Private School Universe Survey 2013-16

Appendix D PSS 2015-16 Questionnaire

Private School Universe Survey 2013-16

OMB: 1850-0641

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15115017
U.S. DEPARTMENT OF EDUCATION

OMB No. 1850-0641: Approval Expires 06/30/2016

NATIONAL CENTER FOR EDUCATION STATISTICS

Conducted by:

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU

PRIVATE SCHOOL SURVEY
2015-16 SCHOOL YEAR

PLEASE NOTE:
The 2015-16 Private School Survey is intended to include all private -

▲

SCHOOLS that teach ANY of the following -

•
•
•
•
•

At least one of grades 1 - 12
Ungraded students between 5 and 18 years old
Kindergarten - traditional year of school primarily for 5-year-olds prior to first grade
Transitional (or readiness) kindergarten - extra year of school for kindergarten-age children
who are judged not ready for kindergarten
Transitional first (or prefirst) grade - extra year of school for children who have attended
kindergarten but have been judged not ready for first grade

▲

EARLY CHILDHOOD PROGRAMS AND DAY CARE CENTERS that have
ANY of the following -

•
•
•

Kindergarten
Transitional (or readiness) kindergarten
Transitional first (or prefirst) grade
For example:
An early childhood center that has a nursery school, a prekindergarten program, and a kindergarten
would be eligible for this survey, since it includes a kindergarten.
But an early childhood center that has a nursery school and a prekindergarten program ONLY
would NOT be eligible for this survey, since it does not include a kindergarten. You would mark
box 2 in item 2b.

FORM PSS-1
(12-05-2014) Draft 3

PLEASE CONTINUE WITH ITEM 1 ON PAGE 3.

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15115025

DEAR ADMINISTRATOR:
The National Center for Education Statistics (NCES) of the U.S. Department of Education requests
your participation in the 2015-16 Private School Survey, a national data collection that is very
valuable to private schools across the country. NCES is authorized to conduct this survey under the
Education Sciences Reform Act of 2002 (ESRA: 20 U.S.C., § 9543).
WHY IS NCES SPONSORING THIS SURVEY?
The purpose of this data collection effort is to obtain current information about private schools,
such as type of school, length of school year, number of students and teachers, and number of high
school graduates, if any. We will use the data to produce a web-based private school search tool
and statistical summaries about the providers of private education in the United States.
WHO SHOULD PARTICIPATE IN THIS SURVEY?
The 2015-16 Private School Survey includes all private schools and early childhood programs
that provide educational instruction to students in kindergarten or at least one of grades 1-12.
WHY SHOULD YOUR SCHOOL PARTICIPATE IN THIS SURVEY?
Private schools are a significant segment of the nation’s educational system. Results from previous
surveys show that approximately 25 percent of all elementary and secondary schools in the United
States are private; these schools enroll approximately 10 percent of the nation’s children and
employ 13 percent of the nation’s teachers. NCES has instituted this survey in recognition of the
importance of private education in the United States. While there is no penalty for not responding, a
high response rate is very important to the success of the survey. We encourage you to participate
in this voluntary survey.
WHERE SHOULD YOU MAIL YOUR COMPLETED QUESTIONNAIRE?
Please return your completed questionnaire using the enclosed envelope. If you do not have the return
envelope, mail your questionnaire to:
U.S. CENSUS BUREAU
ATTN: DCB 60A
1201 E. 10TH STREET
JEFFERSONVILLE, IN 47132-0001

THANK YOU FOR YOUR COOPERATION IN THIS VERY IMPORTANT EFFORT.
SINCERELY,

PEGGY G. CARR
ACTING COMMISSIONER FOR EDUCATION STATISTICS
NATIONAL CENTER FOR EDUCATION STATISTICS

Paperwork Burden Statement
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 1850-0641. The time required to complete this information collection is estimated
to average 20 minutes per response, including the time to review instructions, search existing data resources,
gather the data needed, and complete and review the information collection. If you have any comments
concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.
Department of Education, Washington, DC 20202-4537. If you have comments or concerns about the contents
of this questionnaire, write directly to: Private School Survey, National Center for Education Statistics, 1990
K Street, N.W., #9012, Washington, DC 20006-5651.
FORM PSS-1

§0,S:¤

15115033

1. Please print your name, title, and school telephone number.
050

051

YOUR NAME

TITLE
052

–

SCHOOL TELEPHONE NUMBER

–

2a. Is this institution or organization still in operation?
100

Month

Yes

101

103

No - Please record the ➜
date when closed.

