Initial Survey for K-12 MSP Institute Participants

Attachment G
Initial Survey for K–12 Institute Participants

OMB # 3145-0199
Expires: xxxxxx

Math and Science Partnership Program
Initial Survey for K-12 Institute Participants

Sponsored by the
National Science Foundation
Conducted by
Westat
1650 Research Boulevard
Rockville, Maryland 20850

Privacy Notice
Information from this monitoring system will be retained by the National Science Foundation, a federal agency, and will be an
integral part of its Privacy Act System of Records in accordance with the Privacy Act of 1974 and maintained in the Education
and Professional development activities System of Records 63 Fed. Reg. 264, 272 (January 5, 1998). These are confidential files
accessible only to appropriate National Science Foundation (NSF) officials, their staffs, and their contractors responsible for
monitoring, assessing, and evaluating NSF programs. Only data in highly aggregated form, or data explicitly requested as "for
general use," will be made available to anyone outside of the National Science Foundation for research purposes. Data submitted
will be used in accordance with criteria established by NSF for monitoring research and education grants, and in response to
Public Law 99-383 and 42 USC 1885c.
Public Burden
Paperwork Reduction Act Notice. The Paperwork Reduction Act of 1995 says we must tell you why we are collecting this
information, how we will use it and whether you have to give it to us. The reasons and purpose of this survey are described in
the introduction and instructions for this survey and your response is voluntary. Failure to provide full and complete information,
however, may reduce the possibility of NSF continuing support for the award or project subject to this monitoring survey. An
agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
valid OMB control number. The OMB control number for this survey is 3145-0199. The estimated average burden associated
with this collection of information is .25 hours per respondent, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing the burden should be sent to Suzanne Plimpton, Reports Clearance
Officer for OMB 3145-0199, NSF/OGC, 4201Wilson Boulevard, Arlington, VA 22230.

Initial Survey of K–12 Institute Participants
The National Science Foundation (NSF) is collecting annual information about each of its Math and
Science Partnership (MSP) projects. The purpose is to assess the overall implementation of the MSP
program and to monitor the progress of individual MSP grants.
This form is designed to obtain information from each K–12 teacher and administrator who has
enrolled in a MSP Institute program during the [INSERT SCHOOL YEAR] school year. For the purposes
of this collection, this includes any teacher or administrator enrolled in the summer Institute following the
[INSERT SCHOOL YEAR] school year. The Principal Investigator (PI) of one of the MSP Institutes has
identified you as being an appropriate respondent.

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GLOSSARY
Race and ethnicity terms defined for Questions 2 and 3
Hispanic or Latino. A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.
American Indian or Alaska Native. A person having origins in any of the original peoples of North and
South America (including Central America), and who maintains tribal affiliation or community
attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,
the Philippine Islands, Thailand, and Vietnam.
Black or African American. A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Course descriptions for Question 12
High School Level 1 Mathematics. Includes Algebra 1; Elementary; Beginning; Unified Math 1;
Integrated Math 1; Algebra 1B (second year of two-year sequence for Algebra 1); Math B.
High School Level 2 Mathematics. Includes Geometry; Plane Geometry; Integrated Math 2; Unified Math
II; Math C.
High School Level 3 Mathematics. Includes Algebra 2; Intermediate Algebra; Algebra and Trigonometry;
Advanced Algebra; Algebra and Analytic Geometry; Integrated Math 3; Unified Math III.
High School Level 4 Mathematics. Includes Trigonometry; College Algebra; Algebra 3; Pre-calculus;
Analytic/Advanced Geometry; Trigonometry and Analytic/Solid Geometry; Advanced Math Topics;
Introduction to College Math; Number Theory; Math IV; College Preparation Senior. Math; Elementary
Functions; Finite Math; Math Analysis; Numerical Analysis; Discrete Math; Probability; Statistics.
High School Level 5 Mathematics. Includes Calculus and Analytic Geometry; Calculus; Abstract Algebra;
Differential Equations; Multivariate Calculus; Linear Algebra; Theory of Equations; and Vectors/Matrix
Algebra.
Earth Science. Includes Earth Science; Earth-Space Science; Regents Earth Science; Space Science;
Aerospace Science.
Integrated Science. Includes SS&C; Project 2061; Integrated Science 9, 10; Unified; Comprehensive
Ideas of Investigations in Science; Life/Physical Science; Earth/Life/ Physical Science; Coordinated
Science.

