Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) Operational Field Test (OFT) and Recruitment for Main Study Base-year

Middle Grades Longitudinal Study of 2017-18 (MGLS:2017)

Operational Field Test (OFT) and Recruitment for Main Study Base-year

OMB# 1850-0911 v.12

Appendices OFT1-T-V: Data Collection Instruments

Appendix MS1-T: Student Roster Template

National Center for Education Statistics

U.S. Department of Education

Institute of Education Sciences

Washington, DC

Revised November 2016

Table of Contents

Appendix OFT1-T. Student Rostering Form 1

Appendix OFT1-U1. Student Survey Specifications 2

Appendix OFT1-U2. Parent Interview Survey Specifications 34

Appendix OFT1-U3. Mathematics Teacher Survey Specifications 102

Appendix OFT1-U4. Special Education Teacher Survey Specifications 166

Appendix OFT1-U5. School Administrator Survey Specifications 224

Appendix OFT1-V. Facilities Checklist Specifications 284

Appendix MS1-T. Student Rostering Form 297

Appendix OFT1-T. Student Rostering Form

Appendix T includes the student rostering form referenced in Appendix S.

Appendix T - Rostering Form

Operational Field Test

Instructions: For each student currently enrolled in grade 6 in your school, please provide the below information.

Please be certain to include all children in each grade.

General Student information

Race/Ethnicity (Y/N all that apply)

IEP

ELL

Disability Code

Parent Contact information

Student's Math Teacher

Student's Special Education Teacher, if applicable

StudentID

FirstName

Does student have IEP? (Y/N)

LastName

Suffix

Grade

Date of birth MM/DD/YY

Sex(M/F)

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Hispanic (Y/N)

IEP status (disability codes)

Student ELL Status?

If student has an IEP, please enter the disability code. Disability Code(s): (1) Specific Learning Disability (2) Autism (3) Emotional Disturbance (4) Other

Parent's First Name

Parent's Last Name

Parent's Address

Parent City

Parent State

Parent Zip

Parent's Email

Parent's Home Phone

Parent's Cell Phone

MathTeacherFirstName

MathTeacherLastName

MathTeacherEmail

Math Course Name

Math Course Period/Section

SpecialEDTeacherFirstName

SpecialEDTeacherLastName

SpecialEDTeacherEmail

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

Appendix OFT1-U1. Student Survey Specifications

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 20 minutes per response, including the time to review instructions, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

WARNING – 30 MINUTES

[IF IDLE MORE THAN 30 MINUTES] Your answers have been saved. On the next page, please enter your User Name and Password to continue the survey.

WARNING – 15 MINUTE TIMER FOR PART I

[IF STUDENT TAKES MORE THAN 15 MINUTES TO COMPLETE THE SURVEY] “Thank you for your answers. Now it's time for the next part of the survey. Press submit to finish. ”

[Direct student to the next instrument]

WARNING – WELCOME BACK

[IF STUDENT RETURNING TO SURVEY FOR SECOND OR HIGHER ORDER TIME] Welcome back! Thank you for your responses so far. The survey will begin where you left off. All your prior answers have already been saved. Press “Next” to continue.

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Intro to Part 1.

The first questions are about you.

Please click START to start the next assignment.

ALL

Q1.00A Is English your first language?

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 Yes 1 Q1.00B

 No 0 Q1.00B

NO RESPONSE M Q1.00B

ALL

Q1.00B How well do you read English?

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 Very well 1 Q1.01

 Well 2 Q1.01

 Not well 3 Q1.01

 Not at all 4 Q1.01

NO RESPONSE M Q1.01

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Q1.01 How old are you?

Q1.02

4110104

▼

(9 or younger, 10-14, 15 or older)

NO RESPONSE M Q1.02

PROGRAMMER BOX: QUESTION/SUBQUESTION NUMBERING

THE QUESTION (E.G., Q1.01) AND SUB-QUESTION NUMBERING (E.G., a., b., etc.) SHOULD NOT BE DISPLAYED TO THE RESPONDENT FOR ALL ITEMS IN THE QUESTIONNAIRE.

PROGRAMMER BOX: SOFT CHECK CONDITIONS

CONDITION 1: For item grid questions, the soft check, “Your responses are very important. Please answer as many questions as possible. Press “Edit” to return to this screen or press “Next” to continue. ”, should appear when all items are missing on a screen.

CONDITION 2: The soft check, “It is very important to the success of the study that you continue to provide complete responses. Please use the PREVIOUS button at the bottom of each page to back up and answer questions that were left blank..”, should appear when three consecutive questions that are select all/select one questions are left blank.

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Q1.02 What is your birth date?

PROGRAMMER: INSERT DROP DOWN FIELDS

Month Day Year

BIRTH DATE Q1.03

4110103

4110102

4110101

(January-December) (1-31) (2001-2009)

NO RESPONSE M Q1.03

SOFT CHECK: IF MONTH = 1, 3, 5, 7, 8, 10, OR 12, DAY CAN BE 1-31. IF MONTH = 2,

DAY CAN BE 1-29. IF MONTH = 4, 6, 9, 11, DAY CAN BE 1-30.

IF MONTH = 2 & DAY = 29 & YEAR ≠ 2004 & YEAR ≠ 2008, OR IF MONTH = 2 & DAY = 30 OR 31, Q1.02= OUT OF RANGE.

IF MONTH = 4, 6, 9, 11 & DAY =31, Q1.02= OUT OF RANGE.