Year

Day
102

➜

GO TO item 3 below.

Are any of grades K to 12 or comparable ungraded levels taught by this institution or
organization?
115
1

Yes ➜

Which grades?
Mark (X) all that apply, then GO TO item 2c below.
055

059
1

Kindergarten

056

063
1

4th

060
1

1st

5th

061
1

2nd

6th

062
1

3rd

12th

Ungraded

068
1

9th

10th

11th

065
1

058

8th

064
1

057

067
1

066
1

7th

(1) Which of the following describes the reason(s) this institution or organization
does NOT teach any of grades K-12 or comparable ungraded levels?
Mark (X) all that apply, then GO TO item 3 below.
075
1

Adult education or postsecondary education

Tutoring program or before and after school program

Prekindergarten, nursery school, early childhood center, or day care center

Other - Please describe. ➜

076
077

078

079

c. Is this a private school or program? For this survey, all non-public elementary or secondary schools
are considered private schools.
For example, Roman Catholic schools, Hebrew day schools, Lutheran schools, private boarding
schools, nonsectarian private schools, private schools that provide special education services to public
school districts, private schools that receive tuition for some students from public school districts.
130
1

Yes

No ➜

Which of the following best describes your school or program?
Mark (X) only one box, then GO TO item 3 below.
132
1

Public school, including public charter, state-run, Bureau of
Indian Education, or Department of Defense school

Other ➜ Please describe the type of school or program. C
131

3. If you marked "No" for any of items 2a-c, do not complete this questionnaire. Please return it
in the enclosed envelope. If you do not have the return envelope, mail your questionnaire to:
U.S. CENSUS BUREAU
ATTN: DCB 60A
1201 E. 10TH STREET
JEFFERSONVILLE, IN 47132-0001
If you marked "Yes" for all of items 2a-c above, continue with item 4 on page 4.
FORM PSS-1

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15115041

INSTRUCTIONS
The data you enter on this form will be captured through the use of imaging technology. Please print all
information clearly in ordinary characters, using a black ballpoint pen.
CORRECT marking example –
(Use care to keep characters
in their designated spaces.)

35
x Yes

INCORRECT marking example –

Yes

OR
No

a. If you are unsure about how to answer a question, please give the best answer you can rather than
leaving it blank.

b. If you have any questions, call the U.S. Census Bureau at 1-888-329-5890. Someone will be available
to take your call Monday through Friday, between 8:00 a.m. and 8:00 p.m. (Eastern Time).
Ungraded levels. The term "ungraded levels" refers to schools that classify students by an alternative
means other than particular grade levels (e.g., Kindergarten, 1st grade, 2nd grade, etc.)

4. How many students were enrolled in each of the following grade levels around the first
of October?
Report only for the school or program named on the front of this questionnaire.
Do NOT include postsecondary or adult education students.
Do NOT include children who are enrolled only in day care at this school or program.
In column (1), mark (X) “Yes” or “No” for each grade level.
In column (2), record the number of students for each grade level with “Yes” marked in column (1).
(1)
(2)
Does this
Number of students
school or program
in this grade
have students in this
grade?

Grade levels

135

a. Ungraded (including ungraded special
education students)

Yes ➜

145

b. Nursery and prekindergarten
155

c. Kindergarten (traditional year of school
primarily for 5-year-olds prior to first grade)
165

d. Transitional (or readiness) kindergarten (extra
year of school for kindergarten-age children
who are judged not ready for kindergarten)

e. Transitional first (or prefirst) grade (extra
year of school for children who have attended
kindergarten but have been judged not ready
for first grade)

FORM PSS-1

175

140

,
150

,
160

,
170

,
180

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15115058

4. Continued – How many students were enrolled in each of the following grade levels around the
first of October?
(1)
(2)
Does this
school or program Number of students
in this grade
have students in this
grade?

Grade levels

185

1st

Yes ➜

195

g. 2nd
205

h. 3rd
215

4th
225

5th
235

k. 6th
245

7th
255

m. 8th
265

n. 9th
275

o. 10th
285

p. 11th
295

q. 12th

5. What was the total number of students enrolled in this school or program
around the first of October?
Please sum lines 4(a) through 4(q).

