Appendix I - Links to Constructs

Status: Original and derived artifacts are available for this document.

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Explanation
A

1

B

C

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 fifth-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 5th Child Quex
App B Spring 5th Hearing Eval
App C Spring 5th Parent Interview
App D Spring 5th TQ
App E Spring 5th Reading TQC
App E Spring 5th Math TQC
App E Spring 5th Science TQC
App F Spring 5th SpEd A
App F Spring 5th SpEd B
App G Spring 5th School Adm

Instrument
Spring Fifth-Grade Child Questionnaire, Appendix A
Spring Fifth-Grade Child Questions for Hearing Evaluations, Appendix B
Spring Fifth-Grade Parent Interview, Appendix C
Spring Fiffth-Grade Teacher Questionnaire, Appendix D
Spring Fifth-Grade Reading and Language Arts Teacher Questionanire, Appendix E
Spring Fifth-Grade Mathematics Teacher Questionnaire, Appendix E
Spring Fifth-Grade Science Teacher Questionnaire, Appendix E
Spring Fifth-Grade Special Education Teacher Questionnaire A, Appendix F
Spring Fifth-Grade Special Education Teacher Questionnaire B, Appendix F
Spring Fifth-Grade School Administrator Questionnaire, Appendix G

Page 1 of 117

Spring Fifth-Grade Child Questionnaire, Appendix A
Section
Introduction

Item #
CLQ600

CLQ605

Feelings and attitudes about school

CLQ620

CLQ625

CLQ630

CLQ635

CLQ640

CLQ645

CLQ650

CLQ655

CLQ660

CLQ665

CLQ670

CLQ675

CLQ680

CLQ685

CLQ690

CLQ695

CLQ700

CLQ705

CLQ710

CLQ715

CLQ720
Peer Relationships

CLQ725

CLQ730

CLQ735

CLQ740

CLQ745

CLQ750

CLQ755

CLQ760

CLQ765

CLQ770

CLQ775

CLQ780

CLQ785

CLQ790

CLQ795

CLQ800
Media Usage

CLQ805

CLQ810

CLQ815

CLQ820

CLQ825
Parental monitoring
CLQ830

CLQ835

CLQ840
Life Satisfaction

CLQ845
CLQ850
CLQ855

CLQ860

CLQ865

onnaire, Appendix A
Item Stem

TURN LAPTOP AROUND AND ROTATE LAPTOP SCREEN TO FACE THE CHILD. PLUG
HEADPHONES INTO THE COMPUTER. POSITION LAPTOP IN FRONT OF THE CHILD.
SAY: Now, you are going to use the computer to tell us about yourself. The computer
will read some sentences while you listen on the headphones. [HOLD UP
HEADPHONES.]
SAY: 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.]
SAY: If the volume is too loud or too soft, you can change it with these buttons.
[POINT TO VOLUME BUTTONS ABOVE STICKER.]
SAY: Okay, go ahead and put these headphones on and adjust them so they fit. Then,
you will get started.

Hello.
In a minute, sentences 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.
To go back and change an answer, touch the "BACK" button to move to earlier
screens.
If there is a question you do not want to answer, touch the “NEXT” button to skip it.
Think about yourself and your experiences this school year. How often do the
following things happen?
I try hard to do well in school.
In class, I work as hard as I can.

When I'm in class, I participate in class discussions.

I pay attention in class.

When I'm in class, I listen very carefully.

This school year, how often did you…
Feel like you fit in at your school?

[This school year, how often do you…]
Feel close to classmates at your school?

[This school year, how often do you…]
Feel close to teachers in your school?

[This school year, how often do you…]
Enjoy being at your school?

[This school year, how often do you…]
Feel safe at your school?

How much does each of the following statements describe a person like you?
I finish whatever I begin.

[How much does each of the following statements describe a person like you?]
I try very hard even after making mistakes.

[How much does each of the following statements describe a person like you?]
I continue to work towards my goals, even when they take a long time to complete.
[How much does each of the following statements describe a person like you?]
I keep working hard even when I feel like quitting.

[How much does each of the following statements describe a person like you?]
I continue working on what I set out to do, even when it takes a long time to
complete.

[How much does each of the following statements describe a person like you?]
I keep trying to improve myself, even when it takes a long time to get there.

How true is each of these things about you?
I worry about taking tests.

[How true is each of these things about you?]
It's hard for me to finish my school work.

[How true is each of these things about you?]
I feel ashamed when I make mistakes at school.

[How true is each of these things about you?]
I worry about doing well in school.

[How true is each of these things about you?]
I worry about finishing my work.
Think about yourself and your experiences this school year. How often do the
following things
happen?
Kids in my class make me feel better if I'm having a bad day.

I worry about what other kids think of me.

I feel lonely at school.

Kids in my class let me play with them.

I worry that other kids don't like me.

I feel left out at school.

Kids in my class make me feel happy.

Kids in my class would help me if I hurt myself at school.

I'm afraid other kids will not like me.

Kids in my class tell me that I'm their friend.

I feel alone at school.

Kids in my class would help me if other kids were being mean to me.

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?

During this school year, how often have other students told lies or untrue stories
about you?

During this school year, how often have other students pushed, shoved, slapped, hit,
or kicked you?

During this school year, how often have other students left you out from playing with
them on purpose?

How often do you send texts, messages, or emails using an app, cell phone,
computer, iPad or tablet, or other electronic device?

How often do you play an online game against another online player using an app,
cell phone, computer, iPad or tablet, or other electronic device?

How often do you use a social networking site like Facebook, Twitter, Instagram, or
Vine using an app, cell phone, computer, iPad or tablet, or other electronic device?

Does your family have rules about who you can send texts, messages, or emails to?

Does your family have rules about when you can send texts, messages, or emails?

How often do your parents/guardians…
Know what you do during your free time?
How often do your parents/guardians…
Know how much homework you have?

How often do your parents/guardians…
Know what your school grades are?

The next set of sentences are about how you feel about your life. Think about the
sentence and decide how well it describes you. Does the sentence describe you "Not
at all; A little bit; Somewhat; Quite a bit; or Very much"?
I am happy with the clothes, games, toys, and other things I have.
I am happy with how much attention I get from my parents.
I am happy with the neighborhood and community in which I live.

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.

Source
Construct
ECLS-K:2011 4th Grade CQ (modified) Introduction

Research Question
NA

ECLS-K:2011 4th Grade CQ (modified) Introduction

NA

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

Behavior
engagement

C1

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

Behavior
engagement

C1

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

Behavior
engagement

C1

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

Behavior
engagement

C1

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

Behavior
engagement

C1

K:1998, grade 8 student
questionnaire

School Belonging

C1

K:1998, grade 8 student
questionnaire

School Belonging

C1

K:1998, grade 8 student
questionnaire

School Belonging

C1

K:1998, grade 8 student
questionnaire

School Belonging

C1

K:1998, grade 8 student
questionnaire

School Belonging

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

Developed in collaboration with
Angela Duckworth

Grit

C1

K:1998, grades 3, 5, 8 child
questionnaire

Worry/stress about C1
school

K:1998, grades 3, 5, 8 child
questionnaire

Worry/stress about C1
school

K:1998, grades 3, 5, 8 child
questionnaire

Worry/stress about C1
school

K:1998, grades 3, 5, 8 child
questionnaire

Worry/stress about C1
school

K:1998, grades 3, 5, 8 child
questionnaire

Worry/stress about C1
school

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

Peer social support C2

LaGreca and Stone (1993)

Social distress

C2, C3

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

LaGreca and Stone (1993)

Social distress

C2, C3

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

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

Peer social support C2

LaGreca and Stone (1993)

Social distress

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

C2, C3

C2, C3

C4

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

Espelage and Holt (2001) (modified) Peer victimization

C4

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

C4

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

C4

Also used in ECLS-K:2011 Spring 3rd
grade CQ
Adapted from the PEW September
Tracking Survey (2009) (modified)

Media usage

C5

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

Media usage

C5

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

Media usage

C5

ECLS

Media usage

C5

ECLS

Media usage

C5

Self-Disclosure & Parental
Monitoring/Knowledge Scale (Kerr
and Statin, 2000)
Self-Disclosure & Parental
Monitoring/Knowledge Scale (Kerr
and Statin, 2000)

Parental monitoring C7

Self-Disclosure & Parental
Monitoring/Knowledge Scale (Kerr
and Statin, 2000)

Parental monitoring C7

NIH Toolbox Supplemental Battery

Domain-specific life C6
satisfaction

NIH Toolbox Supplemental Battery

Domain-specific life C6
satisfaction
Domain-specific life C6
satisfaction

NIH Toolbox Supplemental Battery

Parental monitoring C7

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

NA

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

NA

Spring Fifth-Grade Child Questions for Hearing Evaluations, Appendix B
Section
Item # Item Stem
Pre-Test
PTQ001 Do you have a cold or a runny nose today?
Questionnaire
PTQ002 Did you have a cold or a runny nose yesterday?
PTQ003

PTQ004
PTQ005

PTQ006

PTQ007

PTQ008
PTQ009
PTQ010
PTQ011
PTQ012
PTQ013

Source
ECLS-K:2011 fall 2nd
grade
ECLS-K:2011 fall 2nd
grade
Have you had an earache today?
ECLS-K:2011 fall 2nd
grade - Revised
ECLS-K:2011 fall 2nd
Did you have an earache yesterday?
grade - Revised
ECLS-K:2011 fall 2nd
Which ear(s) hurt?
grade
Have you listened to sounds today that were so loud ECLS-K:2011 fall 2nd
you would have to shout so someone close by could grade - Revised
hear you?
Did you listen to any sounds that were that loud
ECLS-K:2011 fall 2nd
yesterday? [Did you listen to any sounds yesterday
grade - Revised
that were so loud you would have to shout so
someone close by could hear you?]
Do you have tubes in your ears now that a doctor put ECLS-K:2011 fall 2nd
there [to keep you from getting earaches or ear
grade - Revised
infections]?
Do you have to wear earplugs when you swim or take ECLS-K:2011 fall 2nd
a bath or shower?
grade
ECLS-K:2011 fall 2nd
In which ear do you have the tube(s)?
grade
New
In which ear do you wear the earplug(s)?
Is it easier for you to hear out of one ear than the
ECLS-K:2011 fall 2nd
other?
grade - Revised
ECLS-K:2011 fall 2nd
Which ear is easier to hear with?
grade - Revised

Construct
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being

Research Question
PQ1; PQ2

Child Health and
Well-Being

PQ1; PQ2

Child Health and
Well-Being

PQ1; PQ2

Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being
Child Health and
Well-Being

PQ1; PQ2

PQ1; PQ2
PQ1; PQ2
PQ1; PQ2
PQ1; PQ2
PQ1; PQ2

PQ1; PQ2
PQ1; PQ2
PQ1; PQ2
PQ1; PQ2

App C Spring 5th PI.2
A

B

C

1

Spring Fifth-Grade Parent Interview, Appendix C

2

Section
Introduction

Item #
INQ.005

Item Stem
Construct
{In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 2012/In the fall of
Introduction
2012/In the spring of 2013/In the spring of 2014/In the spring of 2015}, we spoke with {NAME OF
RESPONDENT} who took part in the Early Childhood Longitudinal Study, Kindergarten Class of 20102011 on {DATE OF LAST INTERVIEW}. Am I talking to the same person?

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?

Introduction
Introduction

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?

Introduction

3

4
5

6
7
8
9
10

11

E

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

Introduction
Introduction

[May I have your name, please?]
Introduction
[May I have your name, please?]
Introduction
(As I mentioned earlier), you and {CHILD} were selected to take part in the Early Childhood
Introduction
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.
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 22 of 117

App C Spring 5th PI.2
A

B

C

INQ.090/090b

{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/In the spring of 2015}, 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.

E

Introduction

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.

12

This call will be recorded for quality control purposes.

13
14
15
16
17
18
19
20
21

Parent
Involvement
22
with Child's
School

Before we begin the interview, I would like to verify some information. I have recorded {CHILD's
Introduction
FIRST, MIDDLE, AND LAST NAME} as {CHILD}'s full name. Is this correct?
INQ180
I have recorded that {CHILD}'s home address is…Is this still correct?
Introduction
INQ190
What is {CHILD}'s home address?
Introduction
I have recorded that {PHONE NUMBER} is {CHILD}'s family's current home phone number. Is this
INQ.200
Introduction
correct?
INQ.205
{What is {CHILD}'s family's current home phone number?}
Introduction
INQ.300
Next, I have a few questions about {CHILD}'s background. Was {CHILD} born in this country, that is, Country of origin
in any of the fifty states or the District of Columbia?
for sample child
INQ.310/312OS In what country or territory was {CHILD} born?
Country of origin
for sample child
INQ.320
In what year did {CHILD} come to the United States to stay?
Length of
residence in U.S.
for sample child
INQ.330
Is {CHILD} a U.S. citizen?
Citizenship of child
INQ.130

PIQ.060

Now, I'd like to ask you about {CHILD}'s school. Is {CHILD} attending {his/her} regularly assigned
school or a school that you or someone else in your household chose?

