Trends in International Mathematics and Science Study (TIMSS 2019) Field Test Recruitment and Pilot Test

Appendix C
Trends in International Mathematics and
Science Study (TIMSS 2019) Pilot Test
Questionnaire Materials

Contents
eTIMSS 2017 Pilot Student Questionnaire – Grade 4...................................................................................2
eTIMSS 2017 Pilot Student Questionnaire – Grade 8.................................................................................12

August 2016

1

Do Not Turn Page Until
Instructed To Do So.

TRENDS IN INTERNATIONAL MATHEMATICS AND SCIENCE STUDY

Student
Questionnaire
Grade 4

© IEA, 2016

The National Center for Education Statistics (NCES), within the U.S. Department of Education, conducts TIMSS in the United States as authorized by the Education Sciences Reform
Act of 2002 (20 U.S.C., § 9543). Your responses are protected by federal statute (20 U.S.C., § 9573) and 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.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB
control number. The valid OMB control number for this voluntary information collection is 1850-0695. The time required to complete this information collection is
estimated to average xx minutes per respondent, including the time to review instructions, and complete and review the information collection. If you have any
comments or concerns regarding the accuracy of the time estimate(s), suggestions for improving the form, or questions about the status of your individual
submission of this form, write directly to: Trends in International Mathematics and Science Study (TIMSS), National Center for Education Statistics, PCP, 550
12th St., SW, 4th floor, Washington, D.C. 20202.
OMB No. 1850-0695, Approval Expires xx/xx/2019.
2

Directions
In this booklet, you will find questions about you and what you think. For each
question, you should choose the answer you think is best.
Let us take a few minutes to practice the kinds of questions you will answer in this
booklet.
Example 1 is one kind of question you will find in this booklet.

Example 1
Do you go to school?
Fill in one oval only.

Yes -- 1
No -- 2

Example 2 is another kind of question you will find in this booklet.

Example 2
How often do you do these things?
Fill in only one oval for each row.
Every day
or almost
every day

2

Once or
twice a
week

Once or
twice a
month

Never or
almost
never

a) I talk with my friends ------------------ 1

2

3

4

b) I play sports ------------------------------- 1

2

3

4

c) I ride a skateboard ---------------------- 1

2

3

4

Grade
Grade 44 Student
eTIMSS Questionnaire
Pilot Student Questionnaire

3

Example 3 is another kind of question you will find in this booklet.

Example 3
What do you think? Tell how much you agree with these
statements.
Fill in only one oval for each row.
Agree
a lot

Agree
a little

Disagree
a little

Disagree
a lot

a) Watching movies is fun --------------- 1

2

3

4

b) I like eating ice cream ----------------- 1

2

3

4

c) I do not like waking up early -------- 1

2

3

4

d) I enjoy doing chores -------------------- 1

2

3

4

• Read each question carefully, and pick the answer you think is best.
• Fill in the oval next to or under your answer.
you decide to change your answer, completely erase your first choice.
• IfThen,
fill in the oval next to or under your new answer.
for help if you do not understand something or are not sure how to
• Ask
answer.

None of your answers will be shared. All your answers 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 (20 U.S.C., § 9573).

Grade
4 Student
Grade 4 eTIMSS
Pilot
Student Questionnaire
Questionnaire

4

3

About You
1
Are you a girl or a boy?
Fill in one oval only.

Girl -- 1
Boy -- 2

4

Grade 4 eTIMSS Pilot Student Questionnaire
Grade 4 eTIMSS Pilot Student Questionnaire

5

1

2
About how many books are there in your home? (Do not
count magazines, newspapers, or your school books.)
Fill in one oval only.

None or very few (0–10 books) -- 1

This shows 10 books

Enough to fill one shelf (11–25 books) -- 2

This shows 25 books

Enough to fill one bookcase
(26–100 books) -- 3

This shows 100 books

Enough to fill two bookcases
(101–200 books) -- 4

This shows 200 books

Enough to fill three or more bookcases
(more than 200) -- 5

2

This shows more than 200 books

Grade 4 eTIMSS Pilot Student Questionnaire
Grade 4 eTIMSS Pilot Student Questionnaire

6

5

3
Do you have any of these things at your home?
Fill in only one oval for each row.

Yes

No

a) A computer or tablet -------------------

1

2

b) Internet ------------------------------------

1

2

4
A. Is there a computer or tablet at your school that you
can use?
Fill in one oval only.

Yes -- 1
No -- 2

B. Is there Internet at your school?
Fill in one oval only.

Yes -- 1
No -- 2

6

Grade 4 eTIMSS Pilot Student Questionnaire
Grade 4 eTIMSS Pilot Student Questionnaire

7

3

Use of Computers or Tablets
5
About how much time do you spend using a computer or
tablet each day?
Fill in one oval only.

