Form Teacher Survey Dat Teacher Survey Dat Teacher Survey Data Abstraction

ATTACHMENT 7:

TEACHER SURVEY DATA ABSTRACTION PROTOCOL

OMB No. 0930-XXXX

Exp. Date MM/DD/YYYY

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0930-0xxx.  Public reporting burden for this collection of information is estimated to average 1 hour and 30 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland, 20857.

Example Teacher Survey Data Abstraction Protocol

Instructions: Please provide information for EACH teacher survey. Enter 0 (zero) for no teachers. Enter DK if the information is unknown or not available. Enter NA if not applicable.

Name of teacher survey: ___________________________________________

School year data were collected: ______________________

School Information

District Name: __________________________________

School Name: __________________________________

Number of teachers who completed the teacher survey, by grade level:

_____6 _____7 _____8 _____9 _____10 _____11 _____12 _____Other (specify: ____)

1. School Climate (including, but not limited to, scales below)

   1. Staff-Student Relationships

   2. Teacher Connectedness to School

   3. Problems Posed by Student Risk Behavior

   4. Clarity of Expectations

   5. Fairness of Rules

   6. Respect for Diversity

   7. Student Engagement

Sample Survey Item from Each Scale	Response Options	Frequency
		Grade								Total
		6	7	8	9	10	11	12	O
Staff-Student Relationships: How many adults at this school really care about every student?	Nearly All Adults
	Most Adults
	Some Adults
	Few Adults
	Almost None
Teacher Connectedness to School: How many adults at this school work hard to ensure a safe and supportive learning environment?	Nearly All Adults
	Most Adults
	Some Adults
	Few Adults
	Almost None
Problems Posed by Student Risk Behavior: How much of a problem at this school is disruptive student behavior?	Insignificant Problem
	Mild Problem
	Moderate Problem
	Severe Problem
Clarity of Expectations: Rules in this school are made clear to students.	Strongly Agree
	Agree
	Disagree
	Strongly Disagree
Fairness of Rules: Students get in trouble for breaking small rules.	Strongly Agree
	Agree
	Disagree
	Strongly Disagree
Respect for Diversity: Adults in this school respect differences in students (e.g., gender, race, culture, sexual orientation).	Strongly Agree
	Agree
	Disagree
	Strongly Disagree
Student Engagement: This school encourages opportunities for students to decide things like class activities or rules.	Strongly Agree
	Agree
	Disagree
	Strongly Disagree

2. School Safety (including, but not limited to, scales below)

   1. Perceptions of School Safety

   2. Victimization

   3. Physical Fights Observed

   4. Weapon Carrying Observed

   5. Other Delinquent Behaviors Observed

Sample Survey Item from Each Scale	Response Options	Frequency
		Grade								Total
		6	7	8	9	10	11	12	O
Perceptions of School Safety: This school is a safe place for students.	Strongly Agree
	Agree
	Disagree
	Strongly Disagree
Victimization: How much of a problem at this school is harassment of bullying among students?	Insignificant Problem
	Mild Problem
	Moderate Problem
	Severe Problem
Physical Fights Observed: How much of a problem at this school is physical fighting between students	Insignificant Problem
	Mild Problem
	Moderate Problem
	Severe Problem
Weapon Carrying Observed: How much of a problem at this school is weapons possession?	Insignificant Problem
	Mild Problem
	Moderate Problem
	Severe Problem
Other Delinquent Behaviors Observed: How much of a problem at this school is vandalism (including graffiti)?	Insignificant Problem
	Mild Problem
	Moderate Problem
	Severe Problem