Principal Survey

An Impact Evaluation of the Teacher Incentive Fund (TIF)

APPENDIX B 7 22 14

Principal Survey

OMB: 1850-0876

Document [doc]
Download: doc | pdf













APPENDIX B


PRINCIPAL SURVEY





  1. Principal Letter


  1. Principal Questionnaire

PRINCIPAL SURVEY COVER LETTER

Dear [PRINCIPAL NAME]:

Your school is participating in the national Evaluation of the Teacher Incentive Fund (TIF) conducted by <TBD> for the U.S. Department of Education. This important study will produce valuable information on the impact of performance-based incentive programs on student achievement, the career paths of principals and teachers, and the ability of schools to retain high-quality staff.

As part of the study, school principals are being asked to complete a Web-based survey this spring 2015. The survey will take about 30 minutes of your time. The survey is designed to learn about the hiring practices of school administrators, understand how principals and teachers are evaluated and compensated for their performance, and assess principals’ understanding of the TIF program. The survey also collects information on principals’ demographic characteristics, educational background, and professional experiences.


While your participation is voluntary, the information collected from principals like you will be extremely important to the study’s findings. We will mail you a check for $20 in appreciation of your participation upon receipt of the completed questionnaire this year and each subsequent year.

The information you provide in this survey will be kept strictly confidential and will not be shared with anyone outside the study team. District officials, principals, and school staff will not have access to the survey data. Responses will be presented only in aggregate form and will not identify any individual or school.


Please use the information below to access the TIF principal survey.

Go to https://www.xxxxxxx.org/

At the login screen, enter the following:

Login ID: [username]

Password: [password]


If you have any questions, please contact xxxxxxx, the deputy survey director, toll free at 866-xxx-xxxx or xxxx.


Thank you for your cooperation and participation in this important study.


Sincerely,

xxxxxxxxxxxxx

Survey Director

OMB Control No.: [Program Name]

Expiration Date:




U.S. DEPARTMENT OF EDUCATION

NATIONAL TEACHER INCENTIVE FUND EVALUATION



PRINCIPAL SURVEY

SPRING 2015










This survey is part of the evaluation of the Teacher Incentive Fund (TIF), a federally funded initiative on performance pay for educators. The survey includes questions about your background, your school’s hiring practices, classroom assignments, and knowledge and perceptions of the TIF funded program.

Please return the completed form to:


If you have questions, please contact:


This survey is authorized by law: The ARRA, Division A, Title VIII, Pub. L. 111–5 and Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act, 2010, Division D, Title III, Pub. L. 111–117.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0876. Public reporting burden for this collection is estimated to average 30 minutes per respondent, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. The obligation to respond to this collection is voluntary. If you have any comments or concerns regarding the status of your individual submission of this survey, please contact (U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Ave, NW, Washington, DC 20208) directly. (Note: Please do not return the completed survey to this address).


This survey is part of the national evaluation of the Teacher Incentive Fund (TIF), a federally funded initiative that will provide valuable information on the potential impact of performance-based incentive programs on student achievement and educator mobility. The survey includes questions about your background, your school’s hiring practices, classroom assignments, and knowledge and perceptions of the TIF funded program.


We would like you to know that:


  • This survey is voluntary, but your response is critical for producing valid and reliable data about your district’s TIF funded program. You may skip any questions you do not wish to answer; however, we hope that you answer as many questions as you can.

  • The survey takes about 30 minutes to complete, and once you have completed it, we will send you $20 to compensate you for your time.

  • Refusal to participate in the principal survey will not affect your employment, or relationship with your school or the evaluation partners, including the U.S. Department of Education, in any way.

  • The study will provide important information that can be used by principals and other educators. Specifically, we will learn whether incentive programs may have a positive impact on student achievement and teacher and principal retention.

  • Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific school or individual. We will not provide information that identifies you or your school to anyone outside the study team, except as required by law. Additionally, no one in your school or district will see your responses.

  • Participation in the principal survey does not impose any special risks to you as a respondent other than accidental disclosure of information. Safeguards are in place to ensure individual respondent’s confidentiality including restricted access to questionnaire data and separating identifying information such as name and school from survey responses. All contractor staff sign a confidentiality pledge and all staff with access to study data have received clearance from the U.S. Department of Education and are subject to severe legal consequences for any breach of confidentiality.