Parent's choice of
school for child

PIQ.065

Does {CHILD} attend a school?

PIQ.066

How many hours each week does {CHILD} usually go to a school for instruction? Please do not
include time spent in extracurricular activities.

School attendance
by homeschooled
child
School attendance
by homeschooled
child

23

24

Page 23 of 117

App C Spring 5th PI.2
A

B

C

E

PIQ.080

When {CHILD} was in kindergarten in the fall of 2010, was that {his/her} first, second, or third year
of kindergarten?

Whether child
repeated
kindergarten
before fall 2010

PIQ.120

How far in school do you expect {CHILD} to go? Would you say you expect {him/her}…

Parent’s
educational
expectations for
child

25

26

PIQ.127
27

PIQ.128
28

PIQ.129
29

PIQ.130
30

PIQ.140
31

PIQ.150
32

PIQ.160
33

PIQ.170
34

PIQ.185
35

To receive less than a high school diploma,
To graduate from high school,
To attend a vocational or technical school after high school,
To attend two or more years of college,
To finish a four- or five-year college degree,
To earn a master's degree or equivalent, or
To finish a Ph.D., MD, or other advanced degree?
Since the beginning of this school year, how many times have any of {CHILD}’s teachers or {his/her} School
school contacted you or any adult in your household about any behavior problems {he/she} is
communication
having in school?
with parents
[Since the beginning of this school year, how many times have any of {CHILD}’s teachers or {his/her} School
school contacted you or any adult in your household...] About any problems {he/she} is having with communication
school work?
with parents
[Since the beginning of this school year, how many times have any of {CHILD}’s teachers or {his/her} School
school contacted you or any adult in your household...] About anything {CHILD} is doing particularly communication
well or better in school?
with parents
Parent
Now I'd like to ask you about {CHILD}'s school.
participation in
Since the beginning of this school year, have you or the other adults in your household attended an school activities
open house or a back-to-school night?
[Since the beginning of this school year, have you or the other adults in your household…] Attended Parent
a meeting of a PTA, PTO, or Parent-Teacher Organization?
participation in
school activities

[Since the beginning of this school year, have you or the other adults in your household…] Gone to Parent attendance
a regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with {CHILD}'s at parent-teacher
teacher?
conferences and
meetings
[Since the beginning of this school year, have you or the other adults in your household…] Attended Parent
a school or class event, such as a play, sports event, or science fair?
participation in
school activities
[Since the beginning of this school year, have you or the other adults in your household…] Served as Parent
a volunteer in {CHILD}’s classroom or elsewhere in the school?
participation in
school activities
During this school year, how many times have you or other adults in your household gone to
Parent
meetings or participated in activities at {CHILD}'s school?
participation in
school activities

Page 24 of 117

App C Spring 5th PI.2
A

B

PIQ.190

C

E

For each of the following statements, please tell me how well {CHILD}'s school has done with each
activity during this school year. The school lets you know between report cards how {CHILD} is
doing in school. Would you say {CHILD}'s school…

School
communication
with parents

36

PIQ.200

Does this very well,
Just OK, or
Doesn't do this at all?
[For each of the following statements, please tell me how well {CHILD}'s school has done with each School
activity during this school year.] The school helps you understand what children at {CHILD}'s age are communication
with parents
like. Would you say {CHILD}'s school…

37

PIQ.210

Does this very well,
Just OK, or
Doesn't do this at all?
[For each of the following statements, please tell me how well {CHILD}'s school has done with each School
activity during this school year.] The school makes you aware of chances to volunteer at the school. communication
with parents
Would you say {CHILD}'s school…

38

PIQ.220

Does this very well,
Just OK, or
Doesn't do this at all?
[For each of the following statements, please tell me how well {CHILD}'s school has done with each School
activity during this school year.] The school provides workshops, materials, or advice about how to communication
with parents
help {CHILD} learn at home. Would you say {CHILD}'s school…

39

PIQ.230

Does this very well,
Just OK, or
Doesn't do this at all?
[For each of the following statements, please tell me how well {CHILD}'s school has done with each School
communication
activity during this school year.] The school provides information on community services to help
with parents
{CHILD} or your family. Would you say {CHILD}'s school…

40

41

PIQ.300
PIQ.410

42

PIQ.420
43

Does this very well,
Just OK, or
Doesn't do this at all?
About how many parents of children in {CHILD}'s class do you talk with regularly, either in person, Parent networks
on the phone, or by texting, emailing, or using a social networking site?
This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
school? Inconvenient meeting times?
participation in
school activities
Has that made it harder for you to participate in activities at {CHILD}'s school?
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
school?] No child care keeps your family from going to school meetings or events?
participation in
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]

Page 25 of 117

App C Spring 5th PI.2
A

B

PIQ.430
44

PIQ.440
45

PIQ.450
46

PIQ.460
47

PIQ.480
48

PIQ.490
49

PIQ.495
50

PIQ.496a/b/c

51

C

E

[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
participation in
school?] Family members can't get time off from work?
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
school?] Problems with safety going to the school?
participation in
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
participation in
school?] The school does not make your family feel welcome?
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
school?] Problems with transportation to the school?
participation in
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]
[This year, have the following reasons made it harder for you to participate in activities at {CHILD}'s Barriers to parent
school?] You don't hear about things going on at school that you might want to be involved in?
participation in
school activities
[Has that made it harder for you to participate in activities at {CHILD}'s school?]
Would you say that you are very satisfied, somewhat satisfied, somewhat dissatisfied, or very
dissatisfied with the school {CHILD} attends this year?

Do you {or your spouse/partner} use a computer or any other electronic device to communicate
with or get information from {CHILD}'s school?

Parent's
satisfaction with
the teachers and
school
Parent
involvement online

How often do you [or your spouse or partner] use a computer or any other electronic device in the Parent
following ways? Would you say never, less than once a year, once or twice a year, several times a involvement online
year, at lease once a month, or weekly?
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?

Page 26 of 117

App C Spring 5th PI.2
A

B

E

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?

PIQ.520

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

PIQ.550

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

PIQ.560

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?

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}...

52

53

54

55

56

PIQ.585

57

C

PIQ.510

Frequency child
does homework at
home

Homework
monitoring by
parents
Grades received at
school

Grades received at
school

School avoidance

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?
Would you say almost never, rarely, sometimes, a lot, or almost always?

Page 27 of 117

App C Spring 5th PI.2
A

B

Family Structure FSQ.010

C

E

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.

Household roster:
current

As I read each person's name again, please tell me if he or she still lives in this household.

58

Does {NAME} still live in this household?
FSQ.015/015OS Why is {NAME} no longer living in this household?
59

FSQ020

{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.}

60

61

Household roster:
former household
member's status
{Other than the people I just asked about, is there anyone else currently living in this household?
Household roster:
For example, anyone who has moved in or any babies born since our last interview? Please tell me current
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.}

Household roster:
current
Household roster:
current

FSQ.025

ENTER LAST NAME OF {NAME}.

FSQ.030

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

FSQ.040

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

FSQ.045

CHECK HOUSEHOLD MATRIX.

FSQ.060
FSQ.110

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

FSQ.120

Who in the household is your spouse or partner?

62

63
64
65
66

67

Page 28 of 117

Household roster:
current
Household roster:
current
Household roster:
current
Marital status of
the primary
caretakers
Marital status of
the primary
caretakers

App C Spring 5th PI.2
A

B

FSQ.121
68

FSQ.122
69

FSQ.130
70

FSQ.140
71

FSQ.150

72

C

E

Change in family
During our last interview with this household (or family), it was reported that you were {the
relationship of
girlfriend or female partner of {CHILD}’s parent or guardian}/the boyfriend or male partner of
respondent to child
{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}?
Change in family
During our last interview with this household (or family), it was reported that {NAME OF
relationship of
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 spouse/partner to
child
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}?
Relationship of
household member
to child
Relationship of
{Are you/Is {NAME}} {CHILD}'s…
household member
Biological or birth mother,
to child
Adoptive mother,
Step mother,
Foster mother or female guardian, or
Other female parent or guardian?
{Are you/Is {NAME}} {CHILD}'s…
Relationship of
Biological or birth father,
household member
Adoptive father,
to child
Step father,
Foster father or male guardian, or
Other male parent or guardian?

Page 29 of 117

App C Spring 5th PI.2
A

B

C

E

FSQ.160

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

Relationship of
household member
to child

FSQ.170

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

Relationship of
household member
to child

FSQ.180/181

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

Relationship of
household member
to child

73

74

75

Page 30 of 117

App C Spring 5th PI.2
A

B

C

E

FSQ.190

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

Ethnicity of child,
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.

76

77

FSQ.196a

78

Race of child,
parent figures,
respondent and
respondent's
spouse (if no
mother or father
figures)
Though we may have asked you about {CHILD}'s ethnicity and race in the past, I do have a few more Ethnicity of child,
questions I'd like to ask about that now. Is {CHILD} a member of a Spanish, Hispanic, or Latino
parent figures,
group?
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?

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

FSQ.197a

Is {CHILD} a member of an Asian group?

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

79

80

Page 31 of 117

App C Spring 5th PI.2
A

B

C

E

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?

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

FSQ.198a

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

Ethnicity of child,
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?

Ethnicity of child,
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}?

FSQ.200b

See matrix.

PLQ.020

Is any language other than English regularly spoken in your home?

Marital status of
the primary
caretakers
Marital status of
the primary
caretakers
Languages spoken
in the home

81

82

83

84

85

Primary
86 Language(s)

Spoken
87
88
89
90
91

Languages spoken
in the home
PLQ.040/040OS What languages other than English are spoken in your home?
Languages spoken
in the home
PLQ.060/060OS What is the primary language spoken in your home?
Languages spoken
in the home
PLQ.083
How often {do/does} {you/{NAME}} use {{NON-ENGLISH LANGUAGE}/a language other than English} Non-English
in speaking to {CHILD}? Would you say never, sometimes, often, or very often?
language use
How often does {CHILD} use {{NON-ENGLISH LANGUAGE}/a language other than English} in
Non-English
PLQ.090
speaking to {you/{NAME}}? Would you say never, sometimes, often, or very often?
language use
PLQ.030

Is English also spoken in your home?

Page 32 of 117

App C Spring 5th PI.2
A

B

PLQ.095

C

E

This year, has it been harder for you to participate in activities at {CHILD}'s school because you or
members of your family speak a language other than English and meetings are conducted only in
English? [Has that made it harder for you to participate in activities at {CHILD}'s school?]

92

Home
Environment,
Activities, and
Cognitive
93 Stimulation

94

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

HEQ.040
HEQ.105

95

Would you say not at all, once or twice a week, 3-6 times a week, or every day?
About how many children's books does {CHILD} have in your home now, including library books?
Please only include books that are for children.
In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following
things with {CHILD}?

Literacy materials
in the home
Literacy related
outings

HEQ.130

Visited a library or bookstore?
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following
things with {CHILD}?]

Outings

HEQ.140

Gone to a play, concert, or other live show?
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following
things with {CHILD}?]

Outings

HEQ.150

Visited an art gallery, museum, or historical site?
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following
things with {CHILD}?]

Outings

HEQ.180

Visited a zoo, aquarium, or petting farm?
[In the past month, that is, since {MONTH} {DAY}, has anyone in your family done the following
things with {CHILD}?]

Outings

96

97

98

99

HEQ.210
100

Non-English
language as a
barrier to parent
involvement with
the school

Attended an athletic or sporting event in which {CHILD} was not a player?
In the past week, how often did {CHILD} read to {himself/herself} or to others outside of school?
Would you say…
Never,
Once or twice a week,
3 to 6 times a week, or
Every day?

Page 33 of 117

Frequency of
reading activities
with child

App C Spring 5th PI.2
A

B

C

E

HEQ.215

Generally, how many minutes did {CHILD} read at each of these times?

HEQ.225

In an average week, how often does {CHILD} use a home computer or other electronic device to
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?

HEQ.226

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

Parental
monitoring child's
use of
electronic/comput
er devices

HEQ.227

Do you monitor what {CHILD} looks at online, or what websites and accounts {CHILD} can join
online? Include everything the child may look at online, such as websites, email, videos, movies,
television shows, online games, chat rooms, and picture or social media sites such as Instagram,
Vine, Snapchat, YouTube, Twitter, and Facebook.

HEQ.228

How many close friends does {CHILD} have?