4

INSTRUCTIONS FOR COMPLETING THE SURVEY
Feedback from K–12 teachers and administrators participating in the MSP program is crucial for
understanding the strengths and weaknesses of the MSP program.
Neither NSF nor the Federal Government will maintain names or contact information associated with this
survey. However, this information is held by the awardee institution. Your responses to the questions,
however, will not be shared with the PI except in summary form.
This survey will take approximately 10 to 15 minutes of your time. Please select the best response(s) for
each item in the survey. DO NOT leave any questions unanswered.

1. Gender: (Circle one response)
Male ........................................................

1

Female .....................................................
Choose not to respond.............................

2
3

2. Which of the following categories describes your ethnicity? (Circle one response.)
Hispanic or Latino...................................
Not Hispanic or Latino............................

1
2

Choose not to respond.............................

3

3. Which of the following categories describes your race? (Circle one response for each item, unless
you choose not to respond to this question. If you choose not to respond, do not circle“yes” or “no”
for items a – e, circle “yes” for item f.)
Yes

No

a. American Indian or Alaska Native..............................................................

1

2

b. Asian ...........................................................................................................

1

2

c. Black or African American .........................................................................

1

2

d. Native Hawaiian or Other Pacific Islander .................................................

1

2

e. White...........................................................................................................

1

2

f.

1

Choose not to respond.................................................................................

4. K–12 school name (or district): _____________________________________________________
NOTE – If you work for a district instead of a solitary school, please name the district. If you work for
more than one school but not an entire district, please list the names of the schools.
5

5. What is the designation of the K–12 school(s) in which you work? (Circle one response)

6.

Elementary school ......................................................................................

1

Middle school ............................................................................................

2

K–8 school .................................................................................................

3

K–12 school ................................................................................................

4

Middle/High school ....................................................................................

5

High school ................................................................................................
Ungraded school (specify)_____________________________________ .

6
7

Other (specify): _____________________________________________

8

Which of these do you consider to be your primary position during the [INSERT SCHOOL
YEAR] school year? (Circle one response.)
Elementary school teacher .........................................................................

1

Middle school teacher .................................................................................

2

High school teacher.....................................................................................
Curriculum specialist .................................................................................

3
4

School-wide subject-specific specialist ......................................................

5

District-wide subject-specific specialist......................................................

6

Department head ........................................................................................
Principal .....................................................................................................

7
8

Vice principal ..............................................................................................

9

Other (specify): _____________________________________________

10

7. How many years have you worked in this position at your current school (or district)? _______

8. How many years have you worked as an educator in a K-12 school system? ________

6

9. Which of the following best describes your current teaching situation? (Circle one response.)
I am an administrator with NO teaching responsibilities ............................

1 (Go to Question 13.)

I am responsible for teaching all core subjects with one classroom of
students ......................................................................................................

2 (Continue with Question 10.)

I teach selected core subjects for several classes of students .....................

3 (Continue with Question 10.)

Other (specify): _____________________________________________

4 (Continue with Question 10.)

10. What grade(s) do you currently teach or provide other services for a mathematics or science
subject? (Circle one response for each item.)
Yes
No
a. Pre-kindergarten..........................................................................................
1
2
b. Kindergarten ...............................................................................................

1

2

c. 1st grade ......................................................................................................

1

2

d. 2nd grade.....................................................................................................
e. 3rd grade .....................................................................................................