  • An IRB has reviewed and approved this study. If you have any questions about your rights as a research participant, you can contact IRB at 1-800-xxx-xxxx.


I have read and I understand the above statements and agree to participate in the survey.


Group 6

A1. What position do you currently hold at this school?

MARK ONE ONLY

1 Principal

2 Assistant or vice principal

3 Other (Specify):

A2. How long have you served in your current position at this school?

MARK ONE ONLY

1 Less than one year.

In what month did you begin serving in your current position?

2 One year or more.

How many years have you served in your current position? | | | year(s)

A3. Including this school year, how many years have you served in any administrative position in this school?

| | | years

A4. Including this school year, how many years have you served in any administrative position in any school?

Include all schools in this or any other district.

| | | years

























A5. How satisfied are you with each of the following aspects of your school this year?




MARK ONE BOX IN EACH ROW


very dissatisfied

somewhat dissatisfied

somewhat satisfied

very satisfied

a. Opportunities for professional advancement

1

2

3

4

b. Opportunities to enhance my skills

1

2

3

4

c. Opportunities to earn extra pay

1

2

3

4

d. Use of observations to assess my skills

1

2

3

4

e. Use of student achievement scores to assess my effectiveness

1

2

3

4

f. Feedback on my performance

1

2

3

4

g. Recognition of accomplishments

1

2

3

4

h. Quality of interaction with colleagues

1

2

3

4

i. Efforts of my colleagues

1

2

3

4

j. Morale in the school

1

2

3

4

k. Overall job satisfaction

1

2

3

4





A6. What is the highest level of education you have completed?

MARK ONE ONLY

1 Bachelor’s degree

2 Master’s degree

3 Doctoral degree (Ph. D., Ed. D.)

4 Other (Specify):

A7. What is your year of birth?

| 1 | 9 | | |







A8. Are you of Hispanic or Latino origin?

1 Yes

0 No

A9. What is your race?

SELECT ALL THAT APPLY

1 White

2 Black or African American

3 Asian

4 Native Hawaiian or other Pacific Islander

5 American Indian or Alaska Native

A10. Are you male or female?

MARK ONE ONLY

1 Male

2 Female

Group 13

B1. Which of the following statements best describes the principal’s role in hiring teachers for this school?

MARK ONE ONLY

1 Principal has complete autonomy over teacher hiring

2 Principal is part of a school-level team responsible for teacher hiring

3 Principal receives a set of prescreened candidates from the district office as the pool from which he or she (or a school team) can interview and hire teachers

4 Principal has little or no input in hiring teachers at this school

5 Other (Specify)

B2. In filling teacher vacancies for the 2014-2015 school year, when did your school FIRST begin interviewing potential teachers?

MARK ONE ONLY

1 December 2013 or earlier

2 January 2014

3 February 2014

4 March 2014

5 April 2014

6 May 2014

7 June 2014

8 July 2014

9 August 2014

10 September 2014 or later

d Don’t know

Line 12 11 No vacancies to fill GO TO QUESTION B5

B3. During which period did your school conduct the MOST interviews with potential hires?

Write the number or letter from the list in B2 above (1 through 10 or d) that corresponds to that period.

| | |

B4. Please provide the information requested below about teaching positions for the 2012-2013 school year, including activities before the start of the school year.



number

a. Total number of classroom teacher vacancies | | |

b. Number of applications your school reviewed for the position(s) | | |

c. Number of applicants your school interviewed | | |

d. Number of offers your school made | | |

e. Number of offers that were accepted | | |



B5. How frequently were the following factors about your school used as incentives or benefits when recruiting or interviewing teachers for your school?


MARK ONE BOX IN EACH ROW


never

rarely

sometimes

often

always

a. Salary

1

2

3

4

5

b. Opportunities to earn performance-based pay

1

2

3

4

5

c. Opportunities for career advancement

1

2

3

4

5

d. Opportunities for professional development

1

2

3

4

5

e. The level of teacher involvement in school decision making

1

2

3

4

5

f. Collegiality of teaching staff

1

2

3

4

5

g. The school culture and/or educational philosophy

1

2

3

4

5

h. The school’s reputation

1

2

3

4

5

i. The school’s location or neighborhood

1

2

3

4

5

j. The level of student achievement at the school

1

2

3

4

5

k. The [Program Name]

1

2

3

4

5

l. Other factor 1 (Specify)

1

2

3

4

5






m. Other factor 2 (Specify)

1

2

3

4

5







B6. Of the factors in Question B5, please indicate, in order of importance, the THREE that you feel are the most compelling reasons for teachers to accept a position at your school.

a. Most important factor | |

b. Second most important | |

c. Third most important | |

B7. Of the applicants who DID NOT ACCEPT the offer of a teaching position, do you think any of the factors listed in Question B5 contributed to that decision?