Parental
monitoring child's
use of
electronic/comput
er devices
Child's friends

HEQ.229

What kind of influence is {CHILD}'s {best} friend? Would you say always a good influence, usually a Child's friends
good influence, neither a good nor a bad influence, usually a bad influence, or always a bad
influence?

101

102

Frequency of
reading activities
with child
Use of
electronic/comput
er devices

103

104

105

106

Page 34 of 117

App C Spring 5th PI.2
A

B

HEQ.280
107

108

C

E

Is {CHILD} tutored on a regular basis, by someone other than you or a family member, in a specific Tutoring
subject, such as reading, math, science, or a foreign language?

HEQ.290/290OS What is {CHILD} tutored in?

Tutoring

HEQ300

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?

HEQ.301

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

Child activities
outside of school
hours
Child activities
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
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

HEQ310

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

Child activities
outside of school
hours

HEQ320

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

HEQ325

As part of {CHILD}’s participation in that program, did {he/she} ever take a field trip focused on
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,
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?

HEQ350

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

109

110

111

112

113

114

115

116

117

Page 35 of 117

Child activities
outside of school
hours
Child activities
outside of school
hours

App C Spring 5th PI.2
A

B

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 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}?

HEQ.520

Now, I have a question about meals. In a typical week, please tell me the number of days your
family eats the evening meal together.

119

120

121

HEQ.600a/b
Critical Family
Processes

CCQ.005

Very happy,
Fairly happy, or
Not too happy?
Next, I'd like to talk with you about the child care arrangements you have for {CHILD} this year.
First, I'd like to talk to you about all the child care {CHILD} now receives on a regular basis from
someone other than {you/{his/her} parents} {or {his/her} guardians}. This does not include
occasional baby-sitting or backup care providers.

CCQ010
125

127
128

CCQ.060
CCQ.065
CCQ.070
CCQ.075

129

CCQ.080
130

CCQ.085
131

Frequency of
family dinner
together
Amount of sleep

On an average school night, how many hours of sleep does {CHILD} get?
Now, I'd like to ask a question about your relationship with {NAME OF CURRENT PARTNER}. Would Marital/partner
you say that your relationship is…
satisfaction

124

126

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

CFQ.100

123

Child Care

E

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

118

122

C

HEQ370

Is {CHILD} now receiving care from a relative on a regular basis (including care provided before or
after school)? This may include grandparents, brothers and sisters, or any relatives other than
{you/{CHILD}'s parents} {or {CHILD}’s guardians}.
How many different regular care arrangements do you currently have with relatives?

Participation in
child care

Participation in
relative care

Participation in
relative care
{Let's talk about the relative who provides the most care for {CHILD} now.} Who is the relative who Participation in
cares for {CHILD}?
relative care
Participation in
Is the care provided by {{CHILD}'s {RELATIVE}/that relative} in your home or another home?
relative care
Time child spends
Does {CHILD} receive that care before school, after school, or on weekends?
in care
arrangements
Is the care that {CHILD} receives from {{his/her} {RELATIVE}/that relative} regularly scheduled at
Time child spends
least once each week?
in care
arrangements
How many days each week does {CHILD} receive care from {{his/her} {RELATIVE}/that relative}?
Time child spends
in care
arrangements

Page 36 of 117

App C Spring 5th PI.2
A

B

CCQ.090
132

CCQ.110
133

CCQ.115
134

135
136

CCQ.165
CCQ.170
CCQ.175

137

CCQ.180
138

CCQ.185
139

CCQ.190
140

CCQ.205
141

CCQ.260
142
143
144

CCQ.325
CCQ.330
CCQ.335

145

CCQ.340
146

C

E

How many hours each week does {CHILD} receive care from {{his/her} {RELATIVE}/that relative}?

Time child spends
in care
arrangements
You said that {CHILD} was cared for by {NUMBER} other {relatives/relative} on a regular basis. How Time child spends
in care
many hours each week does {CHILD} receive care from {these/this} other {relatives/relative}?
arrangements
{Now I'd like to ask you about any care {CHILD} receives from nonrelatives in a private home, not
Participation in
including child care centers.} Is {CHILD} now receiving care in a private home on a regular basis
nonrelative care
from someone who is not related to {him/her} (including care provided before or after school)?
This includes home child care providers, regular sitters or neighbors. {It does not include child care
centers.}
Participation in
How many different regular care arrangements do you currently have with nonrelatives?
nonrelative care
{Let's talk about the nonrelative who provides the most care for {CHILD} now.} Is that care provided Participation in
in your home or another home?
nonrelative care
Does {CHILD} receive that care before school, after school, or on weekends?
Time child spends
in care
arrangements
Is the care that {CHILD} receives from that person regularly scheduled at least once each week?
Time child spends
in care
arrangements
Time child spends
How many days each week does {CHILD} receive care from that person?
in care
arrangements
Time child spends
How many hours each week does {CHILD} receive care from that person?
in care
arrangements
You said that {CHILD} was cared for by {NUMBER} other {nonrelative/nonrelatives} on a regular Time child spends
basis. How many hours each week does {CHILD} receive care from {this nonrelative/these in care
nonrelatives}?
arrangements
{Now I'd like to ask you about any care {CHILD} receives from day care centers or before- or after- Participation in
school programs.} Is {CHILD} now attending a day care center or a before- or after-school program center-based care
at a school or in a center on a regular basis?
How many different day care centers or before- or after-school care programs does {CHILD} Participation in
currently go to on a regular basis?
center-based care
{Let's talk about the program where {CHILD} spends the most time now.} Is that program located in Participation in
the school {CHILD} currently attends?
center-based care
Time child spends
Does {CHILD} go to that program before school, after school, or on weekends?
in care
arrangements
Does {CHILD} go to that program on a regularly scheduled basis at least once each week?
Time child spends
in care
arrangements

Page 37 of 117

App C Spring 5th PI.2
A

B

CCQ.350
147

CCQ.353
148

CCQ.355
149

CCQ.375
150

CCQ.376
151

CCQ.377

152

Non-Resident
Parents

NRQ.040

153

C

E

How many days each week does {CHILD} go to that program?

Time child spends
in care
arrangements
As part of {CHILD}'s participation in that program, did {he/she} ever take a field trip focused on Science related
science activities, for example to a science museum or center, a science lab, a planetarium, or a field trips in centernature center?
based care
Time child spends
Other than regular school hours, how many hours each week does {CHILD} go to that program?
in care
arrangements
You said that {CHILD} attended {NUMBER} other day care {center/centers} or before- or after- Time child spends
school {program/programs} on a regular basis. How many hours each week does {CHILD} attend in care
{this program/these programs}?
arrangements
Sometimes children spend time caring for themselves, either at home or somewhere else, without Time child spends
an adult or older child responsible for them. Does {CHILD} spend time caring for {himself/herself} in self-care
on a regular basis before or after school?
How many hours per week does {CHILD} take care of {himself/herself}?
Time child spends
in self-care
The next questions are about {CHILD}'s contact with {his/her} {biological/adoptive} {father/mother}. Current contact
and nature of
[We understand that some of these questions may be difficult {for adoptive parents} to answer;
relationship with
however, these are standard questions we ask when a child does not live with {his/her} biological biological/adoptive
parents. Any information you can provide will be helpful.]
parents no longer
living in household
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?

NRQ.123

154

How many times have {CHILD} and {his/her} {biological/adoptive} {father/ mother} talked on the
Current contact
telephone or in a video call to each other, e-mailed, texted, or had some other type of contact that and nature of
was not in person in the past 4 weeks?
relationship with
biological/adoptive
parents no longer
living in household

Page 38 of 117

App C Spring 5th PI.2
A

Country of
Origin for NonResident
155
Biological
Parents

B

C

E

COQ.005/OS

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

COQ.010

How old was {CHILD’}’s biological mother when she first moved to {any of the fifty states in the
United States or the District of Columbia /the United States}?

156

COQ.020/OS
157

COQ025
158

Discipline,
DWQ.010
Warmth, and
159
Emotional
Supportiveness
DWQ.015

Country of origin
for nonresident
parents
Now we'd like to ask {another question} about {CHILD}'s biological father. {I know you mentioned Country of origin
that {CHILD}'s biological father is deceased, and I am sorry for this loss. We understand that it may for nonresident
be hard to talk about those who are no longer living, but I was hoping I could ask a couple quick
parents
background questions about where he was from.} In what country was {his/her} biological father
born?
How old was {CHILD’}’s biological father when he first moved to {any of the fifty states in the United Country of origin
for nonresident
States or the District of Columbia /the United States}?
parents
Now, I'm going to read some statements. Please tell me whether each statement is completely
Parent-child
true, mostly true, somewhat true, or not at all true.
relationship:
{CHILD} and I often have warm, close times together.
warmth
Most of the time I feel that {CHILD} likes me and wants to be near me.

DWQ.025

Even when I'm in a bad mood, I show {CHILD} a lot of love.

DWQ.035

I express affection by hugging, kissing, and holding {CHILD}.

DWQ.040
DWQ.045
DWQ.050

Being a parent is harder than I thought it would be.
{CHILD} does things that really bother me.
I find myself giving up more of my life to meet {CHILD}'s needs than I ever expected.

Parent-child
relationship:
warmth
Parent-child
relationship:
warmth
Parent-child
relationship:
warmth
Parenting Stress
Parenting Stress
Parenting Stress

DWQ.060

I often feel angry with {CHILD}.

Parenting Stress

160

161

162
163
164
165
166

Page 39 of 117

App C Spring 5th PI.2
A

B

DWQ070a/b/
c/d/e/f

167

DWQ.075
168

DWQ077a/b/c

C

E

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.
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.
How often do you argue with {CHILD}? Please include major arguments as well as minor
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
typically occurs in your home.

Parent-child
relationship:
communication

Time spent arguing
with child
Inconsistent
Discipline

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?

169

DWQ.081a/b

170

Child's Health
CHQ.010
and Well-Being

Now I’d like to ask some questions about the amount of time {CHILD} plays video games. We want Time child spent
you to include games played on systems like Playstation, Wii, or Xbox, or on handheld devices such playing video
as a Nintendo DS, Sony PSP, iPod, iPad, or cellphone, or games played on the computer.
games
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.

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

171

172
173

CHQ.020
CHQ.021

How long has it been since {CHILD}'s last visit to a clinic, health center, hospital, doctor's office, or Doctor visits
other place for routine health care?
Has {CHILD} had an ear infection since last spring?
Ear infections since
last spring

Page 40 of 117

App C Spring 5th PI.2
A
174
175

176

B

CHQ.022

C

E

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

Ear aches since last
spring
Since last spring, how many times did a doctor, nurse, or other medical professional tell you that Ear infections since
CHQ.023
{CHILD} had an ear infection?
last spring
CHQ.024/024OS How have {CHILD}’s {ear infections/ear aches} been treated by your doctor, nurse, or other medical Ear
infections/aches
professional since last spring?
treatment since
last spring
CHQ.025
Since last spring, have ear tubes been placed in the right ear, left ear, or both ears when your child Ear tubes since last
spring
had surgery to place tubes in {his/her} ears?

177

178
179
180

CHQ.026
CHQ.027
CHQ.060
CHQ.095

181

CHQ.100
182

CHQ.105
183

CHQ.106
184

CHQ.107
185

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?
Asthma
Does {he/she} receive treatment for this condition?
Asthma
In a typical week, on how many days does {CHILD} get exercise that causes rapid breathing, Exercise/physical
perspiration, and a rapid heartbeat for 20 continuous minutes or more?
activities
For the next set of questions, please base your answer on how {CHILD} compares to other children Behavioral
of the same age. {CHILD} is independent and takes care of {himself/herself} …
comparison to
Better than other children {his/her} age,
peers:
As well as other children,
Independence and
Slightly less well than other children, or
ability to take care
Much less well than other children?
of him/herself
Behavioral
Does {CHILD} pay attention…
comparison to
Better than other children {his/her} age,
peers: Attention
As well as other children,
Slightly less well than other children, or
Much less well than other children?
Behavioral
Does {CHILD} learn, think, and solve problems…
comparison to
Better than other children {his/her} age,
peers: Learn, think,
As well as other children,
solve problems
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 {he/she} Behavioral
comparison to
does this…
peers: Child's
Better than other children {his/her} age,
coordination
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…
Behavioral
Better than other children {his/her} age,
comparison to
As well as other children,
peers: Relating to
Slightly less well than other children, or
children
Much less well than other children?

Page 41 of 117

App C Spring 5th PI.2
A

B

CHQ.108
186

CHQ.109
187

CHQ.110
188

189

190

191

192

193

194

195

C

E

Behavioral
comparison to
peers: Relating to
adults

Would you say {CHILD} behaves and relates to adults…
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…
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?