Less than 30 minutes -- 1
30 minutes up to 1 hour -- 2
From 1 hour up to 2 hours -- 3
2 hours or more -- 4

6
This school year, how often have you used a computer
or tablet to do each of the following?
Fill in only one oval for each row.
Every day
or almost
every day

4

Once or
twice a
week

Once or
twice a
month

Never or
almost
never

a) Complete a school assignment
such as a paper, report, or
presentation --------------------------- 1

2

3

4

b) Find information on the Internet 1

2

3

4

c) Practice things in mathematics
that you were having trouble
learning ---------------------------------- 1

2

3

4

d) Practice things in science that
you were having trouble
learning ---------------------------------- 1

2

3

4

e) Take a test or quiz ------------------- 1

2

3

4

Grade 4 eTIMSS Pilot Student Questionnaire
Grade 4 eTIMSS Pilot Student Questionnaire

8

7

Familiarity with Computer or Tablets
7
How much do you agree with these statements?
Fill in only one oval for each row.

At least
Agree
a lot

Once or
Agree
a little

A few
Disagree
a little

Disagree
a lot

a) I am good at using a computer -- 1

2

3

4

b) I am good at typing ----------------- 1

2

3

4

c) It is easy for me to find
information on the Internet ------ 1

2

3

4

8
Can you do each of the following?
Fill in only one oval for each row.

I definitely
can

a) Write sentences and paragraphs
using a computer --------------------

8

I probably
can

I probably
cannot

I definitely
cannot

1

2

3

4

b) Use a touchscreen on a computer,
tablet or smartphone --------------- 1

2

3

4

c) Type using the correct fingers ----

1

2

3

4

d) Draw a picture using a computer-1

2

3

4

e) Find information on the Internet-1

2

3

4

Grade 4 eTIMSS Pilot Student Questionnaire
Grade 4 eTIMSS Pilot Student Questionnaire

9

5

Thank You!
Thank you for filling out the questionnaire!

Grade 4 eTIMSS Pilot Student Questionnaire

10

9

11

Do Not Turn Page Until
Instructed To Do So.

TRENDS IN INTERNATIONAL MATHEMATICS AND SCIENCE STUDY

Student
Questionnaire
Grade 8

© IEA, 2016
The National Center for Education Statistics (NCES), within the U.S. Department of Education, conducts TIMSS in the United States as authorized by the Education Sciences Reform
Act of 2002 (20 U.S.C., § 9543). Your responses are protected by federal statute (20 U.S.C., § 9573) and 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.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB
control number. The valid OMB control number for this voluntary information collection is 1850-0695. The time required to complete this information collection is
estimated to average xx minutes per respondent, including the time to review instructions, and complete and review the information collection. If you have any
comments or concerns regarding the accuracy of the time estimate(s), suggestions for improving the form, or questions about the status of your individual
submission of this form, write directly to: Trends in International Mathematics and Science Study (TIMSS), National Center for Education Statistics, PCP, 550
12th St., SW, 4th floor, Washington, D.C. 20202.
OMB No. 1850-0695, Approval Expires xx/xx/2019.
12

Directions
In this booklet, you will find questions about yourself. Some questions ask for facts
while other questions ask for your opinion.
Each question is followed by a number of answers. Fill in the oval next to or under
the answer of your choice as shown in Examples 1, 2, and 3.

Example 1
Do you go to school?
Fill in one oval only.

Yes -- 1
No -- 2

Example 2
How often do you do these things?
Fill in only one oval for each row.
Every day
or almost
every day

2
1

Once or
twice a
week

Once or
twice a
month

Never or
almost
never

a) I talk with my friends ------------------ 1

2

3

4

b) I play sports ------------------------------- 1

2

3

4

c) I ride a skateboard ---------------------- 1

2

3

4

Grade 8
8 eTIMSS
Student Pilot
Questionnaire
Grade
Student Questionnaire

13

Example 3
What do you think? Tell how much you agree with these
statements.
Fill in only one oval for each row.
Agree
a lot

Agree
a little

Disagree
a little

Disagree
a lot

a) Watching movies is fun --------------- 1

2

3

4

b) I like eating ice cream ----------------- 1

2

3

4

c) I do not like waking up early -------- 1

2

3

4

d) I enjoy doing chores -------------------- 1

2

3

4

• Read each question carefully, and pick the answer you think is best.
• Fill in the oval next to or under your answer.
• If you decide to change your answer, completely erase your first choice.
Then, fill in the oval next to or under your new answer.