1
1

2
2

f.

4th grade .....................................................................................................

1

2

g. 5th grade .....................................................................................................

1

2

h. 6th grade .....................................................................................................

1

2

i.

7th grade .....................................................................................................

1

2

j.

8th grade .....................................................................................................

1

2

k. 9th grade .....................................................................................................

1

2

l. 10th grade ...................................................................................................
m. 11th grade ...................................................................................................

1
1

2
2

n. 12th grade ...................................................................................................

1

2

o. Ungraded (specify)___________________________________________

1

2

11. Please estimate the percentage of your daily time spent in classroom teaching: ________%

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12. For which mathematics or science subject(s) do you currently teach or provide other services?
(Circle one response for each item. If you teach or provide other services for middle school
mathematics, please indicate whether or not the course includes Algebra 1, Geometry, or Algebra 2.)
Yes

No

a. Elementary school mathematics .................................................................

1

2

b. Middle school mathematics ........................................................................

1

2

c. High school Level 1 Mathematics ..............................................................
d. High school Level 2 Mathematics ..............................................................

1
1

2
2

e. High school Level 3 Mathematics ..............................................................

1

2

f.

High school Level 4 Mathematics ..............................................................

1

2

g. High school Level 5 Mathematics ..............................................................

1

2

h. AP Calculus (AB) .......................................................................................

1

2

i.

AP Calculus (BC) .......................................................................................

1

2

j.

AP Statistics ................................................................................................

1

2

k. Other (specify): _____________________________________________

1

2

l. Elementary school science ..........................................................................
m. Middle school science .................................................................................

1
1

2
2

n. Non-AP Biology .........................................................................................

1

2

o. Non-AP Chemistry......................................................................................

1

2

p. Non-AP Physics ..........................................................................................

1

2

q. Earth Science .............................................................................................

1

2

r.

Integrated Science ......................................................................................

1

2

s. AP Biology .................................................................................................

1

2

t. AP Chemistry ..............................................................................................
u. AP Physics ..................................................................................................

1
1

2
2

v. Other (specify): _____________________________________________

1

2

w. Non-AP computer science ..........................................................................

1

2

x. AP computer science...................................................................................

1

2

Mathematics

 Includes Algebra 1
 Includes Geometry
 Includes Algebra 2

Science

Computer Science

8

13. What degrees have you earned? (For each item, please circle one response per row—or leave blank
if none apply.)
NOTE—Degree options do not include certifications, certificates, endorsements, or licensures.
Degree field
Type of degree

Mathematics Science
Education
Education

Mathematics

Science

Education

a. Bachelor’s degree

1

2

3

4

5

6

b. Master’s degree

1

2

3

4

5

6

c. Ph.D.

1

2

3

4

5

6

d. Ed.D.

1

2

3

4

5

6

e. Professional degree
(e.g., M.D., LPN)

1

2

3

4

5

6

f. Specialist degree

1

2

3

4

5

6

g. Other (specify): _______
____________________

1

2

3

4

5

6

Other

14a. Are you currently working on a degree?
Yes ..........................................................

1

(Continue with Question 14b.)

No............................................................

2

(Go to Question 15.)

14b. What degrees are you currently working on? (For each item, please circle one response per
row—or leave blank if none apply.)
NOTE—Degree options do not include certifications, certificates, endorsements, or licensures.
Degree field
Type of degree

Mathematics Science
Education
Education

Mathematics

Science

Education

a. Bachelor’s degree

1

2

3

4

5

6

b. Master’s degree

1

2

3

4

5

6

c. Ph.D.

1

2

3

4

5

6

d. Ed.D.

1

2

3

4

5

6

e. Professional degree
(e.g., M.D., LPN)

1

2

3

4

5

6

f. Specialist degree

1

2

3

4

5

6

g. Other (specify): _______
____________________

1

2

3

4

5

6

9

Other

15. Which of the following teaching certifications do you hold within your state? (Circle one
response for each item.)
Yes
No
a. Elementary school: General ........................................................................