Behavioral
comparison to
peers: Overall
activity level

Emotional and
psychological
difficulties
Emotional and
CHQ.111
Do you think this is a mild problem, a moderate problem, or a severe problem?
psychological
difficulties
{Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of an Evaluation of
CHQ.115
issue with {independence and taking care of {himself/herself} {or}/paying attention {or}/learning, disabilities and
thinking, and solving problems {or}/ coordination in moving {his/her} arms and legs {or}/behaving health conditions
and relating to other children {or}/ behaving and relating to adults {or}/{his/her} overall activity
level {or}/{his/her} emotional or psychological difficulties}?
CHQ.120
{Since last spring, have you obtained/Did you obtain} a diagnosis or diagnoses of a problem from a Diagnoses of
disabilities and
professional?
health conditions
CHQ.125/125OS What was the diagnosis or were the diagnoses?
Diagnoses of
disabilities and
health conditions
CHQ126/126OS What type of autism spectrum disorder does {CHILD} have? Is it autism, Asperger's Disorder, Diagnoses of
Pervasive Developmental Disorder, something else, or was it identified generally as Autism disabilities and
Spectrum Disorder?
health conditions:
Autism spectrum
disorder
CHQ.130/131 How old was {CHILD} when the first diagnosis of a problem related to {a learning
Diagnoses of
disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)/a
disabilities and
developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder (PDD), or
health conditions
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?
CHQ.135a/b
What was the month and year when the diagnosis was made?
Diagnoses of
disabilities and
health conditions

Page 42 of 117

App C Spring 5th PI.2
A

B

CHQ.140

196

197

CHQ.155
CHQ.173

198

C

E

Prescription
Is {CHILD} now taking any prescription medicine for the condition related to {his/her} {learning
medications
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}}?
Prescription
Is {CHILD} medicated for ADD or ADHD at school, at home, or both?
medications
How long has {CHILD} taken such prescription medicine for the condition related to {his/her} {a
Prescription
learning disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder
medications
(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?
Less than one month,
Less than a year,
1 to 2 years,
3 to 4 years, or
5 years or more?

CHQ.200

199

200

CHQ.206e
CHQ.210

201

CHQ.215
202

For the next question, please base your answer on how {CHILD} compares to other children of the Communication:
same age. Does {CHILD} pronounce words, communicate with and understand others…
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?
Communication
Since last spring, has {CHILD} had a problem with stuttering?
problems
{Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of Evaluation of
{his/her} ability to communicate?
communication
problems
Did you obtain a diagnosis or diagnoses of a problem related to {his/her} ability to communicate
Diagnoses for
from a professional?
communication
problems

Page 43 of 117

App C Spring 5th PI.2
A

B

CHQ.216

203

CHQ.217
204

CHQ.218
205

CHQ.219
206

CHQ.220
207
208

CHQ.221
CHQ.222

209

E

[Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a Hearing ability
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.
[Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a Hearing ability
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 speaks loudly into {his/her} ears or better ear.
Is {CHILD}’s hearing worse in one ear?
Hearing ability
Which best describes {CHILD}'s hearing in {his/her} worse ear? If {CHILD} has a hearing aid or other Hearing ability
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?

CHQ.235

{Besides the ECLS-K:2011 hearing evaluation done for this study, {Since last spring, has/Since the Evaluated for
spring of 2013, has/Since the fall of 2012, has/has}} / {Since last spring, has/Since the spring of hearing ability
2013, has/Since the fall of 2012,
has/Has}} {CHILD}'s hearing {ever} been evaluated by a professional?
.

CHQ.245

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

210

211

C

Which best describes {CHILD}’s hearing? If {CHILD} has a hearing aid or other assistive device, Hearing ability
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?
Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a Hearing ability
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.
[Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a Hearing ability
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.

Diagnoses for
hearing ability

Page 44 of 117

App C Spring 5th PI.2
A

B

C

E

CHQ.246/246OS What was the diagnosis?

CHQ.256a

Diagnoses of
disabilities and
health conditions
How old was {CHILD} when the first diagnosis of a problem related to {his/her} {ability to Diagnoses of
disabilities and
communicate/hearing} was made?
health conditions
Diagnoses of
What was the month and year the problem with {CHILD}'s {ability to communicate/hearing} was
disabilities and
diagnosed?
health conditions
Since last spring, has {CHILD} worn a hearing aid?
Use of hearing aid

CHQ.256b

Has {CHILD} ever worn a hearing aid?

Use of hearing aid

CHQ.257a/b

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

Use of hearing aid

CHQ.258

Use of hearing aid
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
Hearing ability:
{his/her} hearing aid(s). {CHILD} can usually hear and understand what a person says without seeing with hearing aid
his or her face if that person whispers to {him/her} from across a quiet room.

212

CHQ250a/b/c
213

CHQ.255a/b
214

215

216

217

218

CHQ.259
219

Page 45 of 117

App C Spring 5th PI.2
A

B

CHQ.261

[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
Hearing ability:
{his/her} hearing aid(s). ] {CHILD} can usually hear and understand what a person says without
with hearing aid
seeing his or her face if that person shouts to {him/her} from across a quiet room.
[Please indicate whether the following statement describes {CHILD}'s hearing when wearing
Hearing ability:
{his/her} hearing aid(s).] {CHILD} can usually hear and understand what a person says without
with hearing aid
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 Use of hearing aid
{CHILD} wear a hearing aid?
At what age was the recommendation that {CHILD} wear a hearing aid first made?
Use of hearing aid
Use of cochlear
Does {CHILD} have a cochlear implant?
implant
Use of cochlear
In what year was it implanted?
implant
How old was {CHILD} when it was implanted?
Use of cochlear
implant
In what years were they implanted?
Use of cochlear
implant
Use of cochlear
[In what years were they implanted?]
implant
{How old was {CHILD} when it was implanted in the left ear?}{How old was {CHILD} when they were Use of cochlear
implanted?}
implant

221

CHQ.262
222

224
225
226
227
228
229

E

[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.

220

223

C

CHQ.260

CHQ.263
CHQ.264a/b
CHQ.270
CHQ.271
CHQ.272a/b
CHQ.273
CHQ.274
CHQ.275a/b

Hearing ability:
with hearing aid

230

231

CHQ.276a/b
CHQ.277

232

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

Page 46 of 117

App C Spring 5th PI.2
A

B

C

E

CHQ.278

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

CHQ.279

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

233

234

CHQ.280

235

CHQ.285

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

CHQ.286

Is {CHILD}’s difficulty with seeing objects in the distance, things up close (like letters on paper), or Vision ability
both?

236

237

Page 47 of 117

App C Spring 5th PI.2
A
238

B

C

E

CHQ.290

{Since last spring has/Has} {CHILD}'s vision {ever} been evaluated by an eye care professional?

CHQ.300

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

239

CHQ.301/301OS What was the diagnosis?
240

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

CHQ.305a/b

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

CHQ.310a/b

What was the month and year the diagnosis was made?

Diagnoses of
disabilities and
health conditions

CHQ.311

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

Use of glasses or
contact lenses

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?

Use of glasses or
contact lenses

241

242

243

244

245
246

CHQ.313
CHQ.314
CHQ.330

247

Use of glasses or
contact lenses
Do {CHILD}’s glasses or contacts help {him/her} see things up close, see things in the distance, or Use of glasses or
both?
contact lenses
Would you say {CHILD}'s health is …
Child's general
Excellent,
health
Very good,
Good,
Fair, or
Poor?

Page 48 of 117

App C Spring 5th PI.2
A
248

B

CHQ.340
CHQ.350

249

E

CHQ.355

Has a health professional ever recommended that {CHILD} play or work with an animal as a way to Services for
help {him/her} with {a learning disability {or}/Attention Deficit Disorder (ADD) {or}/Attention Deficit disabilities
Hyperactivity Disorder (ADHD) {or}/a developmental delay {or}/autism, Asperger’s disorder,
Pervasive Developmental Disorder (PDD), or other autism spectrum disorder {or}/dyslexia
{or}/dyscalculia {or}/an intellectual disability,
severe cognitive disability, or mental retardation {or}/an orthopedic impairment {or}/a serious
emotional disturbance {or}/a traumatic brain injury/a panic disorder {or}/separation anxiety
disorder {or}/obsessive compulsive disorder {or}/generalized anxiety disorder {or}/an{other}
anxiety disorder {or}/bipolar disorder {or}/depression {or}/speech {or}/a sensory deficit disorder
{or}/oppositional defiant disorder {or}/{TEXT FROM OTHER SPECIFY} {or}/issues related to having a
communication diagnosis {or}/issues related to having a hearing diagnosis {or}/issues related to
having a vision diagnosis}? For example, a health professional may recommend that a child have his
or her own dog that is trained to provide emotional support or participate in an occupational
therapy program that involves riding horses.

CHQ.360

As a result of that recommendation, has {CHILD} ever played or worked with an animal to help
Services for
{him/her} with {a learning disability {or}/Attention Deficit Disorder (ADD) {or}/Attention Deficit
disabilities
Hyperactivity Disorder (ADHD) {or}/a developmental delay {or}/autism, Asperger’s disorder,
Pervasive Developmental Disorder (PDD), or other autism spectrum disorder {or}/dyslexia
{or}/dyscalculia {or}/an intellectual disability,
severe cognitive disability, or mental retardation {or}/an orthopedic impairment {or}/a serious
emotional disturbance {or}/a traumatic brain injury/a panic disorder {or}/separation anxiety
disorder {or}/obsessive compulsive disorder {or}/generalized anxiety disorder {or}/an{other}
anxiety disorder {or}/bipolar disorder {or}/depression {or}/speech {or}/a sensory deficit disorder
{or}/oppositional defiant disorder {or}/{TEXT FROM OTHER SPECIFY} {or}/issues related to having a
communication diagnosis {or}/issues related to having a hearing diagnosis {or}/issues related to
having a vision diagnosis}??

250

251

C

During this school year, has {CHILD} received therapy services or taken part in a program for
Services for
children with disabilities?
disabilities
Did that therapy or program ever involve {CHILD} playing or working with an animal as a way to
Services for
help {him/her} with {a learning disability {or}/Attention Deficit Disorder (ADD) {or}/Attention Deficit disabilities
Hyperactivity Disorder (ADHD) {or}/a developmental delay {or}/autism, Asperger’s disorder,
Pervasive Developmental Disorder (PDD), or other autism spectrum disorder {or}/dyslexia
{or}/dyscalculia {or}/an intellectual disability,
severe cognitive disability, or mental retardation {or}/an orthopedic impairment {or}/a serious
emotional disturbance {or}/a traumatic brain injury/a panic disorder {or}/separation anxiety
disorder {or}/obsessive compulsive disorder {or}/generalized anxiety disorder {or}/an{other}
anxiety disorder {or}/bipolar disorder {or}/depression {or}/speech {or}/a sensory deficit disorder
{or}/oppositional defiant disorder {or}/{TEXT FROM OTHER SPECIFY} {or}/issues related to having a
communication diagnosis {or}/issues related to having a hearing diagnosis {or}/issues related to
having a vision diagnosis}? You may have heard this called Animal Assisted Therapy, or AAT.

Page 49 of 117

App C Spring 5th PI.2
A

B

CHQ.420
252

CHQ.430

253

Parent's
PPQ.100
Psychological
Well-Being and
254 Health

PPQ.110
255

PPQ.120
256

PPQ.130
257

PPQ.140
258

PPQ.150
259

PPQ.160
260

PPQ.170
261

PPQ.180
262

PPQ.190
263

C

E

During this school year, did {CHILD} participate in a special education program?

Participation in
school services for
disabilities
Overall, how satisfied are you with the progress {CHILD} has made in the special services or special Rating school
education program this school year? Are you…
services for
Completely satisfied,
disabilities
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
Depression and
life during the past week. For each statement I read, please indicate how often in the past week
subjective wellyou felt or behaved this way. There are no right or wrong answers.
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
was poor?

Depression and
subjective wellbeing
How often during the past week have you felt that you could not shake off the blues even with help Depression and
subjective wellfrom your family or friends?
being
How often during the past week have you felt that you had trouble keeping your mind on what you Depression and
were doing?
subjective wellbeing
How often during the past week have you felt depressed?
Depression and
subjective wellbeing
How often during the past week have you felt that everything you did was an effort?
Depression and
subjective wellbeing
Depression and
How often during the past week have you felt fearful?
subjective wellbeing
Depression and
How often during the past week have you felt your sleep was restless?
subjective wellbeing
How often during the past week have you felt that you talked less than usual?
Depression and
subjective wellbeing
How often during the past week have you felt lonely?
Depression and
subjective wellbeing

Page 50 of 117

App C Spring 5th PI.2
A

B

C

PPQ.200

How often during the past week have you felt sad?

E

PPQ.210

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

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?