IF Q1.02= OUT OF RANGE: You entered <MONTH entered> <DAY entered> <YEAR entered> as your birthdate. Is that right?

PROGRAMMER BOX: SOFT CHECK: OUT OF RANGE

BELOW THE SOFT CHECK MESSAGE “You entered <MONTH entered> <DAY entered> <YEAR entered> as your birthdate. Is that right? ” PLEASE INCLUDE A “Yes” BUTTON AND A “No” BUTTON. SELECTING THE “Yes” BUTTON WILL ALLOW THE RESPONDENT TO CONTINUE TO Q1.03. SELECTING THE “No” BUTTON SHOULD KEEP THE RESPONDENT ON THE Q1.02 SCREEN AND MAKE THE SOFT CHECK MESSAGE DISAPPEAR SO THAT THE RESPONDENT CAN ADJUST THE PREVIOUS RESPONSE.

ALL

4110200

Q1.03 What is your sex?

Select the one that best describes you.

 Male 1 Q1.04

 Female 2 Q1.04

NO RESPONSE M Q1.04

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Q1.04 The next few questions are about activities you do at school.

Have you participated in the following school-sponsored activities at any time during this school year?

PROGRAMMER: CODE ONE PER ROW

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4020101

4020102

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4020105

4020106

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Select one answer for each row.

	Did not participate	Participated	Participated as an officer, leader, or captain
a. School sports	1 	2 	3 
b. Math or science clubs	1 	2 	3 
c. Performing arts	1 	2 	3 
d. Student government	1 	2 	3 
e. School yearbook, newspaper, or literary magazine	1 	2 	3 
f. Other school clubs	1 	2 	3 
g. Other school-sponsored activities	1 	2 	3 

If Q1.04f>1 or q1.04g>1

Q1.04OTHER

If Q1.04f>1: In what other school clubs did you [participate/participate as an officer, leader, or captain]? Please type your answer.

4020109

(STRING 255)

If Q1.04G>1: In what other school-sponsored activities did you [participate/participate as an officer, leader, or captain]? Please type your answer.

(STRING 255)

4020108

ALL

These questions ask for your opinion about different things, so there are no right or wrong answers.

Q1.05A How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

4050603

4050602

4050601

Select one answer for each row.

	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
a. You have a certain amount of intelligence and you can’t really do much to change it.	1 	2 	3 	4 	5 	6 
b. Your intelligence is something about you that you can’t change very much.	1 	2 	3 	4 	5 	6 
c. No matter who you are, you can change your intelligence.	1 	2 	3 	4 	5 	6 

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Q1.05B How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

4050604

4050605

4050606

Select one answer for each row.

	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
d. You can learn new things, but you can’t really change your basic intelligence.	1 	2 	3 	4 	5 	6 
e. You can always change your intelligence.	1 	2 	3 	4 	5 	6 
f. No matter how much intelligence you have, you can always change it quite a bit.	1 	2 	3 	4 	5 	6 

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Q1.06 How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

4050304

4050303

4050302

4050301

Select one answer for each row.

	Not at all true	A little bit true	Somewhat true	True	Very true
a. I am certain I can learn everything taught in math.	1 	2 	3 	4 	5 
b. I am sure I can do even the most difficult homework problems in math.	1 	2 	3 	4 	5 
c. I am confident I can do all the work in math class if I don’t give up.	1 	2 	3 	4 	5 
d. I am confident I can do even the hardest work in my math class.	1 	2 	3 	4 	5 

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Q1.07 How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

4050404

4050402

4050401

4050403

Select one answer for each row.

	Not at all true	A little bit true	Somewhat true	True	Very true
a. Math will be useful for me later in life.	1 	2 	3 	4 	5 
b. Math helps me in my daily life outside of school.	1 	2 	3 	4 	5 
c. Being someone who is good at math is important to me.	1 	2 	3 	4 	5 
d. I enjoy doing math.	1 	2 	3 	4 	5 

all

4080111

Q1.08 What time do you usually wake up on school days?

PROGRAMMER: INSERT THREE DOWN FIELDS

HOUR MINUTE AM/PM

Q1.09

(1-12) (0-55) (AM/PM)

NO RESPONSE M Q1.09

SOFT CHECK: IF 11:00AM-3:00AM; You answered <HOUR entered>:<MINUTE entered> <AM/PM entered> as the time you usually wake up on school days. If this is wrong, press “Edit” to return to this screen. If this is right, press “Next” to continue.

If partial answer: Please enter the hours, minutes, and AM or PM that you usually wake up on school days. Press "Edit" to return to this screen or press "Next" to continue.

PROGRAMMER BOX Q1.08

DISPLAY HOURS IN DROPDOWN MENU IN 1 HOUR INTERVALS RANGING 1-12 FOR HOUR

DISPLAY MINUTES IN DROPDOWN MENU IN 5 MINUTE INTERVALS RANGING 00-55 FOR MINUTE

DISPLAY “AM” AND “PM” RESPONSE OPTIONS IN DROPDOWN MENU FOR AM/PM

INSERT “:” BETWEEN HOUR AND MINUTE DROPDOWN BOXES

PROGRAMMER BOX Q1.08

PROGRAMMERS: IN QUESTION Q1.08, PLEASE Display help text when THE WORD “USUALLY” is hovered over

Help text for Q1.08 QUESTION TEXT:

If you don’t have a usual time that you wake up on school days, please select the time when you most often wake up on school days.