1

2

b. Elementary school: Mathematics ................................................................
c. Elementary school: Science ........................................................................

1
1

2
2

d. Middle school: General ...............................................................................
e. Middle school: Mathematics .......................................................................

1
1

2
2

f.

Middle school: Science ...............................................................................

1

2

g. High school: Mathematics ..........................................................................

1

2

h. High school: Science–General ....................................................................

1

2

i.
j.

High school: Biology ..................................................................................
High school: Chemistry ..............................................................................

1
1

2
2

k. High school: Physics ...................................................................................

1

2

l.

High school: Earth Science ........................................................................

1

2

m. Special Education........................................................................................

1

2

n. ESL/Bilingual .............................................................................................

1

2

o. Other subject area within state endorsements (specify): _____________

1

2

16. Which of the following have you successfully completed? (Circle one response for each item.)
Yes

No

a. National Board Certification©: .................................................................

1

2

b. Praxis 1 II™: ...............................................................................................

1

2

c. Praxis III™..................................................................................................

1

2

d. Other (specify):______________________________________________

1

2

e. None of the above .......................................................................................

1

17. Is this the first time you have been involved in efforts to work with faculty from colleges or
universities to reform or enhance K–12 instructional practices? (Circle one response.)
Yes .................................................................
No ..................................................................

1

1
2

The Praxis was formerly called the National Teachers Exam (NTE).

10

18. Which of the following leadership roles did you hold (in your school/or at a district level) during
the [INSERT SCHOOL YEAR] school year? (Circle one response for each item.)
Yes
No
a. Served on curriculum committee ................................................................

1

2

b. Served on textbook adoption committee.....................................................

1

2

c. Served on other school-wide or district-wide committee or task force .....

1

2

d. Mentored novice teachers ...........................................................................

1

2

e. Involved in peer coaching activities............................................................

1

2

f.

Served as Lesson Study leader/participant..................................................

1

2

g. Served as officer in a local professional organization for science and/or math

1

2

h. Served as committee chair/officer/representative for a national professional
organization (e.g., NSTA, NCTM) ............................................................

1

2

i.

Served on business/industry math or science task force in local area.........

1

2

j.

Served as math/science supervisor..............................................................

1

2

k. Other (specify): _____________________________________________

1

2

If yes, please describe: _______________________________________

19. Which of the following professional development activities have you participated in during the
past 3 school years? (Circle one response for each item.)
Yes
No
a. Learning content knowledge related to mathematics or science.................

1

2

b. Learning content knowledge not related to mathematics or science ..........

1

2

c. Selecting and adapting instructional material .............................................
d. Using research to inform curriculum development.....................................

1
1

2
2

e. Learning strategies for aligning curriculum with standards........................

1

2

students, and/or students with limited English proficiency .......................
g. Developing leadership skills in working with peers ...................................

1
1

2
2

h. Developing skills in working with parents, school boards, or others
outside of the school ..................................................................................
i. Using technology in instruction ..................................................................

1
1

2
2

j.

Learning how to use data and statistics.......................................................

1

2

k. Other (specify): _____________________________________________

1

2

f.

Working with diverse and/or minority students, special education

11

20. How did you become involved with the MSP Institute program? (Circle one response.)
Encouraged by others and decided to apply (e.g., other teachers, mentors, university
faculty members) ........................................................................................
Noticed an open invitation and decided to apply .......................................

0
1

Recruited/designated by an administrator (excluding school principal)
or specialist at the school, district, or state level (e.g., superintendent,
curriculum specialist, department head or chair, or mathematics/science
coordinator, supervisor, or coach)...............................................................

2

Recruited/designated specifically by my school principal .........................

3

Recruited/designated by local leadership council/curricular committee
or professional development program or organization ..............................

4

Other (specify): _____________________________________________

5

12