190

,
200

,
210

,
220

,
230

,
240

,
250

,
260

,
270

,
280

,
290

,
300

,
305

,
Students
FORM PSS-1

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15115066

6. Around the first of October, how many students enrolled in grades K-12 and comparable
ungraded levels were –
Do NOT include nursery, prekindergarten, postsecondary, or adult education students.
Do NOT include children who are enrolled only in day care at this school or program.
If none, please mark (X) the box.
a. Hispanic or Latino, regardless of race?
320
0

None

Students

b. White, not of Hispanic or Latino origin?
330
0

None

Students

c. Black or African American, not of Hispanic or Latino origin?
325
0

None

Students

d. Asian, not of Hispanic or Latino origin?
316
0

None

Students

e. Native Hawaiian or other Pacific Islander, not of Hispanic or Latino origin?
318
0

None

Students

American Indian or Alaska Native, not of Hispanic or Latino origin?

310
0

None

Students

g. Two or more races, not of Hispanic or Latino origin?
332
0

None

Students

7a. Is this school or program coeducational?
335
1

Yes

No, it is an all-female school

No, it is an all-male school

}

GO TO item 8a on page 7.

b. Around the first of October, how many MALE students in grades K-12 and comparable
ungraded levels were enrolled in this school or program?
Do NOT include nursery, prekindergarten, postsecondary, or adult education students.
Do NOT include children who are enrolled only in day care at this school or program.
If none, please mark (X) the box.
340
0

None

Male students

FORM PSS-1

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15115074

8a. LAST school year (2014-15), were any students enrolled in 12th grade?
345
1

Yes

No ➜

GO TO item 9a below.

b. How many students were enrolled in 12th grade around October 1, 2014?
350

12th graders

c. How many students graduated from the 12th grade with a diploma LAST school year (2014-15)?
Include 2015 summer graduates. Do not include students who received only vocational
certificates, certificates of attendance, or certificates of completion.
If none, please mark (X) the box.
355

None ➜

GO TO item 9a below.

Graduates

d. Of those who graduated with a diploma LAST school year (2014-15), approximately what
percentage went to four-year colleges?
If none, please mark (X) the box.
Round to the nearest whole percent.
360
0

None

Percent

9a. How long is the school day for a kindergarten, transitional kindergarten, or transitional
first grade student?
Mark (X) only one box.
365

{

School or program does not offer kindergarten,
transitional kindergarten, or transtional first grade ➜

Full day (4 hours or more per day)

Half day (less than 4 hours per day)

Both offered

GO TO instructions for
item 10 at top of page 8.

b. How many days per week does a kindergarten, transitional kindergarten, or transitional
first grade student attend?
If the number of days per week varies (e.g., some students attend 3 days per week and some
attend 5 days per week), record the most days that a student would attend in a week.
370

Days per week

FORM PSS-1

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15115082

INSTRUCTIONS AND AN EXAMPLE FOR ITEM 10
In item 10, we ask for the number of teachers for grades K-12 by the amount of time they
teach at THIS school or program.
Example:
The following is an example to illustrate how to report teachers in this item for a school or program
that includes prekindergarten through grade 8.
If this school or program has eight full-time teachers for grades 1-8, one full-time teacher who
teaches kindergarten ½ time and prekindergarten ½ time, a music teacher who teaches two days
each week, a physical education teacher who teaches three days each week, and a teaching
principal who teaches one 30-minute class each day, you would complete item 10 as follows:

✗

None

Full-time teachers

Teach at least ¾ time but less than full time

Teach at least ½ time but less than ¾ time
This number includes the one full-time teacher who teaches
kindergarten ½ time and prekindergarten ½ time. The time he or
she spends teaching prekindergarten is not counted in item 10.
This number also includes the physical education teacher who
teaches three days a week.

None

Teach at least ¼ time but less than ½ time
This includes the music teacher who teaches two days a week.

None

Teach less than ¼ time
This includes the principal who teaches one 30-minute class each
day. The time he or she spends working as a principal is not
included in item 10.