PROGRAMMER BOX: SOFT CHECK: IF 11:00AM-3:00AM

BELOW THE SOFT CHECK MESSAGE “You answered <HOUR entered>:<MINUTE entered> <AM/PM entered> as the time you usually wake up on school days. If this is wrong, press “Edit” to return to this screen. If this is right, press “Next” to continue.” PLEASE INCLUDE AN “Edit” BUTTON AND A “Next” BUTTON. SELECTING THE “Next” BUTTON WILL ALLOW THE RESPONDENT TO CONTINUE TO Q1.09. SELECTING THE “Edit” BUTTON SHOULD KEEP THE RESPONDENT ON THE Q1.08 SCREEN AND MAKE THE SOFT CHECK MESSAGE DISAPPEAR SO THAT THE RESPONDENT CAN ADJUST THE PREVIOUS RESPONSE.

all

Q1.09 What time do you usually go to sleep on school nights?

4080112

PROGRAMMER: INSERT THREE DOWN FIELDS

HOUR MINUTE AM/PM

END1

(1-12) (0-55) (AM/PM)

NO RESPONSE M END1

SOFT CHECK: IF 2:00AM-7:00PM; You answered <HOUR entered>:<MINUTE entered> <AM/PM entered> as the time you usually go to sleep on school nights. If this is wrong, press “Edit” to return to this screen. If this is right, press “Next” to continue.

If partial answer: Please enter the hours, minutes, and AM or PM that you usually wake up on school days. Press "Edit" to return to this screen or press "Next" to continue.

PROGRAMMER BOX Q1.09

display hours in dropdown menu in 1 hour intervals ranging 1-12 for hour

DISPLAY MINUTES IN DROPDOWN MENU IN 5 MINUTE INTERVALS ranging 00-55 for minute

display “am” and “pm” response options in dropdown menu for am/pm

insert “:” between hour and minute dropdown boxes

PROGRAMMER BOX Q1.09

PROGRAMMERS: IN QUESTION Q1.09, PLEASE Display help text when THE WORD “USUALLY” is hovered over

Help text for Q1.09 QUESTION TEXT:

If you don’t have a usual time that you go to sleep on school nights, please select the time when you most often go to sleep on school nights.

PROGRAMMER BOX: SOFT CHECK: IF 2:00AM-7:00PM

BELOW THE SOFT CHECK MESSAGE “You answered <HOUR entered>:<MINUTE entered> <AM/PM entered> as the time you usually go to sleep on school nights. If this is wrong, press “Edit” to return to this screen. If this is right, press “Next” to continue.” PLEASE INCLUDE AN “Edit” BUTTON AND A “Next” BUTTON. SELECTING THE “Next” BUTTON WILL ALLOW THE RESPONDENT TO CONTINUE TO END1. SELECTING THE “Edit” BUTTON SHOULD KEEP THE RESPONDENT ON THE Q1.09 SCREEN AND MAKE THE SOFT CHECK MESSAGE DISAPPEAR SO THAT THE RESPONDENT CAN ADJUST THE PREVIOUS RESPONSE.

ALL

End of Part 1. Thank you. Next are some math problems.

Please click START to start the next assignment.

PROGRAMMER BOX

The Next button will finalize answers, and go to the next module of the in-school session.

ALL

Intro to Part 2.

Next are some more questions about you.

Press "Next" to continue.

all

Q2.01 These questions ask about activities you might do outside of school.

How often do you spend time…

PROGRAMMER: CODE ONE PER ROW

4020270

4020260

4020250

4020230

4020220

4020210

Select one answer for each row.

	Never	Rarely	One to three times a month	Once or twice a week	Every day or almost every day
a. Working on hobbies, arts, crafts, or playing a musical instrument outside of school?	1 	2 	3 	4 	5 
b. Taking music, art, or dance lessons outside of school?	1 	2 	3 	4 	5 
c. Playing organized non-school sports?	1 	2 	3 	4 	5 
d. Participating in a non-school organized group activity, like 4-H, Scouts, or youth group?	1 	2 	3 	4 	5 
e. Doing other activities outside of school?	1 	2 	3 	4 	5 

If Q2.01e>1

Q2.01OTHER

What other activities do you do outside of school? Please type your answer.

(STRING 255)

All

Q2.02 Some people your age get paid for work they do.

4024110

Have you ever been paid to do work outside of the home?

(Do not include chores, helping around the house, or an allowance you might receive.)

 Yes 1 Q2.03

 No 0 Q2.03

PROGRAMMER BOX Q2.02

PROGRAMMERS: IN QUESTION Q2.02, PLEASE Display help text when THE PHRASE “WORK outside of the home” is hovered over

Help text for Q2.02 QUESTION TEXT:

Examples of getting paid to do work outside of the home is for things like babysitting, pet sitting, having a newspaper route, doing lawn work or farm work, or helping neighbors.

ALL

4024120

Q2.03 Do you receive an allowance?

 Yes 1 Q2.04

 No 0 Q2.04

ALL

Q2.04    How often do you use the internet outside of school to do homework or school assignments?

 Never 1 Q2.05

 Rarely 2 Q2.05

 Sometimes 3 Q2.05

 Often 4 Q2.05

 Very often 5 Q2.05

 Always 6 Q2.05

NO RESPONSE M Q2.05

ALL

Q2.05     How often do you go somewhere other than home or school to access the internet when trying to do your homework or school assignments?

 Never 1 Q2.06

 Rarely 2 Q2.06

 Sometimes 3 Q2.06

 Often 4 Q2.06

 Very often 5 Q2.06

 Always 6 Q2.06

NO RESPONSE M Q2.06

ALL

Q2.06    How often do you have a problem with your internet at home when trying to do your homework or school assignments?

