability as identified on the child’s IEP? PLEASE
ECLS-K
SELECT THE CATEGORY BELOW INTO WHICH THE CHILD'S PRIMARY DISABILITY
FITS BEST.
Speech or language impairments; Specific learning disabilities; Emotional
disturbance; Intellectual disability *; Developmental delay; Visual
impairments ﴾including blindness﴿; Hearing impairments ﴾including deafness﴿;
Orthopedic impairments; Other health impairments; Autism; Traumatic brain
injury;
Deaf‐blindness; Multiple disabilities (children included in this categry should be
those who have more than one primary disability which do not include deafblindness or developmental delay); No classification is given
THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD'S SPECIAL EDUCATION EXPERIENCE

11 a-n

13 a-p

During this school year, for which of the following disabilities has this child
received special education or related services, whether for the child’s primary
disability or another of his/her disabilities?
a. Speech or language impairments
b. Specific learning disabilities
c. Emotional disturbance
d. Intellectual disability *
e. Developmental delay
f. Visual impairments ﴾including blindness﴿
g. Hearing impairments ﴾including deafness﴿
h. Orthopedic impairments
i. Other health impairments
j. Autism
k. Traumatic brain injury
l. Deaf‐blindness
m. Multiple disabilities (children included in this category should be those who
have more than one primary disability which do not include deaf-blindness or
developmental delay)
n. No classification given.
During this school year, has this child received any special education or related
services because of a diagnosed Attention Deficit Disorder (ADD) or Attention
Deficit Hyperactivity Disorder (ADHD)?
During this school year, which of the following describe(s) the IEP goals for this
child?
Academics
a. Reading
b. Mathematics
c. Language Arts
d. Science
Speech and language
e. Auditory processing
f. Listening comprehension
g. Oral expression
h. Voice/speech articulation
i. Language pragmatics
Social
j. Social skills
k. General appropriateness of behavior
Life skills
l. Adaptive behavior or self-help skills
Physical/Mobility
m. Fine motor skills
n. Gross motor skills
o. Orientation and mobility
Other
p. Other (PLEASE SPECIFY)

ECLS-K

14 a-m

15 a-n

16
17

During this school year, which of the following related services have been
ECLS-K
provided through the school to this child?
a. Audiology
b. Counseling services
c. Occupational therapy
d. Physical therapy
e. Psychological services
f. Health services
g. Social work services
h. Special transportation
i. Speech or language therapy
j. Orientation services
k. Mobility services
l. Rehabilitation services
m. Other ﴾PLEASE SPECIFY﴿
During this school year, has this child received any of the following?
ECLS-K
a. Adaptive physical education
b. Assistance from classroom aides ﴾for example, teacher aide,
behavioral assistant, special education aide﴿
c. Interpreter for the deaf or hard of hearing ﴾oral or sign﴿
d. Teacher used Braille to provide instruction
e. Child was taught how to use Braille
f. Teacher used American Sign Language to provide instruction
g. Child was taught how to use American Sign Language
h. Teacher used Manual English to provide instruction
i. Child was taught how to use Manual English
j. Teacher used Cued Speech to provide instruction
k. Child was taught how to use Cued Speech
l. Mental health services, personal/group counseling, therapy, or
psychiatric care provided to the child
m. Tutoring/remediation from special education teacher
n. Training, counseling, and other supports/services provided to
this child's family
ECLS-K
During this school year, has this child’s primary placement been a general
education classroom?
During this school year, approximately how many hours per week of direct special ECLS-K
education and related services (that is, service provided directly to the child, from
a teacher or another adult) has this child received?
Of the hours of direct special education and related services reported above,
ECLS-K
approximately how many of those hours per week were the instruction/services
provided outside of a general education classroom but within the school setting?

19 a-l

During this school year, what teaching practices and methods have you and/or
ECLS-K
other special education service providers used with this child?
a. One‐on‐one instruction
b. Small‐group instruction
c. Large‐group instruction
d. Co‐teaching ﴾see definition above﴿
e. Cooperative learning
f. Peer tutoring
g. Computer‐based instruction
h. Direct instruction
i. Cognitive strategies
j. Self‐management
k. Behavior management
l. Instruction received through a sign interpreter
During this school year, which of the following best describes the curriculum
ECLS-K
materials used with this child in the general education classroom?
General education curriculum materials were used without modification; General
education curriculum materials were used with some modifications;
General education curriculum materials were used with substantial modifications;
Specially‐designed commercial materials were used; Teacher ‐designed materials
were used; Child not in this setting; Don't know
During this school year, which of the following best describes the curriculum
ECLS-K
materials used with this child in the special education classroom/program?
General education curriculum materials were used without modification;
General education curriculum materials were used with some modifications;
General education curriculum materials were used with substantial modifications;
Specially‐designed commercial materials were used; Teacher ‐designed materials
were used; Child not in this setting; Don't know
During this school year, has this child had the assistance of a service animal while ECLS-K:2011
at school? A SERVICE ANIMAL IS ANY GUIDE DOG, SIGNAL DOG, OR OTHER DOG
INDIVIDUALLY TRAINED TO PROVIDE ASSISTANCE TO AN INDIVIDUAL WITH A
DISABILITY. SERVICE ANIMALS CAN BE USED FULL TIME OR IN-SCHOOL ONLY AS
PART OF A PROGRAM SUCH AS ANIMAL ASSISTED THERAPY (AAT).
Yes, this child has been assisted by his/her own service dog at school;
Yes, this child has been assisted by a service dog provided by a school program;
No, this child has not been assisted by a service dog at school;