1 Yes. If yes, in the space below, use the list in Question B5 (a-m) above to write those that apply, or write any other factor(s) not on the list.

a. Factor one | |

b. Factor two | |

c. Factor three | |

d. Other (Specify)

0 No factors apply; personal circumstances unrelated to school or position

d Don’t know

n Not applicable

B8. How frequently did your school use the following criteria when assigning teachers to grade levels or subject areas?


MARK ONE BOX IN EACH ROW


never

rarely

sometimes

often

always

a. The teacher’s experience in a grade level or subject area

1

2

3

4

5

b. The teacher’s seniority

1

2

3

4

5

c. The teacher’s content knowledge

1

2

3

4

5

d. The teacher’s ability to produce high test scores in grades/classes in which state or federal assessments are administered

1

2

3

4

5

e. The teacher’s ability to work with certain student populations (e.g., ESL, special needs)

1

2

3

4

5

f. To balance teacher experience and expertise in a grade level or subject

1

2

3

4

5

g. Other (Specify)

1

2

3

4

5








B9. From the list of criteria in Question B8 above (a-g), please list the top three criteria your school uses when assigning teachers to tested grade levels or subject areas (grades/subject areas annually assessed by district and/or state achievement testing).

a. Criterion one | |

b. Criterion two | |

c. Criterion three | |



FGroup 19 or questions in this section, please think about all policies and programs in effect at your school, and not just the [Program Name]. NOTE: For questions C1 to C5, please consider only instances of formal observations conducted in a classroom. Formal observations are standardized by using a rubric or checklist and are usually given at regular intervals. (Informal observations do not use a standardized rubric or checklist and are not conducted on any set schedule.)

C1. Are formal classroom observations being conducted or planned to evaluate teacher performance in your school?

1 Yes

Line 3 0 No go to question c6

C2. For each type of school staff listed below, mark Yes or No to indicate if someone in that position conducts formal classroom observations to evaluate teacher performance this year.

If a listed position is not relevant to your school, mark ’not applicable’.


MARK ONE BOX IN EACH ROW


yes

no

not applicable

a. Principal

1

0

9

b. Other administrator (e.g., assistant or vice principal, department head)

1

0

9

c. Mentor, master, or lead teacher at your school

1

0

9

d. Mentor, master, or lead teacher from a different school

1

0

9

e. Content specialist

1

0

9

f. Other (Specify)

1

0

9




C3. How often are formal observations conducted for classroom teachers during the school year?

A classroom teacher is typically observed | | | times during the school year.

C4. Do teachers have the opportunity to review the instrument or rubric so that they can be informed about the criteria on which they are being assessed?

1 Yes

0 No

C5. Is each teacher shown his or her ratings after the classroom observation?

1 Yes

0 No



C6. For which of the following roles or activities can teachers at your school earn additional pay this school year?

For each Yes answer, indicate in Column B the maximum amount that a teacher could receive.

Roles and Responsibilities

a. can earn additional pay?

b. maximum amount possible

a. Mentor teacher

1 Yes



0 No


$ | | |,| | | |

b. Master or lead teacher

1 Yes



0 No


$ | | |,| | | |

c. Department chair or head

1 Yes



0 No


$ | | |,| | | |

d. Lead curriculum specialist

1 Yes



0 No


$ | | |,| | | |

e. Serving on a school-wide committee or task force

1 Yes



0 No


$ | | |,| | | |

f. Serving on a leadership team in some capacity (Specify)

1 Yes



0 No


$ | | |,| | | |

Other Activities



g. Teaching in a hard-to-staff school (e.g., schools serving large proportions of economically disadvantaged or low-performing students)

1 Yes



0 No


$ | | |,| | | |

h. Teaching high-need subjects (e.g., math, science, or special education)

1 Yes



0 No


$ | | |,| | | |

i. Attending professional development activities or enrolling in graduate-level courses (exclude tuition)

1 Yes



0 No


$ | | |,| | | |

i. An automatic bonus (e.g. 1% of salary) for participating in [Program Name]

1 Yes



0 No


$ | | |,| | | |





The next series of questions focuses on criteria used to measure the performance of teachers (in tested grades and subjects) at your school and to determine performance-based bonuses. Performance-based bonuses refer to bonuses based on measured effectiveness and do not include additional pay for roles/responsibilities and activities (such as those listed in Question C6).