1 2

TOTAL TEACHERS

FORM PSS-1

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15115090

10. Around the first of October, how many persons were teaching in grades K-12 and/or
COMPARABLE ungraded levels at this school or program in the following time categories?
Consider only the amount of time an individual works as a teacher during a typical week
at THIS school or program.
Include:
• Regular classroom teachers
• Teachers who teach subjects such as music, art, physical education, and special education
• Teaching principals or administrators who teach a regularly scheduled class at this school or
program
Do NOT include:
• Teachers who teach ONLY nursery, prekindergarten, postsecondary, or adult education
• Student teachers, teacher aides, day care aides, or short-term substitute teachers
• Counselors, library media specialists or librarians, speech therapists, social workers, or
administrators UNLESS they also teach a regularly scheduled class at THIS school or program
If none, please mark (X) the box.
385

None

Full-time teachers

390
0

Teach at least ¾ time but less than full time

395

Teach at least ½ time but less than ¾ time

400

Teach at least ¼ time but less than ½ time

405
0

Teach less than ¼ time

410

TOTAL TEACHERS

FORM PSS-1

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15115108

11. Which of the following best describes this school or program?
Mark (X) only one box.
415
1

REGULAR school – elementary or secondary

MONTESSORI school

SPECIAL PROGRAM EMPHASIS school – such as a science or math school, performing
arts school, talented or gifted school, foreign language immersion school, etc.

SPECIAL EDUCATION school – primarily serves students with disabilities

CAREER/TECHNICAL/VOCATIONAL school – primarily serves students being trained
for occupations

EARLY CHILDHOOD PROGRAM OR DAY CARE CENTER – such as kindergarten only,
prekindergarten and kindergarten only, kindergarten and transitional first grade only,
day care and transitional kindergarten only, etc.

ALTERNATIVE/OTHER school – offers a curriculum designed to provide alternative or
nontraditional education; does not specifically fall into the categories of regular, special
program emphasis, special education, or vocational school – Please describe. C
416

12a. Is a major role of this school or program to support homeschooling?
420
1

Yes

b. Is this school or program located in a private home that is used primarily as a family residence?
425
1

Yes

13a. Does this school or program have a religious orientation or purpose?
430
1

Yes

No ➜

GO TO item 14 on page 12.

b. Is this school or program affiliated with a religious organization or institution?
435
1

Yes

FORM PSS-1

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15115116

13c. What is this school’s or program’s religious orientation or affiliation?
Mark (X) only one box.
440

Is this school –
Mark (X) only one box.

Roman Catholic

African Methodist Episcopal

445
1

Parochial (or inter-parochial)

Amish

Diocesan

Assembly of God

Private

Baptist

Brethren

Calvinist

Christian (no specific denomination)

Church of Christ

Church of God

Church of God in Christ

Church of the Nazarene

Disciples of Christ

Episcopal

Friends

Greek Orthodox

Islamic

Jewish

Latter Day Saints

Lutheran Church – Missouri Synod

Evangelical Lutheran Church in America (formerly AELC, ALC, or LCA)

Wisconsin Evangelical Lutheran Synod

Other Lutheran

Mennonite

Methodist

Pentecostal

Presbyterian

Seventh-Day Adventist

Other – Specify

441

FORM PSS-1

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15115124

14. To which of the following associations or organizations does this school or program belong?
Mark (X) all that apply.
450

This school or program does NOT belong to ANY associations or organizations

RELIGIOUS
455
1

Accelerated Christian Education (ACE) (or School of Tomorrow)

American Association of Christian Schools (AACS)

Association of Christian Schools International (ACSI)

Association of Christian Teachers and Schools (ACTS)

Association of Classical and Christian Schools (ACCS)

Christian Schools International (CSI)

Evangelical Lutheran Education Association (ELEA)

Friends Council on Education (FCE)

General Conference of the Seventh-Day Adventist Church (GCSDAC)

Islamic School League of America (ISLA)

Jesuit Secondary Education Association (JSEA)

National Association of Episcopal Schools (NAES)

National Catholic Educational Association (NCEA)

National Christian School Association (NCSA)

National Society for Hebrew Day Schools (Torah Umesorah)

Oral Roberts University Educational Fellowship (ORUEF)

The Jewish Community Day School Network (RAVSAK)

Solomon Schechter Day School Association (SSDSA)

Southern Baptist Association of Christian Schools (SBACS)

Other religious school association(s) – Specify

460
465
467
468
470
480
485
490
492
495
500
505
510
515
520
522
525
530
535

536

FORM PSS-1

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15115132

14. Continued – To which of the following associations or organizations does this school or
program belong?
Mark (X) all that apply.
SPECIAL EMPHASIS
540
1