23 a-z

24
25

During this school year, which of the following assistive technologies and devices ECLS-K
has this child used?
Mobility aids
a. Vans, vehicles
b. Wheelchair
c. Walker
d. White cane
Communication aids
e. Electronic with voice output ﴾for example, Touch Talker﴿
f. Electronic without voice output ﴾for example, device with visual display or
printed speech output﴿
g. Non‐electronic ﴾for example, manual printing board﴿
Hearing assistance
h. Hearing aids
i. FM loops
j. TTYs/TDDs
k. Cochlear implants
l. Real‐time captioning
Visual aids
m. Braille texts
n. Electronic Braille devices
o. Digital texts
p. Magnifying devices
q. Close‐captioned television ﴾CCTV﴿
Learning aids (non-computer)
r. Tape recorder
s. Calculator
t. Electronic spelling devices
Computer hardware designed or adapted for children with disabilities (for
example, alternate keyboards, switch interface)
u. Used solely by individual child
v. Shared with other children
Computer software designed for children with disabilities
w. Reading
x. Writing
y. Mathematics
Other assistive technologies or devices
z. Other (PLEASE SPECIFY)
ECLS-K
Does this child have a computer, laptop, or word processing device assigned to
him/her for use full time this school year?
During this school year, on average, how often have you met with general
ECLS-K
education teacher﴾s﴿ to discuss this child's program or progress?
Not applicable because I am the child's general education teacher; Not applicable
to my work with this child; Every day or several times a week;
Once a week or several times a month; Once a month; A few times over the
school year; Once during this school year; Never during this school year
On average, how long were the meetings with the general education teacher﴾s﴿ to ECLS-K
discuss this child's program or progress?
1 to 15 minutes ; 16 to 30 minutes; 31 to 45 minutes; 46 to 60 minutes; More than
60 minutes

28 a-h

33
34

During this school year, approximately how often have you communicated with
ECLS-K
this child's parents about this child's program or progress ﴾by phone, in person, or
in writing, including e‐mail﴿?
Every day or several times a week; Once a week or several times a month; Once a
month; A few times over the school year; Once during this school year; Never
during this school year
During this school year, has this child received formal individual evaluations in any ECLS-K
of the following areas for purposes of developing IEP goals?
a. Psychological
b. Speech/language
c. Vision
d. Hearing
e. Learning style
f. Motor skills
g. Academics
h. Other ﴾PLEASE SPECIFY﴿
To what extent is this child expected to achieve the same general education goals ECLS-K
as other children at his/her grade level this school year?
Child is expected to attain grade level achievement for all of the academic content
standards; Child is expected to attain grade level achievement for some of the
academic content standards; Child is expected to attain grade level achievement
for only a few of the academic content standards; Child is not expected to attain
grade level achievement for any of the academic content standards; There are no
academic content standards at this grade level; Don't know
What percentage of this child's current IEP goals have been met or nearly met at ECLS-K
this point in the school year?
76 to 100 percent; 51 to 75 percent; 26 to 50 percent; 1 to 25 percent;
0 percent
Which of the following best expresses the likelihood that this child will continue to ECLS-K
receive some level of special education services ﴾through an IEP﴿ in the next
school year?
Definitely will continue in special education; Very likely to continue in special
education; Rather likely to continue in special education; Rather unlikely to
continue in special education; Very unlikely to continue in special education;
Definitely will not continue in special education (will be dismissed from services)
During this school year, to what extent has this child participated in any grade‐
ECLS-K
level assessment administered as part of the school's testing program?
Child did not participate in the school's testing or assessment program; Child
participated in alternate assessments and no regular assessments; Child
participated in some alternate assessments and some regular assessments;
Child participated fully in the school's regular testing or assessment program;
There is no testing or assessment program at this grade level; Don't know
Did this child receive special accommodations to participate in the school's regular ECLS-K
testing or assessment program this school year?
ECLS-K
In which grade is this child enrolled?
Kindergarten; First grade; Second grade; Third grade; Fourth grade; Fifth grade or
higher; This child is in an ungraded classroom
Date Questionnaire Completed:

Appendix H
Construct
Child's receipt of services:
gifted/talented
Child's receipt of services: special
education
Type of special education services

Research
Question
SEQ1
SEQ1
SEQ1

Length of diagnosis and services

SEQ7

Age/Grade of first IEP and services for
child
Age/Grade of first IEP and services for
child

SEQ7

Transition activities

SEQ1

Transition activities

SEQ1

Transition activities

SEQ1

Child’s disability

SEQ2

XPERIENCE DURING THE CURRENT SCHOOL YEAR.

SEQ7

Child’s disability

SEQ2

Child's disability

SEQ2

IEP goals

SEQ5

Type of special education services

SEQ1, SEQ2

Type of special education services

SEQ1, SEQ2

Child’s classroom placement

SEQ1;SEQ3,
SEQ5
Frequency of special education services SEQ1

Frequency of special education services: SEQ1, SEQ3
outside general education classroom

Teaching methods and materials

SEQ1, SEQ2

Teaching methods and materials

SEQ1, SEQ2

Teaching methods and materials

SEQ1, SEQ2

Teaching methods and materials:
assistive technology

SEQ1, SEQ2

Teaching methods and materials:
assistive technology

SEQ2, SEQ5

Teaching methods and materials:
assistive technology
Staff communication

SEQ5, SEQ7

Staff communication

SEQ5, SEQ7

Parent communication

SEQ6

Participation in assessment

TQ3, SEQ5,
SEQ7

Expectation for achievement of general
education goals

TQ3, SEQ5

IEP goal achievement

SEQ1; SEQ7

IEP goal achievement

TQ3, SEQ7

Participation in assessment

TQ3, SEQ3,
SEQ5

Participation in assessment: special
accommodations
Current grade level

TQ3, SEQ3,
SEQ5
N/A

N/A

Spring Fourth-Grade School Administrator Questionnaire For New Schools, Appendix H
Section
School
Characteristics