PPQ.225

During the past 12 months, would you say that you experienced a lot of stress, a moderate amount Parent health
of stress, relatively little stress, or almost no stress at all?
These next questions are about whether your family is able to afford the food that you need. I am Family food
going to read you several statements that people have made about their food situation. For these security
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}, 2015.

264

265

266

267

Food Security

FDQ.130a/b/c

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.

268

269

FDQ.140
FDQ.150

272
273
274

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…

Family food
security
Family food
security

Almost every month
Some months, but not every month, or
In only 1 or 2 months?

270

271

Depression and
subjective wellbeing
Depression and
subjective wellbeing
Parent health

FDQ.160
FDQ.170
FDQ.180
FDQ.190

In the last 12 months, did you ever eat less than you felt you should because there wasn't enough Adult food security
money for food?
In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money for Adult food security
food?
In the last 12 months, did you lose weight because there wasn't enough money for food?
Adult food security
In the last 12 months, did {you/you or other adults in your household} ever not eat for a whole day Adult food security
because there wasn't enough money for food?

Page 51 of 117

App C Spring 5th PI.2
A

B

C

E

FDQ.191

How often did this happen? Would you say…
Almost every month,
Some months, but not every month, or
In only 1 or 2 months?

FDQ.192

Now I am going to read you several statements that people have made about the food situation of Children's food
their children. For these statements, please tell me whether the statement was often true,
security
sometimes true, or never true in the last 12 months, that is, since last {CURRENT MONTH}, 2015 for
{your child/children living in the household who are under 18 years old}.

275

Adult food security

a. {I/We} relied on only a few kinds of low-cost food to feed {{CHILD}/the children} because {I
was/we were} running out of money to buy food. Was that often true, sometimes true, or never
true for {you/your household} in the last 12 months?
b.{I/We} couldn't feed {{CHILD}/the children} a balanced meal because {I/we} couldn't afford that.
Was that often true, sometimes true, or never true for
{you/your household} in the last 12 months?
c. {{CHILD} was/The children were} not eating enough because {I/we} just couldn't afford enough
food.

276

FDQ210

In the last 12 months, that is, since last {CURRENT MONTH}, 2015, did you ever cut the size of Children's food
{CHILD}'s/any of the children's} meals because there wasn't enough money for food?
security

FDQ240

In the last 12 months {was {CHILD}/were any of the children} ever hungry but you just couldn't Children's food
afford more food?
security

FDQ242

In the last 12 months, did {{CHILD}/any of the children} ever skip a meal because there wasn't Children's food
enough money for food?
security

FDQ243

How often did this happen? Would you say…
Almost every month,
Some months, but not every month, or
In only 1 or 2 months?

277

278

279

280

Children's food
security

Page 52 of 117

App C Spring 5th PI.2
A

B

C

E

FDQ250

In the last 12 months}, did {CHILD}/any of the children} ever not eat for a whole day because there Children's food
wasn't enough money for food?
security

PEQ.020

{Now I have a few questions about education.} What is the highest grade or year of school that
{you/{NAME}} {have/has} completed?

281

282

Parent's
Education

283
284
285

PEQ.021
PEQ.030
PEQ.040
PEQ.050

286
287
288

Parent's
289
Employment
290
291
292

PEQ.060
PEQ.062
EMQ.020
EMQ.030
EMQ.040
EMQ.050
EMQ.060

293

294

EMQ.070
EMQ.080

295

296
297

EMQ.100
EMQ.120

{Do/Does} {you/{NAME}} have a high school diploma, or its equivalent, such as a GED, or neither?

Parent education
Parent education

{Are you/Is {NAME}} currently attending or enrolled in any courses from a school, college, or
Parent education
university?
{Are you/Is {NAME}} currently taking courses full-time or part time?
Parent education
{Are you/Is {NAME}} currently participating in a job training or on the job training program? Please Job training
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
Parent education
hours spent on homework for the training program.
What type of school or job training {are you/Is {NAME}} currently in?
Parent education
Parent
During the past week, did {you/{NAME}} work at a job for pay?
employment
Parent
{Were you/Was {NAME}} on leave or vacation from a job?
employment
Parent
How many jobs {do you/does {NAME}} have now?
employment
About how many total hours per week {do you/does {NAME}} usually work for pay {counting
Parent
{all/both} {# of jobs from EMQ.040 IF MORE THAN TWO} jobs}?
employment
{Have you/Has {NAME}} been actively looking for work in the past 4 weeks? By actively looking for Parent
work, we mean activities such as checking with a public employment agency, a private employment 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.
Parent
What {have you/has {NAME}} been doing in the past 4 weeks to find work?
employment
What {were you/was {NAME}} doing most of last week? Would you say…
Parent
Keeping house, or caring for children or other family members,
employment
Going to school,
Retired,
Unable to work, or
Something else? What was that? (SPECIFY)
Parent
Could {you/{NAME}} have taken a job last week if one had been offered?
employment
Parent
For whom {do/does/did} {you/{NAME}} work {when {you/{he/she}}last worked}?
employment

Page 53 of 117

App C Spring 5th PI.2
A

B

EMQ.130

298

EMQ.140

299

EMQ.150

300

EMQ.210
301

E

Parent
What kind of business or industry {is/was} this?
employment
Parent
What kind of work {are/is/were/was} {you {NAME}} doing?
employment
What {are/were} {your/{NAME}'s} most important activities or duties on this job? What
Parent
{do/does/did} {you/{NAME}} actually do at this job?
employment
{Since last spring/Since {CHILD} was born}, {have you/has {NAME}} served on active duty in the U.S. Active duty military
Armed Forces, military Reserves, or National Guard? Active duty does not include training for the service: since child
Reserves or National Guard, but does include activation, for example, for the war in Afghanistan.
was born

EMQ.215

{Are you/Is {NAME}} currently on active duty in the U.S. Armed Forces, military Reserves, or Active duty military
National Guard?
service: current

WPQ.100

In the past 12 months, have you or anyone in your household received Temporary Assistance for Public assistance
Needy Families, sometimes called {TANF or} {STATE TANF PROGRAM NAME}?

WPQ.110

In the past 12 months, have you or anyone in your household received food stamps, also called
Public assistance
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?
Free/reduced lunch

302

Welfare and

C

303 Other Public

Transfers
304

WPQ.170

305
306

Parent Income
and Assets
307

WPQ.180
PAQ.100

Are these lunches free or reduced price?
In studies like this, households are sometimes grouped according to income. What was the total
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?

Page 54 of 117

Annual family
income

App C Spring 5th PI.2
A

B

PAQ.110

308

PAQ.120

309

C

E

Annual family
income

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?

PAQ.140/140OS 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)?

310

Mobility and

CMQ.010

Have you moved since {DATE OF LAST INTERVIEW}?

Annual family
income
Housing

Child Mobility

311 Tracking

Updates
312
313
314
315

Child Mobility
CMQ.020/020O Why did you move?
S
CMQ.680
WAS THIS INTERVIEW CONDUCTED BY TELEPHONE OR IN-PERSON?
Closing
CMQ.690/690O WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, A CHINESE LANGUAGE, VIETNAMESE, OR Closing
S
ANOTHER LANGUAGE?
CMQ.695
WHERE WAS THIS INTERVIEW CONDUCTED?
Closing

Page 55 of 117

App C Spring 5th PI.2
A

B

CMQ.700

CMQ.701

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?

Closing

CMQ.702

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.

Closing

317

319
320

E

Closing

We really appreciate the time you have taken over the past 6 years to talk to us. You and others
who have participated in the study have given us a wealth of information for researchers and
policymakers to use to learn more about children’s educational experiences. At this time we do not
have plans to contact you next year, but someone may follow up with you in the future to see how
{CHILD} is doing. If you want to know more about the study, please go to nces.ed.gov/ecls.

316

318

C

Thank you very much for your cooperation and for taking the time to participate in the Early
Childhood Longitudinal Study.

CMQ.703
CMQ.720

Page 56 of 117

Closing
Closing

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

A2 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)

Construct
Subjects taught

Research
Question
TQ3

Use of class time, by subject area TQ1

A3 a -j

A4

A5

A6 a-d

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)
How many days a week do children have recess?
Zero; One; Two; Three; Four; Five; Other/Varies by
week
On days when children have recess, between the
school day starting time and the dismissal time,
how many times a day do children have recess?
What percentage of children in your class(es) have
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

ECLS-K

Use of class time, by subject area TQ1

ECLS-K

Class activities (outside of class)/
recess

TQ1

ECLS-K

Class activities (outside of class)/
recess

TQ1

ECLS-K

Parent involvement in school

TQ2

A7 a-i

Views on School
Climate and School
Environment

B1 a-h

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

Please indicate the extent to which you agree or
ECLS-K
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.
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.

Methods of assessing children's
progress

TQ1

School climate

TQ4

Teacher
Background

B2 a-e

To what extent do you agree or disagree with the
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.

ECLS-K

Teacher’s sense of efficacy; Job
satisfaction

C1

What is your gender?

ECLS-K

Teacher demographic information TQ4

C2

In what year were you born?

ECLS-K

Teacher demographic information TQ4

C3

Are you Hispanic or Latino?

ECLS-K

Teacher demographic information TQ4

C4

Which best describes your race? MARK ONE OR
ECLS-K
MORE RESPONSES TO INDICATE WHAT YOU
CONSIDER YOURSELF TO BE.
Counting this school year, how many years have
ECLS-K
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

Teacher demographic information TQ4

C5 a-j

TQ4

Teaching experience, by grade and TQ4
program

C6

C7
C8

C9 a-n

Counting this school year, how many total years
have you been a school teacher, including years in
which you taught part-time?
Is this school year the first year you have taught in
this school?
What is the highest level of education you have
completed?

ECLS-K

Teaching experience, total years

TQ4

New

First year teaching in this school

TQ4

ECLS-K

Teacher's education

TQ4

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.)

Teacher's education: major field of TQ4
study

C10 a-n

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.)

Teacher's education: major field of TQ4
study

C11 a-d

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?

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

C12

Type of teaching certification held TQ4

C13

Date questionnaire completed

N/A

N/A

Spring Fifth-Grade Reading and Language Arts Teacher Questionnaire, Appendix E
Section
Item #
Item Stem
Source
Construct
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 classroom. Items not SSRS Elementary Social skills and approaches to
included due to copyright restrictions (26 items total)
Scale A; ECLS-K
learning
A2 a-g
School liking and avoidance
Please indicate how often each of these items applies to the child Adapted from
Ladd & Price,
identified on the cover of this 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
B1 a-m
Classroom
Source: Adapted Classroom behaviors
Please read each statement and decide
Behaviors
from the
whether it is a "true" or "untrue" description of this child's
Temperament in
reaction to a number of situations within the past six months. If
you cannot answer one of the items because you have never seen Middle Childhood
Questionnaire.
the child in that situation, then mark "not applicable."
Simonds, J. and
a. Is easily distracted when listening to a story.
Rothbart, M.
b. Can stop him/herself when s/he is told to stop.
(2004)
c. Looks around the room when doing school work.
d. Can stop him/herself from doing things too quickly.
e. When working on an activity, has a hard time keeping her/his
mind on it.
f. Has an easy time waiting.
g. Has a hard time paying attention.
h. Has a hard time waiting his/her turn to talk when excited.
i. Needs to be told to pay attention.
j. Gets distracted when trying to pay attention in class.
k. Likes to plan carefully before doing something.
l. Is good at following directions.
m. Has a hard time slowing down when rules say to walk.

Research
Question
TQ5
TQ5

TQ5

Peer Relationships C1 a-i

For the items below, please think about the friends with whom the Adapted from
child identified on the cover of this questionnaire has associated Vandell, 2001.
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."

Peer relationships

TQ5

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

C3 a-d

Please indicate how often each of these items applies to the child Adapted from the Peer acceptance/exclusion
Child Behavior
identified on the cover of this
Scale. Gary W.
questionnaire, particularly in the context of his or her behavior
Ladd, 2010
with peers.
a. Seems concerned when other children are distressed.
b. Is not chosen as playmate by peers.
c. Peers avoid this child.
d. Is kind towards peers.
e. Is excluded from peers' activities.
f. Is cooperative with peers.
g. Shows concern for moral issues (for example, fairness, welfare
of others).
h. Is ignored by peers.
i. Offers help or comfort when other children are upset.
During this school year, how often have other students…
Source: Adapted Target of victimization by other
from Espelage
students
and Holt, 2011

TQ5

TQ5

C3 a-d

C4 a-d

C5 a-d

Student
Information

D1 a-d

Source: Adapted Target of victimization by other
from Espelage
students
and Holt, 2011

TQ5

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?
Source: Adapted Victimization of other students by TQ5
During this school year, how often has this student…
from Espelage
this student
a. Teased, made fun of, or called
and Holt, 2001
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?
Thinking about the child identified on the cover of this
Source: Pierce,
questionnaire compared to a typical child in his/her grade, please Hamm, and
evaluate this child in the following areas.
Vandell, 1999.
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 subject areas? ECLS-K
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies

Peer relationships; emotional
intelligence

TQ5

Grade/class configuration

TQ1

D2

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

ECLS-K

Family mobility

TQ3

D3

Please indicate the total number of times this child has been
absent from your reading/language arts class during the current
school year.