   Do not have internet in the home.......................................................... .. 0 Q2.07

 Never 1 Q2.07

 Rarely 2 Q2.07

 Sometimes 3 Q2.07

 Often 4 Q2.07

 Very often 5 Q2.07

 Always 6 Q2.07

NO RESPONSE M Q2.07

ALL

4021103

4021104

4021105

4021102

4021101

Q2.07A Do you ever...

	Yes	No
a. Watch short video clips for fun on YouTube, Vine, or other sites?	1 	0 
b. Look up information online for your own interests (for example, using Google, Reddit, Tumblr, or other sites)?	1 	0 
c. Play video games, computer games, or mobile games?	1 	0 
d. Video chat through programs like Facetime, OoVoo, or Skype?	1 	0 
e. Message with friends using texting, KIK, iMessage, Snapchat, WhatsApp, or some other app?	1 	0 

ALL

4021110

4021109

4021108

4021107

4021106

4021111

4021110

Q2.07B Do you ever...

	Yes	No
f. Post photos or updates on social media sites (such as Twitter, Instagram, Facebook, Snapchat, or Ask.fm)?	1 	0 
g. Send emails to friends, family members, teachers, or others?	1 	0 
h. Make your own digital art or music (such as painting, graphics, video editing, making digital music)?	1 	0 
i. Write computer programs (code) or develop apps?	1 	0 
j. Do some other activity using a computer, tablet, phone, or similar device?	1 	0 

If Q2.07J>1

Q2.07OTHER

What other activity do you do using a computer, tablet, phone, or similar device? Please type your answer.

(STRING 255)

ALL

4021201

Q2.08 On a typical weekday, how much time do you spend using all electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.) for school-related activities?

▼

Hours

Minutes

▼

(Hours: 0-24; Minutes: 00, 15, 30, 45)

ALL

4021202

Q2.09 On a typical weekday, how much time do you spend using all electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.) for any activity?

▼

Hours

Minutes

▼

(Hours: 0-24; Minutes: 00, 15, 30, 45)

ALL

4021203

Q2.10 On a typical weekend day, how much time per day do you spend using all electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.) for school-related activities?

▼

Hours

Minutes

▼

(Hours: 0-24; Minutes: 00, 15, 30, 45)

ALL

4021204

Q2.11 On a typical weekend day, how much time per day do you spend using all electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.) for any activity?

▼

Hours

Minutes

▼

(Hours: 0-24; Minutes: 00, 15, 30, 45)

ALL

Q2.12 Next are some questions about things that may happen at school.

How often does the following happen at school?

PROGRAMMER: CODE ONE PER ROW

4010303

4010205

4010204

4010203

4010202

4010201

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often
a. I feel like a real part of my school.	1 	2 	3 	4 	5 
b. People notice when I’m good at something.	1 	2 	3 	4 	5 
c. Other students take my opinions seriously.	1 	2 	3 	4 	5 
d. People are friendly to me.	1 	2 	3 	4 	5 
e. I’m included in lots of activities.	1 	2 	3 	4 	5 
f. I feel safe at this school.	1 	2 	3 	4 	5 

all

Q2.13 The next questions are about the students at your school.

How often did the following happen at your school in the last month?

PROGRAMMER: CODE ONE PER ROW

4010602

4010603

4010601

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often
a. Physical conflicts (fights) among students.	1 	2 	3 	4 	5 
b. Students bullied other students.	1 	2 	3 	4 	5 
c. Students yelled and screamed at the teachers.	1 	2 	3 	4 	5 

all

Q2.14 Now we want you to answer these questions thinking only about teachers that you have class with.

How often does the following happen with your teachers?

PROGRAMMER: CODE ONE PER ROW

4010504

4010505

4010503

4010502

4010501

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. I get along well with my teachers.	1 	2 	3 	4 	5 	6 
b. My teachers listen to what I have to say.	1 	2 	3 	4 	5 	6 
c. If I need extra help, I receive it from my teachers.	1 	2 	3 	4 	5 	6 
d. My teachers treat me fairly.	1 	2 	3 	4 	5 	6 
e. My teachers care about my feelings.	1 	2 	3 	4 	5 	6 

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Q2.15 The next questions are about your classmates this school year. Please think only about the students who are in your classes.

How often are the following statements true?

PROGRAMMER: CODE ONE PER ROW

4030105

4030104

4030103

4030102

4030101

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. My classmates think it is important to be my friend.	1 	2 	3 	4 	5 	6 
b. My classmates like me the way I am.	1 	2 	3 	4 	5 	6 
c. My classmates care about my feelings.	1 	2 	3 	4 	5 	6 
d. My classmates like me as much as they like other classmates.	1 	2 	3 	4 	5 	6 
e. My classmates really care about me.	1 	2 	3 	4 	5 	6 

all

Q2.16 Next are a few questions about people your age who you hang out with, including people you know from school or from somewhere else.

How important is it to the people your age who you hang out with that they...

PROGRAMMER: CODE ONE PER ROW

4030203

4030202

4030201

Select one answer for each row.

	Not at all important	A little bit important	Somewhat important	Important	Very important
a. Attend classes regularly?	1 	2 	3 	4 	5 
b. Get good grades?	1 	2 	3 	4 	5 
c. Work hard in school?	1 	2 	3 	4 	5 

all

Q2.17 Of the people your age who you hang out with, how many...

PROGRAMMER: CODE ONE PER ROW

4030307

4030306

4030305

4030303

4030304

4030302

4030301

Select one answer for each row.