Item #
A1

A2 a-d

A4
A5

A8 a-h

A10 a-c

A11

School-FamilyCommunity
Connections

B1 a-f

B2 a-b

B5 a-b

B6 a-f

B7 a-i

B8 a-g

B9 a-f

B10 a-k

B11

B12
School Policies
and Practices

C1
C2
C3

C4 a-d

C6 a-d

C8 a-d

C10 a-b

C11

School Programs D1
for Particular
Populations
D2

D4 a-c

D7a-b

D8 a-e

Federal
Programs: Title
I, Adequate
Yearly Progress,
and Title III
E1
E2
E3
E4

Staffing and
Teacher
Characteristics

F1 a-f

F2 a-h

F3 a-e

F4 a-b

F5 a-b

School
Administrator
Characteristics

G5 a-c

G6 a-f

G8 a-f

G10

G11

G12

G13

G14

rth-Grade School Administrator Questionnaire For New Schools, Appendix H
Item Stem
Source
How many instructional days will this school provide during this academic year? IF THIS IS ECLS-K
A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF INSTRUCTIONAL DAYS A
GIVEN CHILD WOULD ATTEND.C15
School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE ECLS-K
FOLLOWING.
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. Total enrollment for your school (across all grades) around October 1, 2014, or the date
nearest to that for which data are available
c. Number of children who have enrolled in your school Sicne October 1, 2014
d. Number of children who have left your school since October 1, 2014, and have not
returned
Approximately, what is the Average Daily Attendance for your school this year? WRITE IN ECLS-K
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.
Mark all grade levels included in your school.
ECLS-K
Which of the following characterizes your school? MARK ALL THAT APPLY.

ECLS-K

Regular public school (not including magnet school)
Public magnet school
Charter school
Catholic school: Diocesan; Parish; Private order
Other private school, religious affiliation
Private school affiliated with NAIS, no religious affiliation
Other private school, no religious or NAIS affiliation
Early childhood center (school/center includes preschool and/or early grades)
Special education school -- primarily serves chldren with disabilities
Year-round school
Bureau of Indian Education (BIE) or tribal school
IF YOU MARKED "CHARTER SCHOOL" IN Q 15, GO TO Q A6. IF YOU DID NOT MARK
"CHARTER SCHOOL," THEN SKIP TO Q A8.
In what year did this school start providing instruction as a public CHARTER school?

ECLS-K

Which of the following characterizes your public CHARTER school? For profit; Not for
profit

ECLS-K

ECLS-K
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 SHOUD ADD TO YOUR TOTAL SCHOOL ENROLLMENT OR THE
PERCENT COLUMN SHOULD ADD TO 100%.
a. Hispanic/Latino of any race
b. American Indian or Alaska Native, not Hispanic or Latino
c. Asian, not Hispanic or Latino
d. Black or African American, not Hispanic or Latino

e. Native Hawaiian or Other Pacific Islander, not Hispanic or Latino
f. White, not Hispanic or Latino
g. Two or more races, not Hispanic or Latino
h. Total school enrollment (sum of a through g)
If your school is a private, magnet, or charter school, please check here and SKIP TO Q A11. ECLS-K:2011
Grade 1
About what percentage of the children enrolled in this school attend from outside of this
school’s assigned attendance area because….

ECLS-K

a. They have special needs (gifted and talented, children with disabilities, etc.) and attend
to receive a specialized program or service?
b. They transferred into the school because their previous school did not make adequate
yearly progress (AYP)? (Adequate yearly progress is your state's measure of yearly
progress toward achieving state academic standards.)
c. They attend this school under public school choice for reasons other than their assigned
school did not make AYP (that is, excluding those who are reported in b)?
About what percentage of the children enrolled in this school are eligible for free or
reduced-price lunch?

ECLS-K

Please indicate how often each of the following activities is provided by your school.

ECLS-K

a. PTA, PTO, or Parent-Teacher-Student organization meetings
b. Reports (report cards) of chldren's performance provided to parents
c. Information on the child's standardized assessment scores provided to parents
d. Teacher-parent conferences
e. School performances to which parents are invited
f. Classroom programs like class plays, book nights, or family math nights
During this school year, how often has your school used the following ways to
ECLS-K:2011
communicate with all parents?
a. Electronic communication to all parents, such as group emails, electronic newsletters,
website postings, "robocalls" (mass automated phone calls), text alerts, or other electronic
notices for all parents
b. Non-electronic communications to all parents, such as letters, newsletters, phone calls,
or other non-electronic messages for all parents
During this school year, has your school used an online tool or website that is available to ECLS-K:2011
the general public and that parents can access without a login or password?
During this school year, has your school (or any teacher)) used an online tool or website
ECLS-K:2011
that parents can only access with a login or password to get information about their child,
the child's class, or the school?