C7. Is it possible for teachers in tested grades and subjects at your school to earn a bonus based solely on their performance for the 2014-2015 school year?

1 Yes GO TO C8

0 No GO TO C9

C8. What is the maximum possible performance-based bonus amount that a teacher in a tested grade and subject at your school can earn this school year? (If you are not sure, please provide your best estimate.)

Round to the nearest $100.

$ | | |, | | | |

C9. Which of the following performance criteria are used to evaluate teachers in tested grades and subjects at your school or to determine their performance-based bonus?

In column A, indicate whether the performance criterion is used to evaluate teachers’ performance at your school.

In column B, indicate whether the performance criterion helps determine whether teachers at your school may receive a performance-based bonus or the amount of the bonus they may receive. If it is not possible for teachers at your school to earn performance-based bonuses, please mark “N/A” for not applicable.


for each criterion, mark one box in column a and one box in column b


a. is criterion used to evaluate teachers’ performance?

b. does criterion affect teachers’ performance-based bonuses?

student achievement

yes

no

yes

no

n/a

a. Student test scores at a point in time (e.g., average scores, proficiency rates, or Adequate Yearly Progress – AYP based on 2014-2015 scores only)

1

0

1

0

9

b. Growth in student test scores between the current and prior school year(s) at the school level (e.g., value-added, average gains)

1

0

1

0

9

c. Growth in student test scores between the current and prior school year(s) in certain student groups (e.g., grade level, team, subject area)

1

0

1

0

9

d. Growth in student test scores between the current and prior school year(s) in teachers’ individual classes

1

0

1

0

9

direct observation






e. Classroom observations

1

0

1

0

9

f. Professional judgment of principal or other administrator, other than classroom observations

1

0

1

0

9

attendance






g. Teacher attendance

1

0

1

0

9

h. Student attendance

1

0

1

0

9

stakeholder input






i. Reviews from other teachers

1

0

1

0

9

j. Parent input

1

0

1

0

9

k. Student input

1

0

1

0

9

l. other (Specify)

1

0

1

0

9



C10. Are teachers at your school eligible for non-monetary benefits in recognition of their performance or added responsibilities?

1 Yes

Line 92 0 No go to section D

C11. Which of the following non-monetary benefits are available to teachers at your school?


MARK ONE BOX IN EACH ROW


yes

no

a. Release from classroom teaching for mentoring or other leadership activities

1

0

b. Decision making authority on issues such as hiring staff or adopting curriculum

1

0

c. Priority in teaching assignments (e.g., grade level or subject area)

1

0

d. Priority in student assignment

1

0

e. Other (Specify)

1

0







C12. How much do you agree or disagree with each of the following statements?




MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. The district’s teacher performance measures are an accurate measure of individual teacher performance.....................................................

1

2

3

4

b. I use the district’s performance measures to inform decisions about staffing and providing additional support to teachers (e.g., staff assignments and professional development needs)…………………………………..……....

1

2

3

4





Group 25



NOTE: For the questions in this section, please think about all policies and programs in effect at your school, and not just the [Program Name].

D1. Have you been (or expect to be) observed by a trained observer this year?

Line 130 1 Yes go to D2

Line 129 0 No go to D3



D2. How many times during this school year have you been (or expect to be) observed by a trained observer to evaluate your performance?

| | | observation(s) this school year to date

| | | more observation(s) expected by the end of the school year



D3. For which of the following roles or activities can you earn additional pay this school year?

For each Yes answer, indicate in Column B the maximum amount that you could receive, and in Column C, the amount you expect to receive.