• Ask for help if you do not understand something or are not sure how to answer.
None of your answers will be shared. All your answers 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 (20 U.S.C., § 9573).

Grade
8 Student
Grade 8 eTIMSS
Pilot
StudentQuestionnaire
Questionnaire

14

3
2

About You
1
Are you a girl or a boy?
Fill in one oval only.

Girl -- 1
Boy -- 2

2
About how many books are there in your home? (Do not
count magazines, newspapers, or your school books.)
Fill in one oval only.

None or very few (0–10 books) -- 1
Enough to fill one shelf
(11–25 books) -- 2
Enough to fill one bookcase
(26–100 books) -- 3
Enough to fill two bookcases
(101–200 books) -- 4
Enough to fill three or more bookcases
(more than 200) -- 5

4

Grade 8 Student Questionnaire

Grade 8 eTIMSS Pilot Student Questionnaire

15

1

3
A. What is the highest level of education completed by
your mother (or stepmother or female legal guardian)?
Fill in one oval only.

Less than high school -- 1
Some high school -- 2
High school graduate -- 3
Associate’s degree (2-year college program) -- 4
Bachelor’s degree (4-year college program) -- 5
Master’s degree or professional
degree (MD, DDS, lawyer, minister) --- 6
Doctorate (Ph.D., or Ed.D.) -- 7
I don’t know -- 8

B. What is the highest level of education completed by
your father (or stepfather or male legal guardian)?
Fill in one oval only.

Less than high school -- 1
Some high school -- 2
High school graduate -- 3
Associate’s degree (2-year college program) -- 4
Bachelor’s degree (4-year college program) -- 5
Master’s degree or professional
degree (MD, DDS, lawyer, minister) -- 6
Doctorate (Ph.D., or Ed.D.) -- 7
I don’t know -- 8

2

Grade 8 eTIMSS Pilot Student Questionnaire

16

Grade 8 Student Questionnaire

5

4
Do you have any of these things at your home?
Fill in only one oval for each row.

Yes

No

a) A computer or tablet -------------------

1

2

b) Internet ------------------------------------

1

2

5
A. Is there a computer or tablet at your school that you can
use?
Fill in one oval only.

Yes -- 1
No -- 2

B. Is there Internet at your school?
Fill in one oval only.

Yes -- 1
No -- 2

6

Grade 8 Student Questionnaire

Grade 8 eTIMSS Pilot Student Questionnaire

17

3

Use of Computers or Tablets
6
About how much time do you spend using a computer or
tablet each day?
Fill in one oval only.

Less than 30 minutes -- 1
30 minutes up to 1 hour -- 2
From 1 hour up to 2 hours -- 3
2 hours or more -- 4

7
This school year, how often have you used a computer
or tablet to do each of the following?
Fill in only one oval for each row.
Every day
or almost
every day

4

Once or
twice a
week

Once or
twice a
month

Never or
almost
never

a) Complete a school assignment
such as a paper, report, or
presentation --------------------------- 1

2

3

4

b) Find information on the Internet 1

2

3

4

c) Practice things in mathematics
that you were having trouble
learning ---------------------------------- 1

2

3

4

d) Practice things in science that
you were having trouble
learning ---------------------------------- 1

2

3

4

e) Take a test or quiz ------------------- 1

2

3

4

Grade 8 eTIMSS Pilot Student Questionnaire

18

Grade 8 Student Questionnaire

7

Familiarity with Computer or Tablets
8
How much do you agree with these statements?
Fill in only one oval for each row.

At least
Agree
a lot

Once or
Agree
a little

A few
Disagree
a little

Disagree
a lot

a) I am good at using a computer -- 1

2

3

4

b) I am good at typing ----------------- 1

2

3

4

c) It is easy for me to find
information on the Internet ------ 1

2

3

4

9
Can you do each of the following?
Fill in only one oval for each row.

I definitely
can

8

I probably
can

I probably
cannot

I definitely
cannot

a) Write sentences and paragraphs
using a computer -------------------- 1

2

3

4

b) Use a touchscreen on a computer,
tablet or smartphone --------------- 1

2

3

4

c) Type using the correct fingers ---- 1

2

3

4

d) Draw a picture using a computer-1

2

3

4

e) Find information on the Internet-1

2

3

4

Grade 8 Student Questionnaire

Grade 8 eTIMSS Pilot Student Questionnaire

19

5

Thank You!
Thank you for filling out the questionnaire!

Grade 8 Student Questionnaire

20

9

21