ECLS-K

Attendance

TQ3; TQ5

D4 a-c

D5
D6

D7

Does this child receive (or has he/she received during this school ECLS-K
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
Is English this child's native language?
ECLS-K

Receipt of remedial or gifted
services

Native language other than English TQ2; TQ3

Receipt of instruction for English
Does this child participate in an instructional program designed to ECLS-K
language learners
teach English language skills to children with limited English
proficiency?
Would you say the instruction this child receives is primarily …
Adapted from the Receipt of instruction for English
Programs that focus on developing students' literacy in two
"Types of
language learners
languages; programs that focus on developing students' literacy language
solely in English; other program(s) (PLEASE SPECIFY); No
instruction
specialized language program is provided to this child.
educational
programs,"
provided by the
National
Clearinghouse for
English Language
Acquisition.

D8 a-c

ECLS-K

D9 a-c

On the days when this child receives specialized language
ECLS-K
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

D10

D11

TQ3; TQ7

TQ1; TQ3

TQ1; TQ3

Receipt of instruction for English
language learners
Receipt of instruction for English
language learners

TQ1; TQ3

During this school year, how often is this child's reading instruction ECLS-K
provided in his/her native language?

Receipt of instruction for English
language learners

TQ1; TQ3

Does this child have an IEP on record with the school?

IEP status

TQ3; SEQ1

ECLS-K

TQ1; TQ3

D12 a-b

D13

D14 a-d

D15
D16

Does this child receive instruction in any of the following types of ECLS-K
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
Does this child receive special accommodations (for example, for a ECLS-K
disability or limited English proficiency) to participate in the
school's testing or assessment program?
Overall, how would you rate this child’s academic skills in each of ECLS-K
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 her/his ability in
ECLS-K
READING AND LANGUAGE ARTS?
How many instructional groups based on achievement or ability ECLS-K
levels in READING do you currently have in this child's class?

D17

In which reading instructional group is this child currently placed? ECLS-K

D18

During this school year, have this child's parents/guardians
ECLS-K
participated in the following activities?
a. Attend regularly-scheduled conferences at your school
b. Attend parent/teacher informal meetings that you initiated to
talk about the child's progress
c. Returned your telephone calls or e-mails
d. Initiated contact with you
e. Volunteered to help in your classroom or school
How involved at the school would you say this child’s
ECLS-K
parents/guardians are?
During this school year, besides regular teacher conferences, have ECLS-K
you communicated with this child's parents/guardians?
ECLS-K
Was the purpose of the communication with this child's
parents/guardians to discuss
a. Behavior problems the child is having in school
b. Any problems the child is having with school work

D19
D20
D21

Receipt of special education
services

TQ1; TQ3; SEQ1

Use of accommodations in
assessments

TQ3; TQ7

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

Working to the best of one's
ability
Use of achievement grouping:
Reading

TQ5

Placement in achievement
grouping: Reading
Parent involvement in school
activities

TQ5

Parent involvement in school
activities
Communication with parents
about child's performance
Communication with parents
about child's performance

TQ2

TQ1; TQ3

TQ2

TQ6
TQ6

D21

D22

ECLS-K

c. Anything the child is doing particularly well in or better in at
school
Date questionnaire completed

Communication with parents
about child's performance

TQ6

N/A

Part 2: To be completed only if there is a red dot next to the child's name on the cover of this questionnaire.
E1 a-j From the first day of school until today, please indicate on how
Reading and
ECLS-K, updated
Time spent on specific activities TQ7
Language Arts
many days you have covered each of the following READING AND to reflect
and skills in reading/language arts
Instruction
LANGUAGE ARTS skills and concepts in this child's class. Please
"Common Core
include the time during which you provide direct instruction as
State Standards,"
well as the time you spend supervising students as they work.
corestandards.org
a. Understanding key ideas and details, for
example, identifying the main idea or theme;
summarizing; comparing characters and settings; using details and
quotations from the text to support understanding of the passage;
etc.
b. Understanding craft and structure, for
example, understanding metaphors and similes; explaining the
structure of a story, drama, or poem; describing the influence of
the narrator's point of view; etc.
c. Integrating knowledge and ideas, for example, analyzing how
visual or multi-media presentation of a text contributes to the
meaning or tone of the text comparing treatment of similar
them+D66es in stories and myths; etc.
d. Understanding key ideas and details, for example, quoting
accurately from a text; summarizing main ideas from a text; etc.

e. Understanding craft and structure, for example, comparing the
structure of events, concepts, or information in two or more texts;
analyzing different accounts of the same event; etc.

f. Integrating knowledge and ideas, for example, using
information from multiple print or digital sources to locate an
answer; explaining how the author uses evidence to support a
point in the text; integrating information from several texts to
write or speak knowledgeably about the topic; etc.

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; etc.
j. Understanding conventions of standard English, for example,
explaining the functions of conjunctions and prepositions; using
verb tense to convey various times; using punctuation to separate
items in a series; etc.
E2 a-k

How often do the children in this class engage in the following
reading and language arts activities?
a. Read silently
b. Read books they have chosen themselves
c. Make oral presentations about what they have read
d. Do a group activity or project about what they have read
e. Discuss different interpretations of what they have read
f. Look up vocabulary words and write
definitions
g. Demonstrate understanding of words by relating 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. Cite evidence from literary or informational texts ﴾in books
and/or digital sources﴿ in their writing
j. Spend extended time writing and revising text that they have
written
k. Edit their classmates' writing

TQ7
ECLS-K, updated Time spent on specific activities
to reflect
and skills in reading/language arts
"Common Core
State Standards,"
corestandards.org

Classroom and
Student
Characteristics

F1

F2

F3
F4

F5
F6 a-b

F7

F8 a-d

F9
F10

F11

As of today’s date, how many children…
a. Are currently enrolled in this class?
b. Are boys?
c. Are girls?
What grade levels are included in this class?
a. 3rd grade or lower
b. 4th grade
c. 5th grade
d. 6th grade
e. 7th grade or higher

ECLS-K

Classroom characteristics:
enrollment, gender distribution

TQ7

ECLS-K

Classroom characteristics: grade
levels within class

TQ7

How many of the children in this class are repeating their grade
this year?
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 average day?
How many children in this class are below grade level, about on
grade level, or above grade level in their English reading skills and
in social studies?
a. English reading skills?
b. Social studies?
At this point in the school year, how would you rate the behavior
of the children in this class?

ECLS-K

Classroom characteristics: number TQ2; TQ3
of repeaters
Student absenteeism
TQ2

Approximately what percentage of the students in this class
demonstrate the following problems?
a. Have difficulty paying attention in class
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 disability?

ECLS-K

ECLS-K
ECLS-K

Student absenteeism
Students above or below grade
level in reading/social studies

TQ2
TQ3

ECLS-K

Overall behavior of the class

TQ2; TQ5

New. From Abry, Classroom climate (student
Swanson, & Fabes difficulties)
(2012)

TQ2; TQ5

ECLS-K

Number of students with
disabilities
Number of English language
learners

TQ3

Number of English language
learners

TQ3

Do you have any children who are English language learners in this ECLS-K
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.)
ECLS-K
How many English language learners (ELLs) do you have in this
class?

TQ3

Classroom
Instruction and
Evaluation

G1 a-e

G2
G3

G4

ECLS-K:2011
In a typical day, how much time do children in this reading and
Grade 1
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
How often do children in this reading and language arts class go to ECLS-K
the school library or media center?
ECLS-K
In this class, how frequently do you or your students use
computers or the following electronic devices for instructional
purposes in reading and language arts? Please include any
desktop, laptop, or other computer-type devices.
a. Desktop or laptop computer or other computer-type device (for
example, iPad/other tablet, eReader such as Kindle or Nook)
b. Cell phone/smartphone (for example, iPhone)
c. Interactive whiteboard ﴾for example, SMART Board, Activboard﴿
d. Document camera or document projector (for example, ELMO,
HoverCam)
e. LCD or DLP projector
f. Digital camera (still or video)
g. CD player, MP3 player/iPod, cassette/tape player
h. DVD player, VCR, or video streaming device (for example, Roku)
i. TV
j. Student response
system (for example, clickers, responders, ActiVote,
ActivExpression)
k. Microphone or classroom audio sound system (for example,
TopCat, Redcat)

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.

ECLS-K

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

Availability, use, and adequacy of TQ1
resources
Availability, use, and adequacy of TQ1
resources

Use of homework

TQ1

Staff Activities

G5

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?

Use of homework

TQ1

G6 a-e

In this class, how often do you use a formal assessment in
ECLS-K:2011
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

Response to Intervention-related TQ6
policies and practices

H1

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

ECLS-K:2011
Grade 1

Professional development
activities

TQ4

H2 a-c

How often did you participate in professional development
activities covering the following topics in the last 12 months?
a. How to use assessment data to identify students who are
struggling or at risk of failure in READING
b. How to use and apply assessment data to guide READING
instruction
c. How to implement the READING curriculum

Adapted from
Reading First
Impact Study-Teacher Survey

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

TQ6

Spring Fifth-Grade Math Teacher Questionnaire, Appendix E
Section
Item #
Item Stem
Source
Construct
Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.
Student
Are you this child's primary teacher in the following ECLS-K
A1 a-d
Grade/class configuration
Information
subject areas?
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies
How long has this child been in your math class this ECLS-K
A2
Family mobility
school year until now?
A3
Please indicate the total number of times this child ECLS-K
Attendance
has been absent from your math class during the
current school year.

Research
Question
TQ1

TQ3
TQ3; TQ5

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

Receipt of remedial or gifted
services

ECLS-K

Native language other than English TQ2; TQ3

A6

During this school year, how often is this child's
math instruction provided in his/her native
language?

ECLS-K

Receipt of instruction for English
language learners

TQ2; TQ3

A7

Overall, how would you rate this child’s academic
skills in math, based on curriculum standards for
his/her current grade level?
How often does this child work to the best of
her/his ability in MATH?

ECLS-K

Comparison to peers: academic
skills for current grade level in
math
Working to the best of one's
ability

TQ5

A4 a-b

A5

A8

ECLS-K

TQ3; TQ7

TQ5

A9

How many instructional groups based on
achievement or ability levels in MATHEMATICS do
you currently have in this child's class?

ECLS-K

Use of achievement grouping:
mathematics

TQ1; TQ3

A10

In which mathematics instructional group is this
ECLS-K
child currently placed?
During this school year, have this child's
ECLS-K
parents/guardians participated in the following
activities?
a. Attend regularly-scheduled conferences at your
school
b. Attend parent/teacher informal meetings that
you initiated to talk about the child's progress
c. Returned your telephone calls or e-mails
d. Initiated contact with you
e. Volunteered to help in your classroom or school

Placement in achievement
grouping: mathematics
Parent involvement in school
activities

TQ5

During this school year, besides regular teacher
ECLS-K
conferences, have you communicated with this
child's parents/guardians?
Was the purpose of the communication with this
ECLS-K
child's parents/guardians to discuss
a. Behavior problems the child is having in school
b. Any problems the child is having with school
work
c. Anything the child is doing particularly well in or
better in at school

Communication with parents
about child's performance

TQ6

Communication with parents
about child's performance

TQ6

A11

A12

A13

A14
Date questionnaire completed
Part 2: To be completed only if there is a red dot next to the child's name on the cover of this questionnaire

TQ2

N/A

Mathematics
Instruction

B1 a-g

From the first day of school until today, please
ECLS-K, updated Time spent on specific activities
indicate on how many days you have covered each
to reflect
and skills in mathematics
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 algebraic thinking, for example, using
parentheses in numerical expressions; writing and
interpreting simple numerical expressions;
generating and graphing numerical patterns; etc.
b. Understanding place value, for example,
understanding the value of a digit in one place as
compared to an adjacent place; using whole
number exponents to denote powers of 10;
reading, writing, and comparing decimals to
thousandths; rounding decimals; etc.
c. Adding, subtracting, multiplying, and dividing
multiple‐digit whole numbers and decimals to
hundredths
d. Understanding fractions, for example, adding
and subtracting fractions with unlike denominators;
understanding the relationship between decimals
and fractions; solving real world problems involving
multiplying and dividing fractions by whole
numbers; etc.