Roles and Responsibilities

a. can earn additional pay?

b. maximum amount possible

c. amount you expect to receive

a. Additional roles or responsibilities in the school or district

1 Yes



0 No


$ | | |,| | | |

$ | | |,| | | |

Other Activities




b. Working in a hard-to-staff school (e.g., schools serving large proportions of economically disadvantaged or low-performing students)

1 Yes



0 No


$ | | |,| | | |

$ | | |,| | | |

c. Attending professional development activities or enrolling in graduate level courses (exclude tuition)

1 Yes



0 No


$ | | |,| | | |

$ | | |,| | | |

d. An automatic bonus (e.g. 1% of salary) for participating in [Program Name]

1 Yes



0 No


$ | | |,| | | |

$ | | |,| | | |









The next series of questions focuses on criteria used to measure your performance and to determine performance-based bonuses. Performance-based bonuses refer to bonuses based on measured effectiveness and do not include additional pay for roles/responsibilities and activities (such as those listed in Question D3).

D4. Is it possible for you to earn a bonus based solely on your performance for the 2014-2015 school year?

Line 133 1 Yes GO TO D5

Line 134 0 No GO TO D7

D5. What do you think is the maximum performance-based bonus that someone in your position could possibly earn for this school year?

Round to the nearest $100.

$ | | | , | | | |

D6. What is your best estimate of the actual amount of performance-based bonus that you will receive?

Round to the nearest $100.

$ | | | , | | | |





D7. Did you receive a bonus based solely on your performance last year?

1 Yes

0 No


D8. How much do you agree or disagree with the following statements about the performance-based bonuses that were distributed based on measured performance last year?


MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. It was explained why I did (or did not) receive a performance-based bonus.......................

1

2

3

4

b. I understand how the amounts of the performance-based bonuses were determined

1

2

3

4

c. I received information about the performance-based bonus in a timely manner......................

1

2

3

4

d. I feel the performance-based bonus payouts were fair

1

2

3

4

e.   I understand how I can adjust my practices this year to try to earn a bonus or larger bonus …………………………….

1

2

3

4


D9. Which of the following performance criteria are used to evaluate your performance or to determine your performance-based bonus?

In column A, indicate whether the performance criterion is used to evaluate your performance.


In column B, indicate whether the performance criterion helps determine whether you may receive a performance-based bonus or the amount of the bonus you may receive. If you are not eligible for a performance-based bonus, please mark “N/A” for not applicable.



for each criterion, mark one box in column a and one box in column b


a. is criterion used to evaluate your performance?

b. does criterion affect your performance-based bonus?

student achievement

yes

no

yes

no

n/a

a. Student test scores at a point in time (e.g., average scores, proficiency rates, or Adequate Yearly Progress – AYP based on 2014-2015 scores only)

1

0

1

0

9

b. Growth in student test scores between the current and prior school year(s) at the school level (e.g., value-added, average gains)

1

0

1

0

9

c. Growth in student test scores between the current and prior school year(s) in certain student groups (e.g., grade level, team, subject area)

1

0

1

0

9

direct observation






d. Observations by trained observers

1

0

1

0

9

input from stakeholders






e. Teacher assessments

1

0

1

0

9

f. Parent input

1

0

1

0

9

other measures






g. Other measure 1 (Specify)

1

0

1

0

9

h. Other measure 2 (Specify)

1

0

1

0

9



D10. What is your academic-year base administrative salary for the current school year?

Do not include the value of potential performance-based bonuses. Please report your before-tax earnings from July 1, 2014 to June 30, 2015.

Round to the nearest $100.

$ | | | | , | | 0 | 0 |



D11. Does your base administrative salary include additional pay for any roles or activities you may have performed this year?

Line 131 1 Yes GO TO D10

Line 132 0 No GO TO Section E

D12. Please indicate the amount of your base administrative salary that is due to additional pay for performing roles or activities.

Round to the nearest $100.

$ | | |, | | | |



D13. How much do you agree or disagree with each of the following statements?




MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. The district’s principal performance measures are an accurate measure of my performance

1

2

3

4

b. The district’s principal performance measures are fair

1

2

3

4

c. The district’s principal performance measures are used to support principal improvement.....

1

2

3

4





Group 137

E1. Has the [Program Name] affected your choice of where to work as a school administrator?

1 Yes

Line 5 0 No go to question E3

E2. How has the [Program Name] affected your choice of where to work as a school administrator?

MARK ONE ONLY

1 I stayed at my school because of the [Program Name]

2 I came to my school to get into the [Program Name]

E3. Tell us about the professional development activities in which teachers at your school participated during the 2014-2015 school year.