	None	Some	About half	Most	All or almost all
a. Are members of a gang?	1 	2 	3 	4 	5 
b. Have ever used a weapon in a fight?	1 	2 	3 	4 	5 
c. Have ever stolen things?	1 	2 	3 	4 	5 
d. Have ever hit someone, trying to seriously hurt them?	1 	2 	3 	4 	5 
e. Have ever damaged property that didn’t belong to them on purpose?	1 	2 	3 	4 	5 
f. Have been suspended from school at least once this year?	1 	2 	3 	4 	5 
g. Have skipped school at least once this year?	1 	2 	3 	4 	5 

all

Q2.18 Of the people your age who you hang out with, how many have ever pressured you to…

PROGRAMMER: CODE ONE PER ROW

4030406

4030405

4030404

4030403

4030402

4030401

Select one answer for each row.

	None	Some	About half	Most	All or almost all
a. Try cigarettes?	1 	2 	3 	4 	5 
b. Try e-cigarettes or vaping?	1 	2 	3 	4 	5 
c. Try marijuana or other drugs?	1 	2 	3 	4 	5 
d. Drink beer, wine, or liquor?	1 	2 	3 	4 	5 
e. Skip school?	1 	2 	3 	4 	5 
f. Commit a crime or do something violent?	1 	2 	3 	4 	5 

ALL

Q2.19 In the last month, how often…

4080105

4080104

4080103

4080102

4080101

	Select one answer for each row
	Never	Rarely	Sometimes	Often	Very often
a. Did you wake up feeling tired?	1 	2 	3 	4 	5 
b. Did you have trouble falling asleep?	1 	2 	3 	4 	5 
c. Did you have trouble staying asleep?	1 	2 	3 	4 	5 
d. Did you move a lot when you slept / had restless sleep?	1 	2 	3 	4 	5 
e. Did you have trouble staying awake while sitting in class or watching TV?	1 	2 	3 	4 	5 

all

Q2.20 In the last month, how often…

PROGRAMMER: CODE ONE PER ROW

4040103

4040102

4040101

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often
a. Did you have a headache?	1 	2 	3 	4 	5 
b. Did you have aches, pains, or soreness in your muscles or joints?	1 	2 	3 	4 	5 
c. Did you have a stomachache?	1 	2 	3 	4 	5 

ALL

4110300

Q2.21 Are you Hispanic or Latino/Latina?

 Yes 1 Q2.22

 No 2 Q2.23

NO RESPONSE M Q2.23

PROGRAMMER BOX Q2.21

display help text when hovering over THE WORDS “Hispanic or Latino/Latina” for Q2.21

help text:

Hispanic or Latino/Latina: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultures or origin (or descent), regardless of race.

Q2.21=1

Q2.22 Which of the following best describes you?

4110410

Select all that apply.

4110420

 Mexican, Mexican-American, or Chicano/Chicana 1 Q2.23

 Cuban 2 Q2.23

4110440

4110430

 Dominican 3 Q2.23

 Puerto Rican 4 Q2.23

4110450

 Central American such as Guatemalan, Salvadoran, Nicaraguan, Costa Rican, Panamanian, or Honduran 5 Q2.23

4110460

 South American such as Colombian, Argentine, or Peruvian 6 Q2.23

4110471

4110470

 Other Hispanic or Latino/Latina 99 Q2.23

Please type your answer. (STRING (255)

NO RESPONSE M Q2.23

SOFT CHECK: IF Q2.22=99 AND Q2.22_SPEC UNANSWERED Please type in which other Hispanic or Latino/Latina category best describes you.

ALL

Q2.23 Which of the following best describes your race?

Select all that apply.

4110520

4110510

 White 1 Q2.25

4110530

 Black or African American 2 Q2.25

 Asian 3 Q2.24

4110540

 Native Hawaiian or other Pacific Islander 4 Q2.25

4110550

 American Indian or Alaska Native 5 Q2.25

NO RESPONSE M Q2.25

PROGRAMMER BOX Q2.23

Display help text for each response option of Q2.23 when hovered over with each help text displaying only its corresponding definition:

White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American: a person having origins in any of the black racial groups of Africa.

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.

Native Hawaiian or other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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.

Q2.23=3

Q2.24 Which of the following best describes you?

Select all that apply.

4110610

 Asian Indian 1 Q2.25

4110620

 Chinese 2 Q2.25

4110630

 Filipino 3 Q2.25

4110640

 Japanese 4 Q2.25

4110660

4110650

 Korean 5 Q2.25

 Vietnamese 6 Q2.25

4110670

 Other Asian: 99 Q2.25

4110671

Please type your answer. (STRING 255)

NO RESPONSE M Q2.25

SOFT CHECK: IF Q2.24=99 AND Q2.24_SPEC UNANSWERED: Please type in which other Asian race category best describes you.

all

Q2.25 How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

4051104

4051103

4051102

4051101

Select one answer for each row.

	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
a. I feel close to others who share my race/ethnicity.	1 	2 	3 	4 	5 	6 
b. Other people judge me based on my race/ethnicity.	1 	2 	3 	4 	5 	6 
c. I get in fights with other people because of my race/ethnicity.	1 	2 	3 	4 	5 	6 
d. People do not want to hang out with me because of my race/ethnicity.	1 	2 	3 	4 	5 	6 

all

Q2.26 Now imagine a ladder that represents how your school is set up.

4051020

- At the top of the ladder are the students in your school who have the most respect, receive the highest grades, and are the most popular.