TQ7

e. Using concepts of geometric measurement, for
example, converting among different measurement
units; making plots or graphs to display fractions of
a unit; understanding and using units of volume;
solving volume problems using multiplication and
addition; etc.
f. Representing and interpreting data, for example,
making line plots or other visuals to display
fractions of a unit; using operations on fractions to
answer questions about a line plot; etc.
g. Understanding geometric concepts, for example,
using axes (perpendicular lines) to define a
coordinate system; classifying two-dimensional
figures such as squares and rectangles; etc.
B2 a-m How often do the children in this class engage in the ECLS-K, updated Time spent on specific activities
following mathematics activities?
to reflect
and skills in mathematics
"Common Core
State Standards,"
corestandards.org
a. Solve mathematics problems from textbooks or
workbooks
b. Solve mathematics problems from the
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

TQ7

Classroom and
Student
Characteristics

C1 a-c

C2 a-e

C3
C4 a-b

C5
C6

C7

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 or tablet (e.g., iPad, Surface) for
math (beyond using the device's calculator)
l. Interpret visual representations (for example,
diagrams, graphs, tables, models)
m. Create visual representations (for example,
diagrams, graphs, tables, models)
ECLS-K
As of today’s date, how many children…
a. Are currently enrolled in this class?
b. Are boys?
c. Are girls?
What grade levels are included in this class?
ECLS-K
a. 3rd grade or lower
b. 4th grade
c. 5th grade
d. 6th grade
e. 7th grade or higher
How many of the children in this class are repeating ECLS-K
their grade this year?
How many children in this class…
ECLS-K
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
mathematics skills?

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

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

TQ2

C8 a-d

C9
C10

C11
Classroom
Instruction and
Evaluation

D1 a-e

Items asking the percentage of the students in the New. From Abry, Classroom climate (student
TQ2; TQ5
classroom who demonstrate behaviors or
Swanson, & Fabes difficulties)
characteristics that either disrupt or create a
(2012)
challenging learning environment. Items not
included due to copyright restrictions (4 items
total).
TQ3
How many children in this class have a diagnosed ECLS-K
Number of students with
disability?
disabilities
Do you have any children who are English language ECLS-K
Number of English language
TQ3
learners in this class? (English language learners are
learners
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
Number of English language
TQ3
have in this class?
learners
In a typical day, how much time do children in this ECLS-K:2011
Proportion of time students spend TQ1
math class spend in the following activities?
Grade 1
working independently, small
a. Working independently
group, large group
b. Working on individual tasks under teacher
direction
c. Working with peers under teacher direction
d. Working in small groups with teacher
e. Teacher lecture with large group and/or large
group discussion led by teacher

D2 a-h

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. Desktop or laptop computer or other computertype device (for example, iPad/other tablet,
eReader such as Kindle or Nook)
b. Cell phone/smartphone (for example, iPhone)
c. Interactive whiteboard ﴾for example, SMART
Board, Activboard﴿
d. Document camera or document projector (for
example, ELMO, HoverCam)
e. LCD or DLP projector
f. Digital camera (still or video)
g. CD player, MP3 player/iPod, cassett/tape player
h. DVD player, VCR, or video streaming device (for
example, Roku)
i. TV
j. Student resonse system (for example, clickers,
responders, ActiVote, ActivExpression)

Availability, use, and adequacy of TQ1
resources

k. Microphone or classroom audio sound system
(for example, TopCat, Redcat)
D3

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.

Use of homework

TQ1

D4

On days when homework is assigned, how much
ECLS-K
time do you expect children in this class to spend on
homework in math?

Use of homework

TQ1

Staff Activities

D5 a-e

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

Response to Intervention-related TQ6
policies and practices

E1

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

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

E2 a-c

Spring Fifth-Grade Science Teacher Questionnaire, Appendix E
Research
Question
Section
Item #
Item Stem
Source
Construct
Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.
Are you this child's primary teacher in the following ECLS-K
Student
A1 a-d
Grade/class configuration
TQ1
subject areas?
Information
a. Reading/language arts
b. Mathematics
c. Science
d. Social studies
How long has this child been in your science class ECLS-K
A2
Family mobility
TQ3
this school year until now?
Please indicate the total number of times this child ECLS-K
A3
Attendance
TQ3; TQ5
has been absent from your science class during the
current school year.
Native language other than English TQ2; TQ3
A4
Is English this child's native language?
ECLS-K
A5

A6

A7

During this school year, how often is this child's
ECLS-K
science instruction provided in his/her native
language?
Overall, how would you rate this child’s academic ECLS-K
skills in SCIENCE, based on curriculum standards for
his/her current grade level?

Receipt of instruction for English
language learners

TQ2; TQ3

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

TQ5

How often does this child work to the best of
his/her ability in SCIENCE?

Working to the best of one's
ability

TQ5

ECLS-K

A8

During this school year, have this child's
ECLS-K
parents/guardians participated in the following
activities?
a. Attend regularly-scheduled conferences at your
school
b. Attend parent/teacher informal meetings that
you initiated to talk about the child's progress
c. Returned your telephone calls or e-mails
d. Initiated contact with you
e. Volunteered to help in your classroom or school

Parent involvement in school
activities

TQ2

A9

During this school year, besides regular teacher
ECLS-K
conferences, have you communicated with this
child's parents/guardians?
Was the purpose of the communication with this
ECLS-K
child's parents/guardians to discuss
a. Behavior problems the child is having in school
b. Any problems the child is having with school
work
c. Anything the child is doing particularly well in or
better in at school

Communication with parents
about child's performance

TQ6

Communication with parents
about child's performance

TQ6

A10

A11
Date questionnaire completed
Part 2: To be completed only if there is a red dot next to the child's name on the
cover of this questionnaire.

N/A

Science Instruction

B1 a-h

From the first day of school until today, please
ECLS-K, updated to Time spent on specific activities
indicate on how many days you have covered each reflect "Common
and skills in science
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.﴿
a. Physical science, for example, understanding
matter, chemical reactions, gravity, energy, etc.
b. Life science, for example, learning about
organisms, life cycles, food chains,
ecosystems, etc.
c. Earth science, for example, learning about the
solar system; interactions of the geosphere,
hydrosphere, atmosphere, and biosphere; effects of
human activity on Earth's resources and
environments, etc.
d. Conceptual modeling, for example, developing
and using models to describe events, phenomena,
e.
etc.Scientific testing, for example, planning and
conducting investigations, observing and measuring
using appropriate tools and fair tests to generate
data, etc.
f. Analysis and conclusions, for example, analyzing
the results of a scientific investigation and
determining whether the results support the initial
prediction, etc.
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.

TQ7

B2 a-l

How often do the children in this class engage in the ECLS-K, updated to Time spent on specific activities
following science activities?
reflect "Common and skills in science
a. Read a science textbook or e-book
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 hands-on science equipment (e.g.,
magnifying glass, scales, thermometers,
microscopes, dissecting tools, etc.)
f. Use "virtual" science equipment, that is, use
computer-based interactive renderings of science
equipment
g. Engage in hands‐on activities or investigations
in science

TQ7

h. Engage in "virtual" activities or investigations in
science, that is, using computer-based tools for the
activities or investigations
i. Talk about measurements and results from
children’s hands‐on activities
j. Talk about measurements and results from
"virtual" activities
k.Prepare a written science report
l. Take a science test or quiz
m. Use library or media center resources for science

Classroom and
Student
Characteristics

C1 a-c

As of today's date, how many children: are currently ECLS-K
in this class, are boys, are girls

Classroom characteristics:
enrollment, gender distribution

TQ1; TQ2

C2 a-e

What grade levels are included in this class?

Classroom characteristics: grade
levels within class

TQ2

a. 3rd grade or lower
b. 4th grade
c. 5th grade
d. 6th grade

ECLS-K

C3
C4 a-b

C5
C6
C7
C8

C9
C10

C11

e. 7th grade or higher
How many of the children in this class are repeating ECLS-K
their grade this year?
How many children in this class…
ECLS-K

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

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
Student absenteeism
average day?
How many children in this class are below grade
Students above or below grade
ECLS-K
level, about on grade level, or above grade level in
level in science
science?
At this point in the year, how would you rate the ECLS-K
Overall behavior of the class
behavior of the children in this class?
Items asking the percentage of the students in the New. From Abry, Classroom climate (student
Swanson, & Fabes difficulties)
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
Number of students with
disability?
disabilities
Do you have any children who are English language ECLS-K
Number of English language
learners in this class? (English language learners are
learners
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
Number of English language
have in this class?
learners

TQ3
TQ2
TQ2; TQ5
TQ2; TQ5

TQ3
TQ3

TQ3

Classroom
Instruction and
Evaluation

D1 a-e

In a typical day, how much time do children in this
science 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

D2 a-h

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. Desktop or laptop computer or other computertype device (for example, iPad/other tablet,
eReader such as Kindle or Nook)
b. Cell phone/smartphone (for example, iPhone)
c. Interactive whiteboard ﴾for example, SMART
Board, Activboard﴿
d. Document camera or document projector (for
example, ELMO, HoverCam)
e. LCD or DLP projector
f. Digital camera (still or video)
g. CD player, MP3 player/iPod, cassett/tape player
h. DVD player, VCR, or video streaming device (for
example, Roku)
i. TV
j.
Student resonse system (for example, clickers,
responders, ActiVote, ActivExpression)
k. Microphone or classroom audio sound system
(for example, TopCat, Redcat)

ECLS-K:2011 Grade Proportion of time students spend TQ1
1
working independently, small
group, large group

Availability, use, and adequacy of TQ1
resources

D3

D4

D5 a-e

Staff Activities

E1
E2 a-c

In an average week, how many days a week is
ECLS-K
Use of homework
TQ1
science homework assigned in this class? Please
count homework assigned over the weekend as one
day.
On days when homework is assigned, how much
ECLS-K
Use of homework
TQ1
time do you expect children in this class to spend on
homework in science?
In this class, how often do you use a formal
ECLS-K:2011 Grade Response to Intervention-related TQ7
assessment in SCIENCE for the following purposes? 1
policies and practices
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
Did you participate in any professional
ECLS-K:2011 Grade Professional development
development* within the last 12 months?
1
activities
How often did you participate in professional
Adapted from
Professional development
development activities covering the following topics Reading First
activities; Response to
in the last 12 months?
Impact Study-Intervention-related policies and
a. How to use assessment data to identify students Teacher Survey
practices
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

TQ4
TQ6

Spring Fifth-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix F
Item #
1

What is your gender?

Source
ECLS-K

2

In what year were you born?

ECLS-K

3

Are you Hispanic or Latino?

ECLS-K

4

Which best describes your race? MARK ONE OR MORE
ECLS-K
RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO
BE.

5

What is the highest level of education you have completed?

6

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?
ECLS-K
Counting this school year, how many total years have you
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

7

8

9 a-m

10

Item Stem

ECLS-K

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

Have you ever taken a college course that addressed issues
ECLSrelated to the following?
K:2011
a. Using published research evidence to identify and select
Grade 1
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?

13

ECLS-K

14

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?

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﴿

16 a-d

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.
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:

evel Questionnaire, Appendix F
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

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 Fifth-Grade Special Education Teacher Child-Level Questionnaire, Appendix F
Item #

Item Stem

Source

1

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?

ECLS-K

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?

ECLS-K

2
3 a-f

4

5
6

ECLS-K
ECLS-K

ECLS-K

ECLS-K

7

To what extent were you involved in planning the transition from last year's
ECLS-K
special education program to this year's special education program for this child?

8

To what extent did you communicate with the person(s) who provided special
education for this child last year?

ECLS-K

9

Have you reviewed this child’s records related to special education services
provided before this school year?

ECLS-K

10

What is this child’s primary disability as identified on the child’s IEP? PLEASE
SELECT THE CATEGORY BELOW INTO WHICH THE CHILD'S PRIMARY DISABILITY
FITS BEST.

ECLS-K

THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD'S SPECIAL EDUCATION EXPERIENCE

11 a-n

12

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

ECLS-K

ECLS-K

14 a-m

15 a-n

16
17

18

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
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
materials used with this child in the general education classroom?

ECLS-K

21

During this school year, which of the following best describes the curriculum
materials used with this child in the special education classroom/program?

ECLS-K

22

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).

23 a-z

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﴿

20

Learning aids (non-computer)

ECLS-K

24
25

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)
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
education teacher﴾s﴿ to discuss this child's program or progress?

ECLS-K
ECLS-K

26

On average, how long were the meetings with the general education teacher﴾s﴿ to ECLS-K
discuss this child's program or progress?

27

ECLS-K
During this school year, approximately how often have you communicated with
this child's parents about this child's program or progress ﴾by phone, in person, or
in writing, including e‐mail﴿?

28 a-h

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?

29

30

What percentage of this child's current IEP goals have been met or nearly met at
this point in the school year?