For each topic listed, indicate the following:

A: Was the topic the focus of professional development (PD) in which teachers participated?

B: If yes, approximately what percentage of teachers at your school received PD in the topic?

C: In general, to what extent do you feel the PD was beneficial to the participants?




In each row, mark one box in Column A. If Yes, complete columns B and C.


a. focus of pd?

b. percent of teachers

c. perceived benefit of the pd

yes

no

not at all

slightly

some-what

highly

a Understanding components of the [Program Name]

1

0

| | | |

1

2

3

4

b. Understanding performance measure used as part of the [Program Name]

1

0

| | | |

1

2

3

4

c. Direct feedback based upon individual performance ratings as measured by the [Program Name]

1

0

| | | |

1

2

3

4

d. Differentiated instructional strategies based on student assessments

1

0

| | | |

1

2

3

4

e. Instructional techniques and strategies

1

0

| | | |

1

2

3

4

f. Aligning curricula to state or district standards

1

0

| | | |

1

2

3

4



E4. Please indicate the extent to which you agree or disagree with each statement about the [Program Name] at your school.


MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. The [Program Name] has been clearly communicated to me

1

2

3

4

b. This school has less chance of earning a bonus because of the characteristics of our student population

1

2

3

4

c. The evaluation system omits important aspects of school administration that should be considered

1

2

3

4

d. The [Program Name] contributes to greater collegiality and professionalism among the staff at this school

1

2

3

4

e. Teachers at this school are more comfortable with formal observations of their teaching because of the [Program Name]

1

2

3

4

f. Parents and the school community believe the [Program Name] is important

1

2

3

4

g. The [Program Name] is likely to continue for the foreseeable future

1

2

3

4

h. I played an important role in implementing the [Program Name] at my school

1

2

3

4





Group 37



F1. In 2015-16, I have the potential to earn additional pay


MARK ONE PER ROW



yes

no

a. Based solely on performance (e.g., measured by student achievement growth, observations, or a combination of measures)

1

0

b. Based on performance measured by student achievement growth

1

0

c. Based on performance measured by observations

1

0

d. Based on my school’s characteristics (e.g., schools serving large proportions of economically disadvantaged or low-performing students)

1

0

e. For taking on additional roles or responsibilities in the school or district

1

0



F2. How much do you agree or disagree with each of the following statements?


MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. The district should provide additional pay based on principal performance in 2015-16................

1

2

3

4

b. The district should use student achievement growth to measure principal performance in 2015-16 .

1

2

3

4

c. The district should use multiple observations to measure principal performance in 2015-16…..

1

2

3

4





F3. How much do you agree or disagree with each of the following statements?


MARK ONE BOX IN EACH ROW


strongly disagree

disagree

agree

strongly agree

a. The district should provide additional pay based on teacher performance in 2015-16................

1

2

3

4

b. The district should use student achievement growth to measure teacher performance in 2015-16 .

1

2

3

4

c. The district should use multiple observations to measure teacher performance in 2015-16……

1

2

3

4



F4. If you have any additional thoughts you would like to share about the [Program Name] or clarifications on your responses, please use the space below.














Group 37

G1. Please provide your contact information below. We will use it to reach you in case we need to clarify any of your responses. We will also use the address to mail your check if you would like to receive it at an address other than your school address.

Providing this information is voluntary.



Name:______________________________________________________________________

Street address:______________________________________________________________

City:____________________________ State:___________________ Zip Code:_________

Home Telephone: | | | |-| | | |-| | | | |

Area Code Number

Cell Phone: | | | |-| | | |-| | | | |

Area Code Number

Work email:_________________________________________________________________

Home email:_________________________________________________________________

Best time to reach you by phone: Day: ______________________ Time: ________________

G2. A follow-up questionnaire will be sent to you at your school next year. Please provide the name and contact information of someone who will know how to reach you if you are no longer at your current school.

Providing this information is voluntary.



Person’s Name:

Relationship to you:

Street address:

City:_______________________________ State:_________________ Zip Code:

Home Telephone: | | | |-| | | |-| | | | |

Area Code Number

Email:


Thank you for completing this questionnaire.


File Typeapplication/msword
AuthorBetsy Warner
Last Modified ByBetsy Warner
File Modified2014-07-22
File Created2014-07-22

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