- At the bottom are the students who have the least respect, receive the worst grades, and are the least popular.

Where would you place yourself on this ladder?

Select the place on the ladder that best represents where you would be.

[NOTE [NOTE TO PROGRAMMER: THE LADDER SHOULD APPEAR HERE, AFTER THE QUESTION TEXT WITH THE RADIO BUTTONS ADJACENT TO THE LADDER ON THE RIGHT SIDE]

School

Select one only.

Select one only.

 1 (top of the ladder) 1 Q2.27

 2 2 Q2.27

 3 3 Q2.27

 4 4 Q2.27

 5 5 Q2.27

 6 6 Q2.27

 7 7 Q2.27

 8 8 Q2.27

 9 9 Q2.27

 10 (bottom of the ladder) 10 Q2.27

NO RESPONSE M Q2.27

PROGRAMMER BOX Q2.26

*NOTE: WE WANT TO VISUALLY REPRESENT A LADDER WITH 10 RUNGS, EACH OF WHICH WILL HAVE A CORRESPONDING RADIO BUTTON. THE STUDENT WILL SELECT THE RADIO BUTTON THAT MATCHES WHERE HE/SHE THINKS he/she WOULD BE ON THE LADDER.

all

Q2.27 How often do your parents/guardians...

PROGRAMMER: CODE ONE PER ROW

4060305

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. Respect your privacy?	1 	2 	3 	4 	5 	6 
b. Give you a lot of freedom?	1 	2 	3 	4 	5 	6 
c. Make most of the decisions about what you can do?	1 	2 	3 	4 	5 	6 
d. Believe you have a right to your own point of view?	1 	2 	3 	4 	5 	6 

all

Q2.28 How often do your parents/guardians...

PROGRAMMER: CODE ONE PER ROW

4060405

4060404

4060403

4060402

4060401

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. Know what you do during your free time?	1 	2 	3 	4 	5 	6 
b. Know how much homework you have?	1 	2 	3 	4 	5 	6 
c. Know what you spend your money on?	1 	2 	3 	4 	5 	6 
d. Know when you have an exam or paper due at school?	1 	2 	3 	4 	5 	6 
e. Know what your school grades are?	1 	2 	3 	4 	5 	6 

PROGRAMMER BOX Q2.28c

display help text when hovering over THE WORDS “your money” for Q2.28c.

Help text for Q2.28c QUESTION TEXT:

Some people your age do not have their own money to spend. If you do not have your own money, please select “Never” for this question.

all

Q2.29 How often does the following happen with your parents/guardians?

PROGRAMMER: CODE ONE PER ROW

4060503

4060502

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. I tell my parents/guardians about my friends without them asking (for example, which friends I hang out with and how my friends feel about various things).	1 	2 	3 	4 	5 	6 
b. I tell my parents/guardians about school without them asking (for example, how each subject is going or my relationships with teachers).	1 	2 	3 	4 	5 	6 
c. I keep a lot of secrets from my parents/guardians about what I do during my free time.	1 	2 	3 	4 	5 	6 

4060503

4060502

4060501

all

Q2.30 The next questions are about where you live.

How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

4060605

4060604

4060603

4060602

4060601

Select one answer for each row.

	Not at all true	A little bit true	Somewhat true	True	Very true
a. There are a lot of adults in my neighborhood who I want to be like when I grow up.	1 	2 	3 	4 	5 
b. I want to get away from my neighborhood as soon as I can.	1 	2 	3 	4 	5 
c. I can count on people in my neighborhood to help me if I need it.	1 	2 	3 	4 	5 
d. I feel very safe walking and playing in my neighborhood.	1 	2 	3 	4 	5 
e. I feel very safe participating in after school activities in my community.	1 	2 	3 	4 	5 

all

Q2.31A How often are the following statements true for you?

I see myself as someone who...

PROGRAMMER: CODE ONE PER ROW

4050105

4050104

4050103

4050102

4050101

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
a. Does things carefully and completely.	1 	2 	3 	4 	5 	6 
b. Can be somewhat careless.	1 	2 	3 	4 	5 	6 
c. Is a reliable worker.	1 	2 	3 	4 	5 	6 
d. Tends to be disorganized.	1 	2 	3 	4 	5 	6 
e. Tends to be lazy.	1 	2 	3 	4 	5 	6 

all

Q2.31B How often are the following statements true for you?

I see myself as someone who...

PROGRAMMER: CODE ONE PER ROW

4050110

4050109

4050108

4050107

4050106

Select one answer for each row.

	Never	Rarely	Sometimes	Often	Very often	Always
f. Keeps working until things are done.	1 	2 	3 	4 	5 	6 
g. Does things efficiently (quickly and correctly).	1 	2 	3 	4 	5 	6 
h. Makes plans and sticks to them.	1 	2 	3 	4 	5 	6 
i. Is easily distracted.	1 	2 	3 	4 	5 	6 
j. Has trouble paying attention.	1 	2 	3 	4 	5 	6 

all

Q2.32 How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

4050904

4050903

4050902

4050901

Select one answer for each row.

	Not at all true	A little bit true	Somewhat true	True	Very true
a. I like to explore strange places.	1 	2 	3 	4 	5 
b. I like to do frightening things.	1 	2 	3 	4 	5 
c. I like new and exciting experiences.	1 	2 	3 	4 	5 
d. I prefer friends who are exciting and unpredictable.	1 	2 	3 	4 	5 

all

Q2.33 How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

4050704

4050703

4050702

4050701

Select one answer for each row.