Have the following types of information been provided in the online tool or website that
parents can only access with a login and password?
a. Classroom-specific assignments, including homework

ECLS-K:2011

b. Child- or parent-specific information, such as progress reports between grading periods
How much of a problem are the following in the neighborhood where this school is
ECLS-K
located?
a. Tensions based on dracial, 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
To the best of your knowledge how often do the following types of problems occur at your ECLS-K
school?
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. Class cutting
Does your school take any of the following measures to ensure the safety of children?
ECLS-K
a. Security guards, unarmed
b. Security guards, armed
c. Metal detectors
d. Locked doors during the school day
e. A requirement that visitors sign in
f. Intercoms or telephones in classrooms
g. Other (PLEASE SPECIFY)
To what extent is each of the following matters a problem in this school? Indicate whether ECLS-K
each is a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a problem in
this school.
a. Student tardiness
b. Student absenteeism
c. Student aggressive or disruptive behavior
d. Teacher absenteeism
e. Teacher turnover
f. Overcrowding
During the past year, to what extent did any of the following changes occur at your school? ECLS-K
a. Funding levels decreased
b. Enrollment increased
c. Enrollment decreased
d. The number of students receiving free or reduced-price lunch increased
e. Student mobility increased (that is, the number of students transferring in and out of
the school increased)
f. There has been a reduction in staffing
g. Class sizes increased
h. Class sizes decreased

i. Salaries increased
j. Salaries decreased
k. Number of English language learners increased
During the past year, were salaries frozen at your school?

ECLS-K:2011
Grade 1

IF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO C1. IF YOUR
SCHOOL IS NOT A PRIVATE, MAGNET OR CHARTER SCHOOL, GO TO Q B12.
During the past year, were changes made to your school's assigned attendance area?

ECLS-K:2011
Grade 1
How many third-grade children were retained at their current grade level last school year? ECLS-K
ECLS-K
How many fourth-grade children were retained at their current grade level last school
year?
Adapted from
Is a school-wide positive behavioral intervention and support program (for example,
Positive Behavioral Support, Positive Behavioral Intervention System) implemented at your FRSS 99
Dropout
school?
Prevention
Services and
Programs
survey
For each of the following statements about READING and MATH, indicate how strongly you Adapted from
agree or disagree.
WA (RTI) and
HB 2136:
For READING
Spring 2010
a. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut
scores, goals/targets, or percentiles) that are used to determine which students are
struggling or at risk of failure in READING.
b. At this school, we use data from screening tests to determine if core instruction in
READING is meeting the needs of most of our students.
For MATH
c. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut
scores, goals/targets, or percentiles) that are used to determine which students are
struggling or at risk of failure in MATH.
d. At this school, we use data from screening tests to determine if core instruction in
MATH is meeting the needs of most of our students.
Is Response to Intervention (RtI) currently used at your school in fourth grade, either
Adapted from
partially or fully implemented? RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP
IDEA national
APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND
Assessment
MONITORING WITHIN THE GENERAL EDUCATION SETTING.
Implementatio
n Study (LEA)
Is RtI currently implemented at your school in fourth grade in the following areas?
Adapted from
IDEA national
a. Math
Assessment
b. Reading
Implementatio
c. Writing
n Study (LEA)
d. Behavior/Social skills
Approximately how many years ago did your school begin implemementing RtI in fourth
ECLS-K:2011
grade in any subject? Less than 1 year ago; 1 to 2 years ago; More than 2 years ago
Grade 1
For the 2014-2015 school year, how has your school made information available to
Adapted from
parents/guardians to help them understand how RtI is being implemented in your school? IDEA national
Assessment
a. Communication through written materials such as letters, email, school website, or
Implementatio
newsletters
n Study (LEA)

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
Has your school implemented the Common Core State Standars at any grade(s)?

Are the Common Core State Standares currently implemented at your school in fourth
grade in the following areas?

Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)

ECLS-K:2011

a. Reading and Language Arts
b. Mathematics
Approximately how many years ago did your school begin implementing the Common Core ECLS-K:2011
State Standards in any grade or subject? Less than 1 year ago; 1 to 2 years ago; More
than2 years ago
Do any of the children in this school come from a home where a language other than
ECLS-K
English is spoken?

What percentage of children in this school are English language learners (ELL)?

ECLS-K

What percentage of children in fourth grade are English language learners (ELL)?

ECLS-K

Are any of the following services provided to families of children from households where a ECLS-K
language other than English is spoken?
a. Translators are made available to parents for parent/teacher and parent/school staff
meetings and/or meetings are conducted in the parents' non-English language.
b. Translations of written communications are provided to these parents.
c. Home visits are made to families of these children.
Since the beginning of this school year (2014-2015), how many students have been NEWLY Adapted from
evaluated at your school to determine if they are eligible for an IEP?
IDEA national
Assessment
Implementatio
n Study (LEA)
Of those students who have been NEWLY evaluated at your school this school year (2014- Adapted from
2015), how many were found eligible for an IEP, including those who may have an IEP for IDEA national
speech only?
Assessment
Implementatio
n Study (LEA)
What method(s) are used in your school to determine special education ELIGIBILITY for
Adapted from
students with learning disabilities? IF A COMBINATION OF THESE METHODS IS USED AT
IDEA national
YOUR SCHOOL, MARK YES FOR BOTH A AND B. RESPONSE TO INTERVENTION (RTI) IS A
Assessment
MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE
Implementatio
INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING.
n Study (LEA)
a. IQ-achievement discrepancy model which shows whether there is a discrepancy
between expected performance and actual performance

n Study (LEA)

b. Response to Intervention (RtI) model
Approximately what percentage of your fourth-graders are in each of the following
instructional programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND
INDICATE IF THE PROGRAM IS NOT OFFERED IN FOURTH GRADE OR IN ANY GRADE IN
YOUR
SCHOOL.
a. Special
education with an Individualized Education Program (IEP)

ECLS-K

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
Where are children with Individualized Education Programs (IEPs) typically served in this
ECLS-K
school? 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
The following items pertain to public schools only. IF YOURS IS A PRIVATE SCHOOL CHECK ECLS-K:2011
HERE.