American Montessori Society (AMS)

Association Montessori International (AMI)

Other Montessori association(s)

Association of Military Colleges and Schools (AMCS)

Association of Waldorf Schools of North America (AWSNA)

National Association of Private Special Education Centers (NAPSEC)

Other association(s) for exceptional children

European Council for International Schools (ECIS)

National Association for the Education of Young Children (NAEYC)

National Association of Laboratory Schools (NALS)

National Coalition of Girls’ Schools (NCGS)

Other special emphasis association(s) – Specify

542
545
550
555
575
580
585
590
600
602
605

606

OTHER SCHOOL ASSOCIATIONS OR ORGANIZATIONS
610
1

Alternative School Network (ASN)

National Association of Independent Schools (NAIS)

State or regional independent school association

National Coalition of Alternative Community Schools (NCACS)

National Independent Private Schools Association (NIPSA)

The Association of Boarding Schools (TABS)

Other school association(s) – Specify

620
622
625
630
635
640

641

FORM PSS-1

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15115140

15. How many days are in the school YEAR for students in this school or program?
645

Days per school YEAR

16. How long is the school DAY for students in this school or program?
Report BOTH hours and minutes, e.g., 06 hours and 00 minutes, 05 hours and 45 minutes, etc.
If the length of day varies by grade level, record the longest day.
655

650

Hours

AND

Minutes

17. Does this school or program have a library media center?
(A library media center is an organized collection of printed and/or audiovisual and/or computer
resources which is administered as a unit, is located in a designated place or places, and makes
resources and services available to students, teachers, and administrators. A library media center
may be called a school library, media center, resource center, information center, instructional
materials center, learning resource center, or any other similar name.)
660
1

Yes

18a. Does this school participate in the National School Lunch Program (that is, the federal free
or reduced-price lunch program)?
1

Yes

No ➜

GO TO item 19a below.

b. Around the first of October, how many students at this school were APPROVED for free
or reduced-price lunches?
Do NOT include nursery or prekindergarten students.
If none, please mark (X) the box.
None

K-12 students approved

19a. Around the first of October, did any students enrolled in this school receive Title I services
at this school or at any other location?
(Title I is a federally funded program that provides educational services, such as remedial reading or
remedial math, to children who live in areas with high concentrations of low-income families.)
1

Yes

No ➜

GO TO item 20 on page 15.

b. How many students participate in the Title I program?
If none or all, please mark (X) the box.
0

No K-12 students

All K-12 students

K-12 students

FORM PSS-1

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15115157

20. Please enter the date you completed this questionnaire.
Report month as a number, i.e., 01 for January, 02 for February, etc.
Month

Day

670

Year

671

672

21. Please verify this school’s or program’s name and mailing address that are printed below.
If any part of the name and mailing address is incorrect, enter the correction(s), as necessary,
in the appropriate space(s) below.
School or program name
700

Mailing address
701

City
702

ZIP Code + 4

State
703

704

–

22a. Is the physical or street address of this school or program the same as the mailing address?
705
1

Yes

b. Please print this school’s or program’s physical or street address.
Street
706

City
707

State
708

ZIP Code
709

THANK YOU FOR PARTICIPATING IN THIS IMPORTANT SURVEY.
YOUR TIME AND EFFORT ARE APPRECIATED.
PLEASE RETURN THE QUESTIONNAIRE IN THE ENCLOSED ENVELOPE.
IF YOU DO NOT HAVE THE RETURN ENVELOPE, MAIL YOUR QUESTIONNAIRE TO:
U.S. CENSUS BUREAU
ATTN: DCB 60A
1201 E. 10TH STREET
JEFFERSONVILLE, IN 47132-0001
FORM PSS-1

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15115165

To learn more about the Private School Survey
(PSS) and to access reports from earlier
collections, see the PSS website at:
http://nces.ed.gov/surveys/pss
Additional data collected by the National
Center for Education Statistics (NCES) on
a variety of topics in elementary,
secondary, postsecondary, and
international education are available
from NCES’ website at:
http://nces.ed.gov
For additional data collected by various
Federal agencies, including the
Department of Education, visit the
Federal Statistics clearinghouse at:
http://www.fedstats.gov

OFFICE USE ONLY

FR Code:

FORM PSS-1

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File Type	application/pdf
File Modified	2015-03-04
File Created	2014-12-05