	Not at all true	A little bit true	Somewhat true	True	Very true
a. When I become confused about something I’m learning at school, I try to figure it out.	1 	2 	3 	4 	5 
b. I work my hardest to learn at school, even if I do not like the subject.	1 	2 	3 	4 	5 
c. When something I’m studying at school is difficult, I spend extra time and effort until I understand it.	1 	2 	3 	4 	5 
d. Even if it is boring, I try to learn as much as I can about what I am studying.	1 	2 	3 	4 	5 

all

Q2.34A How often are the following statements true for you?

PROGRAMMER: CODE ONE PER ROW

4050203

4050202

4050201

Select one answer for each row.

	None of the time	A little of the time	Some of the time	A lot of the time	Most of the time	All of the time
a. I think I am doing pretty well.	1 	2 	3 	4 	5 	6 
b. I can think of many ways to get the things in life that are most important to me.	1 	2 	3 	4 	5 	6 
c. I am doing just as well as other people my age.	1 	2 	3 	4 	5 	6 

all

Q2.34B How often are the following statements true for you?

PROGRAMMER: CODE ONE PER ROW

4050205

4050204

4050206

Select one answer for each row.

	None of the time	A little of the time	Some of the time	A lot of the time	Most of the time	All of the time
d. When I have a problem, I can come up with lots of ways to solve it.	1 	2 	3 	4 	5 	6 
e. I think the things I have done in the past will help me in the future.	1 	2 	3 	4 	5 	6 
f. Even when others want me to quit, I know that I can find ways to solve the problem.	1 	2 	3 	4 	5 	6 

all

4070200

Q2.35 As things stand now, how far in school do you think you will go?

Select one only.

 Won’t finish high school 1 END1

 Will graduate from high school, but won’t go any further 2 END1

 Will go to a technical or trade school after high school 3 END1

 Will attend college 4 END1

 Will graduate from college 5 END1

 Will attend a higher level of school after graduating from college 6 END1

 Don’t know 7 END1

NO RESPONSE M END1

PROGRAMMER BOX Q2.35

PLEASE DISPLAY HELP TEXT WHEN THE PHRASE “technical or trade school” is hovered over.

help text for response option 3:

Examples of technical or trade school include automotive work, culinary/food industry, electrical work, carpentry, graphic design, fashion, and information technology.

PLEASE DISPLAY HELP TEXT WHEN THE PHRASE “higher level of school” is hovered over.

help text for response option 6:

Examples of a higher level of school after graduating from college include masters, law, medical, or PhD degrees.

PLEASE DISPLAY HELP TEXT WHEN THE PHRASE “don’t know” is hovered over.

help text for response option 7:

If you are deciding between two response options, please select the one that you think you have a better chance of doing rather than selecting “Don’t know.”

End of Part 2.

Next you will be completing some reading activities.

Press “Next” to continue to the next section.

PROGRAMMER BOX

The Next button will finalize answers, and then route to the next module of the in-school session.

Appendix OFT1-U2. Parent Interview Survey Specifications

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 40 minutes per response, including the time to review instructions, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

INTRO BOX FOR INTRO PAGE

ALL

A. WEB INTRO

A01a. SURVEY INFORMATION

Thank you for being a part of the Middle Grades Longitudinal Study of 2017–18 (MGLS:2017) field test. This will help us learn about children’s development during an important time in their lives.

We also want to learn about family and school experiences that shape children’s development. This is where we need your help. This survey should be filled out by the parent, guardian, or person living with {CFNAME} who knows the most about {his/her} development, schooling, and home life. Your answers are very important to the study’s success and we hope you will complete the survey. This survey is voluntary and you can skip questions you do not want to answer. [You will receive a ($10-50) check for completing this survey.]

Please click the “Next” button below.

ALL

A01c. Before you get started, here are a few helpful hints.

• To answer a question, click the box to choose your response.

• Press the "Next" button to move forward.

• Press the "Back" button to go back.

• Some questions offer text to help you understand the question or the response options. Click on the HELP icon at the top of the screen or the help icon in the survey to see the help text.

• If you need to take a break and leave the interview at any time, click the "Log out" button in the top left-hand corner of your screen. When you log back in, the survey will start from the screen you were on when you logged out.

• To protect your data, your responses will be automatically saved and you will be logged off if you are idle for more than 30 minutes.  

Please click “Next” to begin.

PROGRAMMER BOX

Notes to programmers:

1. Question numbers appear in the specs for programming purposes (i.e., routing, skip logic, etc.) but will be displayed in small font in upper right corner of screen

PROGRAMMER BOX: SOFT CHECK CONDITIONS

CONDITION 1: For item grid questions, the soft check, “Your responses are very important. Please answer as many questions as possible.” should appear when all items are missing on a screen.

CONDITION 2: The soft check, “"Your responses are important. Please answer as many questions as possible.” should appear when three consecutive questions are left blank.

CONDITION 3: When there is a combination of select all/select one questions and questions with an item grid are left blanked in a row, soft check, “Your responses are very important. Please answer as many questions as possible.” should appear when the third blank question in that series is a question with an item grid.

ALL

RFNAME=Respondent’s first name RLNAME= Respondent’s last name

5010200

A02. Are you {RFNAME RLNAME TAKEN FROM CONSENT FORM}?

 Yes 1 A03a

 No 2 A03a

PROGRAMMER BOX A02

Hard check if a02=missing:

Please respond to this question so you may continue.