Did your school receive Federal Title I funds for this school year?

ECLS-K:2011

Is your school operating a Title I targeted assistance or schoolwide program? Targeted
assistance program; Schoolwide program
Did your school receive Federal Title III funds for this school year? (Title III is “Language
Instruction for Limited English Proficient and Immigrant Students.”)
At the end of the LAST school year (2013-2014), did this school make Adequate Yearly
Progress (AYP)? (Adequate Yearly Progress is your state’s measure of yearly progress
toward achieving state academic standards.)

ECLS-K:2011
ECLS-K:2011

ECLS-K:2011,
based on NCLB
Title I
regulations
At the end of the LAST school year (2013-2014), was this school identified for improvement ECLS-K:2011,
due to Adequate Yearly Progress (AYP) requirements? (A school is identified for
based on NCLB
improvement if it does not make Adequate Yearly Progress for two consecutive years or
Title I
more in the same
regulations
content area.)
Approximately how many staff members does your school currently have in the following ECLS-K
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.
a. Regular classroom teachers
b. ESL/bilingual education/language immersion/ELL instruction teachers
c. Drama, music, or art teachers
d. Gym/PE or health teachers
e. Special education teachers and related service providers (for example, speech therapist,
physical therapist, adaptive physical education, etc.)
f. Paraprofessionals (for example, classroom aides)
Does your school currently have any staff members (full- or part-time) in the following
ECLS-K:2011,
categories? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR
Grade 1
SCHOOL.

ECLS-K:2011,
Grade 1
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
Does your school currently have any staff members who do the following as their primary ECLS-K
role or one of their primary roles? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF
MEMBERS AT YOUR SCHOOL.
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
Please indicate the number of regular classroom teachers who have joined or left your
ECLS-K
school since October 1, 2014.
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
Are monetary incentives such as cash bonuses, salary increases, or different steps on the
salary schedule used in your school to reward teachers for...
a. Improved student performance on state tests?
b. Reaching target goals on state tests?
Did this school's principal (or head administrator) complete the majority of the previous
sections or was the majority completed by someone else?

ECLS-K:2011,
Grade 1

If a person other than the school's principal (or head administrator) has completed the
previous sections, please write in the name and title of the person who completed the
majority of the sections.
How long has the individual listed above been employed at this school?

ECLS-K

What is your gender?

ECLS-K

In what year were you born?

ECLS-K

Are you Hispanic or Latino?

ECLS-K

Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT
ECLS-K
YOU CONSIDER YOURSELF TO BE. American Indian or Alaska Native; Asian; Black or African
American; Native Hawaiian or Other Pacific Islander; White
How many years of experience do you have in each of the following positions, including
ECLS-K:2011,
years in which you worked part time?
Grade K
a. Years as a teacher before becoming a school administrator
b. Total numbers of years as a school administrator
c. Number of years as school administrator at this school
Through which, if any, of the types of training programs below did you receive preparation ECLS-K
for fulfilling your role as a school administrator?
a. Traditional university-based training and certification program
b. District-based training program (for example, the Boston Principal Fellowship, New York
City Leadership Academy's Aspiring Principals Program, Chicago's LAUNCH program)
c. City-based training program (for example, Cleveland's First Ring Leadership Academy )
d. State-based training program (for example, New Jersey EXCEL)
e. Training and/or certification program run by a national non- profit organization (for
example, KIPP School Leadership Program, New Leaders for New Schools)
f. Another school administration preparation program
ECLS-K
What is the highest level of education you have completed? High school diploma or
equivalent/GED; Associate's degree; Bachelor's degree; At least one year of coursework
beyond a Bachelor's degree but not a graduate degree; Master's degree; Education
specialist or professional diploma based on at least one year of coursework past a Master's
degree level; Doctorate or an advanced professional degree beyond a Master's degree (for
example, MD, EdD)
What was your major field(s) of study in the highest degree you completed?
ECLS-K
a. Early childhood education
b. Elementarty education
c. Education administration/management
d. Special education
e. Other education-related major (such as secondary education, educational psychology,
science education, music education, etc.)
f. Non-education major (such as history, English, etc.)
What is your best estimate of the percentage of children in your school you know by
ECLS-K
name? Nearly every child; 75% or more; 51% to 75%; 26% to 50%; 25% or less
During school hours, do you speak a language other than English with students at your
school whose native language is not English?

ECLS-K

Do you speak a language other than English with students’ families whose native language ECLS-K
is not English?
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.

ECLS-K

What language(s) other than English do you speak with students at your school or with
their families? Spanish; Vietnamese; A Chinese language; Japanese; Korean; A Filipino
language; Arabic; Other (PLEASE SPECIFY)
Date questionnaire completed/Questionnaire completed by:

ECLS-K

Construct
Length of school year

Research
Question
SAQ1

Enrollment and
attendance

SAQ2

SAQ7

School type (grade levels) SAQ2
School type
SAQ2
(public/private/affiliation;
grades; magnet; etc)

N/A

School type
SAQ2
(public/private/affiliation;
grades; magnet; etc)
School type
SAQ2
(public/private/affiliation;
grades; magnet; etc)
Student demographic
SAQ2
information:
race/ethnicity distribution

SAQ2
School type
(public/private/affiliation;
grades; magnet; etc)
Student demographic
SAQ2
information: transfers
from outside attendance
area

Student demographic
SAQ2
information: indicator of
poverty
School-based programs or SAQ3, SAQ4
services for parents and
families