31

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?

32

During this school year, to what extent has this child participated in any grade‐
level assessment administered as part of the school's testing program?

33

Did this child receive special accommodations to participate in the school's regular ECLS-K
testing or assessment program this school year?

ECLS-K

ECLS-K

34

In which grade is this child enrolled?

35

Date Questionnaire Completed:

ECLS-K

ppendix F
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
Transition activities

SEQ7

Transition activities

SEQ1

Transition activities

SEQ1

Child’s disability

SEQ2

XPERIENCE DURING THE CURRENT SCHOOL YEAR.

SEQ7
SEQ1

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

TQ3, SEQ3,
SEQ5

SEQ5, SEQ7

Current grade level

N/A

N/A

N/A

Spring Fifth-Grade School Administrator Questionnaire For All Schools, Appendix G
Section
School
Characteristics

Item #
Item Stem
A1
How many instructional days will this school provide during this academic year?

Source
ECLS-K

A2 a-d School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE ECLS-K
FOLLOWING.
a. Total enrollment in fifth grade in your school around October 1, 2015, or the date
nearest to that for which data are available
b. Total enrollment for your school (across all grades) around October 1, 2015, or the date
nearest to that for which data are available
c. Number of children who have enrolled in your school Since October 1, 2015
d. Number of children who have left your school since October 1, 2015, and have not
returned
A3
ECLS-K
Approximately, what is the Average Daily Attendance for your school this year?

Construct
Length of school year
Enrollment and
attendance

Research
Question
SAQ1
SAQ2

SAQ7
Enrollment and
attendance
SAQ2
Adequacy of school
facility
School type (grade levels) SAQ2

A4

How many children is this school site designed to accommodate?

ECLS-K

A5

Mark all grade levels included in your school.

ECLS-K

A6

Which of the following characterizes your school? MARK ALL THAT APPLY.

ECLS-K

A7

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 children with disabilities
Year-round school
Bureau of Indian Education (BIE) or tribal school
In what year did this school start providing instruction as a public CHARTER school?

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

ECLS-K

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

A8

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

ECLS-K

A9 a-h Approximately how many or what percentage of the children in your school belongs to
each of the following racial/ethnic groups?

ECLS-K

A9 a-h

A10

ECLS-K
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 A13. ECLS-K:2011
Grade 1

A11 a-c About what percentage of the children enrolled in this school attend from outside of this
school’s assigned attendance area because….

SAQ2
Student demographic
information:
race/ethnicity distribution

ECLS-K

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

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)?
A12

About what percentage of the children enrolled in this school are from the surrounding
neighborhood?

ECLS-K

School characteristics

A13

About what percentage of the children enrolled in this school are eligible for free or
reduced-price lunch?

ECLS-K

Are any of the following programs for fifth-grade children and their families at your school ECLS-K
site? Please include programs run by the school and those run by outside groups.

SAQ2
Student demographic
information: indicator of
poverty
Programs or services for SAQ4
children

a. Before-school child care
b. After-school child care
c. Hearing screening
d. Vision screening
Are any of the following programs or services for parents and families available at your
school site? Please include programs run by the school and those run by outside groups.

Programs or services for
parents and families

School-Family- B1
Community
Connections

B2

a. Parenting education programs (for example, classes on child development, education in
being a parent, understanding children with special needs)
b. Adult literacy programs (including Adult Basic Education)
c. Family literacy program
d. Health or social services offered collaboratively by service agencies like hospitals

ECLS-K

SAQ2

SAQ4

e. Orientation to school setting for new families
f. Child care so that parents can attend school parent meetings or events
g. Programs to learn English for parents or families whose native language is not English
B3 a-f

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 children'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
B4 a-b 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
B5
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?

School-based programs or SAQ3, SAQ4
services for parents and
families

Parent outreach and
communication

SAQ3, SAQ4

Parent outreach and
communication

SAQ3, SAQ4

ECLS-K:2011
During this school year, has your school (or any teacher)) 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?

Parent outreach and
communication

SAQ3, SAQ4

B7 a-b 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?
a. Classroom-specific assignments, including homework
b. Child- or parent-specific information, such as progress reports between grading periods

Parent outreach and
communication

SAQ3, SAQ4

B8 a-f

Neighborhood problems SAQ6

B6

B9 a-i

ECLS-K
How much of a problem are the following in the neighborhood where this school is
located?
a. Tensions based on racial, ethnic, or religious differences
b. Selling or using drugs or excessive drinking in public
c. Gangs
d. Vacant houses and buildings
e. Crime in the neighborhood
f. Violence in the neighborhood
To the best of your knowledge how often do the following types of problems occur at your ECLS-K
school?

School safety

SAQ7

B9 a-i

ECLS-K

School safety

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
B10 a-g Does your school take any of the following measures to ensure the safety of children?

ECLS-K

Measures taken to ensure SAQ7
school safety

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)
B11 a-f 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
B12 a-k 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

SAQ7

SAQ7
Enrollment and
attendance; School
climate; Teacher mobility

Recent changes at the
school

SAQ2

School Policies
and Practices

B13

During the past year, were salaries frozen at your school?

B14

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 C14.
During the past year, were changes made to your school's assigned attendance area?

ECLS-K:2011
Grade 1

Recent changes at the
school

SAQ2

ECLS-K:2011
Grade 1

Recent changes at the
school

SAQ2

C1

Which of the following statements describe your school's grade promotion and retention
practices or policies?
a. This school has a formal retention policy.
b. Children can be retained more than once in each grade.

C2

ECLS-K
How many fourth-grade children were retained at their current grade level last school
year?
How many fifth-grade children were retained at their current grade level last school year? ECLS-K

SAQ2
Retention policies and
practices
C3
SAQ2
Retention policies and
practices
C4
Is a school-wide positive behavioral intervention and support program (for example,
Adapted from Response to Intervention- SAQ9
Positive Behavioral Support, Positive Behavioral Intervention System) implemented at your FRSS 99:
related policies and
school?
practices
Dropout
Prevention
Services and
Programs
survey
C5 a-d For each of the following statements about READING and MATH, indicate how strongly you Adapted from Response to Intervention- SAQ9
agree or disagree.
WA (RTI) and related policies and
HB 2136:
practices
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.
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 fifth grade, either partially Adapted from Response to Intervention- SAQ9
IDEA national related policies and
or fully implemented?
Assessment
practices
Implementatio
n Study (LEA)
C7 a-d Is RtI currently implemented at your school in fifth grade in the following areas?
Adapted from Response to Intervention- SAQ9
IDEA national related policies and
a. Math
Assessment
practices
b. Reading
Implementatio
c. Writing
n Study (LEA)
d. Behavior/Social skills
C8
Has your school implemented the Common Core State Standards at any grade(s)?
ECLS-K:2011 Implementation of
SAQ10
Common Core State
Standards
C9 a-b Are the Common Core State Standards currently implemented at your school in fifth grade ECLS-K:2011 Implementation of
SAQ10
in the following areas?
Common Core State
Standards
a. Reading and Language Arts
C6

C10

School Programs D1
for Particular
Populations

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?
Do any of the children in this school come from a home where a language other than
English is spoken?

ECLS-K

D2

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

ECLS-K

D3

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

ECLS-K

D4 a-c 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.

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

D4 a-c

ECLS-K

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

c. Home visits are made to families of these children.
D5
Since the beginning of this school year (2015-2016), how many students have been NEWLY Adapted from Evaluation for IEP
evaluated at your school to determine if they are eligible for an IEP?
IDEA national
Assessment
Implementatio
n Study (LEA)
D6
Of those students who have been NEWLY evaluated at your school this school year (2015- Adapted from Special education
2016), how many were found eligible for an IEP, including those who may have an IEP for IDEA national eligibility
speech only?
Assessment
Implementatio
n Study (LEA)
D7 a-b What method(s) are used in your school to determine special education ELIGIBILITY for
Adapted from Special education
students with learning disabilities?
IDEA national eligibility
Assessment
a. IQ-achievement discrepancy model which shows whether there is a discrepancy
Implementatio
between expected performance and actual performance
n Study (LEA)
b. Response to Intervention (RtI) model
D8 a-e Approximately what percentage of your fifth-graders are in each of the following
instructional programs?

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

SAQ9

SAQ9

ECLS-K

Delivery of special
education and related
services to children with
disabilities

SAQ4

Where are children with Individualized Education Programs (IEPs) typically served in this
school?

ECLS-K

SAQ4

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

ECLS-K:2011

Delivery of special
education and related
services to children with
disabilities
Services and programs:
Title I

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.”)

ECLS-K:2011

Services and programs:
Title I
ECLS-K:2011 Services and programs:
Title III

SAQ2

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
e. A gifted and talented program
D9

SAQ9

SAQ2

SAQ2

ECLS-K:2011, School status relative to SAQ2
based on NCLB Adequate Yearly Progress
Title I
(AYP)
regulations
E5
At the end of the LAST school year (2014-2015), was this school identified for improvement ECLS-K:2011, School status relative to SAQ2
due to Adequate Yearly Progress (AYP) requirements? (A school is identified for
based on NCLB Adequate Yearly Progress
improvement if it does not make Adequate Yearly Progress for two consecutive years or
Title I
(AYP) and school
more in the same
regulations
improvement
content area.)
F1 a-f Approximately how many staff members does your school currently have in the following ECLS-K
Numbers of full- and part- SAQ2
categories?
time teachers, specialists,
nurses, and
a. Regular classroom teachers
paraprofessionals
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)
F2 a-h Does your school currently have any staff members (full- or part-time) in the following
ECLS-K:2011, Number of staff members SAQ2
Grade 1
and specialists
categories?
a. Teachers of gifted/talented students
b. Reading specialists and interventionists
c. Math specialists and interventionists
d. School nurses or health professionals
e. School psychologists or social workers
f. Guidance counselors
g. Library media specialists/librarians
h. Computer/technology teachers or support staff
F3 a-e Does your school currently have any staff members who do the following as their primary ECLS-K
Response to Intervention- SAQ9
role or one of their primary roles?
related policies and
practices
E4

Staffing and
Teacher
Characteristics

At the end of the LAST school year (2014-2015), did this school made Adequate Yearly
Progress (AYP)? (Adequate Yearly Progress is your state's measure of yearly progress
toward achieving state academic standards.)

a. A school staff member who provides ongoing training or support to classroom teachers
in the delivery of effective READING instruction

F4a-b

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
ECLS-K
Please indicate the number of regular classroom teachers who have joined or left your
school since October 1, 2015.
a. Number of regular classroom teachers who have begun teaching in your school since
October 1, 2015
b. Number of regular classroom teachers who have left your school since October 1, 2015

F5a-h

Teacher mobility

SAQ2; SAQ7

What percentage of your part-time and full-time teachers, including regular classroom,
ESL/bilingual, remedial, special education, art, music, and physical education teachers,
belongs to each of the following racial/ethnic groups?
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 number of teachers (sum of a through g)
F6 a-b 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?
F7 a-f 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

Racial and ethnic
composition of teaching
staff

SAQ2

ECLS-K:2011,
Grade 1

Teacher Incentives

SAQ2

ECLS-K

N/A

N/A

F8

ECLS-K

N/A

N/A

ECLS-K

SAQ8
School administrator
demographic information

F9

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?

School
Administrator
Characteristics

G1

What is your gender?

ECLS-K

SAQ8
School administrator
demographic information

G2

In what year were you born?

ECLS-K

SAQ8
School administrator
demographic information

G3

Are you Hispanic or Latino?

ECLS-K

SAQ8
School administrator
demographic information

G4

Which best describes your race?

ECLS-K

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

SAQ8

School administrator's
formal education and
training

SAQ8

School administrator's
formal education and
training
School administrator’s
familiarity with students

SAQ8

G5 a-c How many years of experience do you have in each of the following positions, including
years in which you worked part time?

ECLS-K:2011,
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
G6 a-f 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)

SAQ8

c. City-based training program (for example, Cleveland's First Ring Leadership Academy )

G7

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
What is the highest level of education you have completed?

G8 a-f What was your major field(s) of study in the highest degree you completed?
a. Early childhood education
b. Elementary 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.)

ECLS-K

ECLS-K

SAQ8

G9

What is your best estimate of the percentage of children in your school you know by
name?

ECLS-K

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

G10

During school hours, do you speak a language other than English with students at your
school whose native language is not English?

ECLS-K

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

G11

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

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

G12

If you do not speak a language other than English with EITHER students OR students’
families whose native language is not English, mark here and SKIP TO Q G14.

ECLS-K

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

G13

What language(s) other than English do you speak with students at your school or with
their families?
Date questionnaire completed/Questionnaire completed by:

ECLS-K

School administrator’s
familiarity with students

G14

ECLS-K

SAQ8