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Neighborhood problems

SAQ6

School safety

SAQ7

Measures taken to ensure SAQ7
school safety

Enrollment and
SAQ7
attendance; School
climate; Teacher mobility

Recent changes at the
school

SAQ2

Recent changes at the
school

SAQ2

SAQ2
Recent changes at the
school
Retention policies and
SAQ2
practices
SAQ2
Retention policies and
practices
Response to Intervention- SAQ9
related policies and
practices

Response to Intervention- SAQ9
related policies and
practices

Response to Intervention- SAQ9
related policies and
practices
Response to Intervention- SAQ9, SAQ3
related policies and
practices; parent outreach
and communication

Response to Intervention- SAQ9, SAQ3
related policies and
practices; parent outreach
and communication

Implementation of
Common Core State
Standards
Implementation of
Common Core State
Standards

SAQ10

Implementation of
Common Core State
Standards
Student demographic
information: language
other than English

SAQ10

SAQ2

Delivery of instruction to SAQ2
English Language Learners
(ELL) and services for
language minority (LM)
families
Delivery of instruction to SAQ2
English Language Learners
(ELL) and services for
language minority (LM)
families
Delivery of instruction to SAQ5
English Language Learners
(ELL) and services for
language minority (LM)
families
Evaluation for IEP

SAQ9

Special education
eligibility

SAQ9

Special education
eligibility

SAQ9

Delivery of special
education and related
services to children with
disabilities

SAQ4

Delivery of special
education and related
services to children with
disabilities
N/A

SAQ4

Services and programs:
SAQ2
Title I
SAQ2
Services and programs:
Title I
Services and programs:
SAQ2
Title III
School status relative to SAQ2
Adequate Yearly Progress
(AYP)
School status relative to SAQ2
Adequate Yearly Progress
(AYP) and school
improvement
Numbers of full- and part- SAQ2
time teachers, specialists,
nurses, and
paraprofessionals

Number of staff members SAQ2
and specialists

Response to Intervention- SAQ9
related policies and
practices

Teacher mobility

SAQ2; SAQ7

Teacher Incentives

SAQ2

N/A

School administrator
SAQ8
demographic information
School administrator
SAQ8
demographic information
School administrator
SAQ8
demographic information
School administrator
SAQ8
demographic information

School administrator's
experience

SAQ8

School administrator's
formal education and
training

SAQ8

School administrator's
formal education and
training

SAQ8

School administrator's
formal education and
training

SAQ8

School administrator’s
familiarity with students

SAQ8

School administrator’s use SAQ8
of a non-English language
School administrator’s use SAQ8
of a non-English language
School administrator’s use SAQ8
of a non-English language
School administrator’s use SAQ8
of a non-English language
School administrator’s
familiarity with students

SAQ8

Spring Fourth-Grade School Administrator Questionnaire For Continuing Schools, Appendix H
Section
School Characteristics

Item #
A1

A2 a-d

School-Family-Community B1 a-f
Connections

B2 a-b

B5 a-b

B6 a-i

B7a-g

B8 a-f

B9 a-k

B10

B11
School Policies and Practices C1
C2

C4 a-d

C6 a-d

C8 a-d

C10 ab

C11

School Programs for
Particular Populations

D6 a-b

D7 a-e

Federal Programs: Title I and E1
Title III
E2
E3
Staffing and Teacher
Characteristics

F1 a-f

F2 a-h

F3 a-e

F4 a-b

F5 a-b

F6
F7
F8

School Administrator
Characteristics

G2
G3
G4
G5 a-c

G6 a-f

G8 a-f

G10

School Administrator Questionnaire For Continuing Schools, Appendix H
Item Stem
How many instructional days will this school provide during this academic year? IF THIS
IS A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF INSTRUCTIONAL DAYS A
GIVEN CHILD WOULD ATTEND.
School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF
THE FOLLOWING.
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. Total enrollment for your school (across all grades) around October 1, 2014, or the
date nearest to that for which data are available
c. Number of children who have enrolled in your school Sicne October 1, 2014
d. Number of children who have left your school since October 1, 2014, and have not
returned
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.
About what percentage of the children enrolled in this school are eligible for free or
reduced-price lunch?

Source
ECLS-K

ECLS-K

Please indicate how often each of the following activities is provided by your school.
ECLS-K
a. PTA, PTO, or Parent-Teacher-Student organization meetings
b. Reports (report cards) of chldren's performance provided to parents
c. Information on the child's standardized assessment scores provided to parents
d. Teacher-parent conferences
e. School performances to which parents are invited
f. Classroom programs like class plays, book nights, or family math nights
During this school year, how often has your school used the following ways to
ECLS-K:2011
communicate with all parents?
a. Electronic communication to all parents, such as group emails, electronic newsletters,
website postings, "robocalls" (mass automated phone calls), text alerts, or other
electronic notices for all parents
b. Non-electronic communications to all parents, such as letters, newsletters, phone calls,
or other non-electronic messages for all parents
During this school year, has your school used an online tool or website that is available to ECLS-K:2011
the general public and that parents can access without a login or password?
During this school year, has your school (or individual teachers) used an online tool or
website that parents can only access with a login or password to get information about
their child, the child's class, or the school?

ECLS-K:2011

Have the following types of information been provided in the online tool or website that ECLS-K:2011
parents can only access with a login and password?

ECLS-K:2011
a. Classroom-specific assignments, including homework
b. Child- or parent-specific information, such as progress reports between grading
periods
To the best of your knowledge how often do the following types of problems occur at
your school?
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. Class cutting
Does your school take any of the following measures to ensure the safety of children?

ECLS-K

a. Security guards, unarmed
b. Security guards, armed
c. Metal detectors
d. Locked doors during the school day
e. A requirement that visitors sign in
f. Intercoms or telephones in classrooms
g. Other (PLEASE SPECIFY)
To what extent is each of the following matters a problem in this school? Indicate
ECLS-K
whether each is a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a
problem in this school.
a. Student tardiness
b. Student absenteeism
c. Student aggressive or disruptive behavior
d. Teacher absenteeism
e. Teacher turnover
f. Overcrowding
During the past year, to what extent did any of the following changes occur at your
ECLS-K
school?
a. Funding levels decreased
b. The number of students receiving free or reduced-price lunch increased
c. There has been a reduction in staffing
d. Class sizes increased
e. Class sizes decreased
f. Salaries increased
g. Salaries decreased
During the past year, were salaries frozen at your school?
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.

During the past year, were changes made to your school's assigned attendance area?
How many third-grade children were retained at their current grade level last school
year?
How many fourth-grade children were retained at their current grade level last school
year?
Is a school-wide positive behavioral intervention and support program (for example,
Positive Behavioral Support, Positive Behavioral Intervention System) implemented at
your school?
For each of the following statements about READING and MATH, indicate how strongly
you agree or disagree.
For READING
a. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut
scores, goals/targets, or percentiles) that are used to determine which students are
struggling or at risk of failure in READING.
b. At this school, we use data from screening tests to determine if core instruction in
READING is meeting the needs of most of our students.

For MATH
c. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut
scores, goals/targets, or percentiles) that are used to determine which students are
struggling or at risk of failure in MATH.
d. At this school, we use data from screening tests to determine if core instruction in
MATH is meeting the needs of most of our students.
Is Response to Intervention (RtI) currently used at your school in fourth grade, either
partially or fully implemented? RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP
APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND
MONITORING WITHIN THE GENERAL EDUCATION SETTING.
Is RtI currently implemented at your school in fourth grade in the following areas?
a. Math
b. Reading
c. Writing

d. Behavior/Social skills
Approximately how many years ago did your school begin implemementing RtI in fourth
grade in any subject? Less than 1 year ago; 1 to 2 years ago; More than 2 years ago
For the 2014-2015 school year, how has your school made information available to
parents/guardians to help them understand how RtI is being implemented in your school?
a. Communication through written materials such as letters, email, school website, or
newsletters

ECLS-K:2011
Grade 1

ECLS-K:2011
Grade 1
ECLS-K
ECLS-K

Adapted from
FRSS 99
Dropout
Prevention
Services
Adapted and
from
WA (RTI) and
HB 2136:
Spring 2010

Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)
Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)

b. Communication through workshops, discussion groups, or other meetings such as PTA
meetings
c. Communication through individual meetings with parents or phone calls
New

d. Information is not distributed on this topic
Has your school implemented the Common Core State Standars at any grade(s)?
Are the Common Core State Standares currently implemented at your school in fourth
grade in the following areas?
a. Reading and Language Arts
b. Mathematics
Approximately how many years ago did your school begin implementing the Common
Core State Standards in any grade or subject? Less than 1 year ago; 1 to 2 years ago;
More than 2 years ago
Do any of the children in this school come from a home where a language other than
English is spoken?
What percentage of children in this school are English language learners (ELL)?
What percentage of children in fourth grade are English language learners (ELL)?
Since the beginning of this school year (2014-2015), how many students have been
NEWLY evaluated at your school to determine if they are eligible for an IEP?

Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)

New

Of those students who have been NEWLY evaluated at your school this school year (2014- ECLS-K
2015), how many were found eligible for an IEP, including those who may have an IEP for
speech only?
What method(s) are used in your school to determine special education ELIGIBILITY for
ECLS-K
students with learning disabilities? IF A COMBINATION OF THESE METHODS IS USED AT
YOUR SCHOOL, MARK YES FOR BOTH A AND B. RESPONSE TO INTERVENTION (RTI) IS A
MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE
INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING.
a. IQ-achievement discrepancy model which shows whether there is a discrepancy
between expected performance and actual performance

ECLS-K

b. Response to Intervention (RtI) model

Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)
Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)

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

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

b. Receive accommodations through a 504 plan
c. Reading instruction for students performing below grade level in reading
d. Math instruction for students performing below grade level in math

Adapted from
IDEA national
Assessment
Implementatio
n Study (LEA)

ECLS-K

e. A gifted and talented program
The following items pertain to public schools only. IF YOURS IS A PRIVATE SCHOOL CHECK
HERE.
Did your school receive Federal Title I funds for this school year?
Is your school operating a Title I targeted assistance or schoolwide program? Targeted
assistance program; Schoolwide program
Did your school receive Federal Title III funds for this school year? (Title III is “Language
Instruction for Limited English Proficient and Immigrant Students.”)
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.
a. Regular classroom teachers

ECLS-K

b. ESL/bilingual education/language immersion/ELL instruction teachers

ECLS-K

c. Drama, music, or art teachers

ECLS-K

d. Gym/PE or health teachers

ECLS-K

e. Special education teachers and related service providers (for example, speech
therapist, physical therapist, adaptive physical education, etc.)
f. Paraprofessionals (for example, classroom aides)
Does your school currently have any staff members (full- or part-time) in the following
categories? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR
SCHOOL.
a. Teachers of gifted/talented students
b. Reading specialists and interventionists

c. Math specialists and interventionists
d. School nurses or health professionals

ECLS-K

e. School psychologists or social workers
f. Guidance counselors
g. Library media specialists/librarians
h. Computer/technology teachers or support staff
Does your school currently have any staff members who do the following as their primary
role or one of their primary roles? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF
MEMBERS AT YOUR SCHOOL.
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 New
assessment data
e. A school staff member who supports teachers in the interpretation and use of
assessment data to guide instruction
Please indicate the number of regular classroom teachers who have joined or left your
school since October 1, 2014.
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 reurned
Are monetary incentives such as cash bonuses, salary increases, or different steps on the
salary schedule used in your school to reward teachers for...
a. Improved student performance on state tests?
ECLS-K
b. Reaching target goals on state tests?
Did this school's principal (or head administrator) complete the majority of the previous
sections or was the majority completed by someone else?
If a person other than the school's principal (or head administrator) has completed the
previous sections, please write in the name and title of the person who completed the
majority of the sections.
How long has the individual listed above been employed at this school?
What is your gender?
In what year were you born?
Are you Hispanic or Latino?
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
How many years of experience do you have in each of the following positions, including
years in which you worked part-time?

ECLS-K

ECLS-K
ECLS-K
ECLS-K

ECLS-K

a. Years as a teacher before becoming a school administrator

ECLS-K

b. Total numbers of years as a school administrator

ECLS-K

c. Number of years as school administrator at this school

ECLS-K

Through which, if any, of the types of training programs below did you receive
preparation for fulfilling your role as a school administrator?

ECLS-K

a. Traditional university-based training and certification program
b. District-based training program (for example, the Boston Principal Fellowship, New
York City Leadership Academy's Aspiring Principals Program, Chicago's LAUNCH program)
c. City-based training program (for example, Cleveland's First Ring Leadership Academy )
d. State-based training program (for example, New Jersey EXCEL)

ECLS-K:2011,
Grade K

e. Training and/or certification program run by a national non- profit organization (for
example, KIPP School Leadership Program, New Leaders for New Schools)
f. Another school administration preparation program
What is the highest level of education you have completed? High school diploma or
equivalent/GED; Associate's degree; Bachelor's degree; At least one year of coursework
beyond a Bachelor's degree but not a graduate degree; Master's degree; Education
specialist or professional diploma based on at least one year of coursework past a
Master's degree level; Doctorate or an advanced professional degree beyond a Master's
degree (for example, MD, EdD)
What was your major field(s) of study in the highest degree you completed?
a. Early childhood education
b. Elementarty education
c. Education administration/management

ECLS-K

d. Special education

ECLS-K

e. Other education-related major (such as secondary education, educational psychology,
science
education,major
music(such
education,
etc.)English, etc.)
f. Non-education
as history,
What is your best estimate of the percentage of children in your school you know by
name? Nearly every child; 75% or more; 51% to 75%; 26% to 50%; 25% or less
During school hours, do you speak a language other than English with students at your
school whose native language is not English?
Do you speak a language other than English with students’ families whose native
language is not English?
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.
What language(s) other than English do you speak with students at your school or with
their families? Spanish; Vietnamese; A Chinese language; Japanese; Korean; A Filipino
language; Arabic; Other (PLEASE SPECIFY)
Date questionnaire completed/Questionnaire completed by:

ECLS-K

Construct
Length of school year

Research
Question
SAQ1

Enrollment and attendance SAQ2

Enrollment and attendance SAQ7

Student demographic
SAQ2
information: indicator of
poverty
School-based programs or SAQ3
services for parents and
families

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

School safety

SAQ7

Measures taken to ensure SAQ7
school safety

Enrollment and
attendance; School
climate; Teacher mobility

SAQ7

Recent changes at the
school

SAQ2

Recent changes at the
school
N/A

SAQ2

Recent changes at the
school
Retention policies and
practices
Retention policies and
practices

SAQ2

N/A

SAQ2
SAQ2

Response to Intervention- SAQ9
related policies and
practices
Response to Intervention- SAQ9
related policies and
practices

Response to Intervention- SAQ9
related policies and
practices

Response to Intervention- SAQ9
related policies and
practices
Response to Intervention- SAQ9, SAQ3
related policies and
practices; parent outreach
and communication

Implementation of
Common Core State
Standards
Implementation of
Common Core State
Standards

SAQ10

SAQ10
Implementation of
Common Core State
Standards
Student demographic
SAQ2
information: language
other than English
Delivery of instruction to SAQ2
English Language Learners
(ELL) and services for
language minority (LM)
families
Delivery of instruction to SAQ2
English Language Learners
(ELL) and services for
language minority (LM)
families
Evaluation for IEP
SAQ9

Special education eligibility SAQ9

Delivery of special
education and related
services to children with
disabilities

SAQ4

N/A

Services and programs:
Title I
Services and programs:
Title I
Services and programs:
Title III
Total number of full- and
part-time teachers,
specialists, nurses, and
paraprofessionals

SAQ2
SAQ4
SAQ2
SAQ2

Numbers of full- and part- SAQ2
time teachers, specialists,
nurses, and
paraprofessionals

Response to Intervention- SAQ9
related policies and
practices

Teacher mobility

SAQ2; SAQ7

Teacher Incentives

SAQ2

N/A
N/A
N/A

School administrator
SAQ8
demographic information

School administrator
demographic information
School administrator
demographic information
School administrator
demographic information
School administrator's
experience

SAQ8

School administrator's
formal education and
training

SAQ8

School administrator's
formal education and
training
School administrator's
formal education and
training

SAQ8

School administrator’s
familiarity with students

SAQ8

SAQ8
SAQ8
SAQ8

SAQ8