ALL

CFNAME=Child’s first name

A03a. Does {CFNAME} {CLNAME} live with you?

 Yes 1 A03

5010301

 No 2 A06

PROGRAMMER BOX A03a

Hard check if a03A=missing:

Please respond to this question so you may continue.

the QUESTION TEXT “live with you” should have a HYPERLINK and infromation icon TO THE BELOW HELP TEXT:

Please select “Yes” if {CFNAME} normally lives with you. For example, if {CFNAME} lives with you all the time, every-other week, or some other regularly scheduled times, or if {CFNAME} has been legally placed under your care.

Please select “No” if {CFNAME} does not normally live with you. For example, if {CFNAME} is only visiting or if {CFNAME} used to live with you, but is now permanently living with someone else.

ASK IF A03a=1

CFNAME=Child’s first name

A03. Are you the parent, guardian, or person in this household who knows the most about {CFNAME}'s development, schooling, and home life?

 Yes 1

5010300

 No 2 A05a

NO RESPONSE M A05a

ASK IF A02=1 and A03=1

RFNAME= Respondent’s first name; RMNAME = Respondent’s middle name; RLNAME = Respondent’s last name; RSUFFIX = Respondent’s suffix to name

A04a. Please check the spelling of your full name.

First name:[RFNAME]

Middle name:[RMNAME]

Last name: [RLNAME]}

Suffix: [RSUFFIX]

If your name is not spelled right, please fix it below. If everything is spelled right, press Next to continue.

5010411

1 First name: [___________________] (STRING 30)

5010412

2 Middle name: [_________________ ] (STRING 30)

5010413

3 Last name: [___________________ ] (STRING 30)

5010414

4 Suffix: [_______________________] (STRING 30)

ASK IF A02=2 OR MISSING and A03=1

RFNAME= Respondent’s first name; RMNAME = Respondent’s middle name; RLNAME = Respondent’s last name

A04b. Please enter your full name.

5010421

1 First name: [___________________](STRING 20)

5010422

2 Middle name: [_________________ ] (STRING 20)

5010423

3 Last name: [___________________ ] (STRING 20)

5010424

4 Suffix: [___________________ ] (STRING 20)

PROGRAMMER BOX A04B

If A02=2 AND A03=1, GOTO A04b. Do not display "Current info" information.

ASK IF A03=2

CFNAME= Child’s first name

5010501

A05a. Is the parent, guardian, or other person living in this household who knows the most about {CFNAME}'s development, schooling, and home life available between now and the end of June 2017 to complete this questionnaire?

 Yes 1 A05b

 No 2 A06

NO RESPONSE M A06

ASK IF A05a=1

A05b. Great! Please provide the name of the person living in this household who knows the most about {CFNAME}’s development, schooling, and home life.

5010503

a First Name: [___________________](STRING 20)

5010504

b Middle Name: [___________________](STRING 20)

5010505

c Last Name: [___________________](STRING 20)

5010506

d. Suffix: [___________________](STRING 20)

ASK IF A05a=1

FPPREINTRO. If [NAME FROM A05B] is available now, please select “Next” to be taken back to the introductory page of this questionnaire and ask [NAME] to begin from there. If [NAME] cannot complete the questionnaire right now, please select “LOGOUT” in the top left area of the screen so [NAME] can log back in at a later time. Thank you very much!

5010502

 Next 1 A01a

 Log out 2

ASK IF A05a=2

CFNAME= Child’s first name

A06. The MGLS:2017 team would like to contact a parent, guardian, or person who lives with {CFNAME} and knows about {his/her} development, schooling, and home life. Please enter the contact information for this person now and a team member will be in touch soon.

5010601

a First Name: [___________________](STRING 20)

5010605

b Middle Name: [___________________](STRING 20)

5010602

c Last Name: [___________________](STRING 20)

5010606

d Suffix: [___________________](STRING 20)

5010603

e Phone Number: [___________________](STRING 10)

5010604

f Email: [___________________](STRING 50)

 Next 1 Exit Screen

PROGRAMMER BOX A06

If A05a=2 and new respondent information is entered at A06, GOTO “Exit Screen".

PROGRAMMER NOTE: When re-entering this case, GOTO to A01a for the new respondent.

HARD CHECK if A06a=MISSING: Please provide the name of {CFNAME}’s parent, guardian or a person who lives with {CFNAME} and knows about {his/her} development, schooling and home life so you may continue.

ASK IF A06=1

Exit Screen

Thank you for your time. We will contact {FIRST NAME} {LAST NAME} soon. We appreciate you helping make MGLS:2017 a success!

PROGRAMMER BOX EXIT SCREEN

FIRST NAME and LAST NAME would be taken from the information provided on the previous screen (A06).

ALL ELIGIBLE RESPONDENTS

CFNAME= Child’s first name

A07. Please check the spelling of {CFNAME}’s full name.

First name:[CFNAME]

Middle name: [CMNAME]

Last name:[CLNAME]

Suffix: [CSUFFIX]

If [CFNAME]’s name is not spelled right, please fix it below. If everything is spelled right, press Next to continue.

5010701

a First name: [___________________](STRING 20)

5010702

b Middle name: [_________________ ] (STRING 20)

5010703

c Last name: [___________________ ] (STRING 20)

5010704

d Suffix: [___________________ ] (STRING 20)

ASK IF A03=1

CFNAME= Child’s first name

A08. What is {CFNAME}'s sex?

5010800

 Male 1

 Female 0

ALL

CFNAME= Child’s first name

A09. What is {CFNAME}’s date of birth?

PROGRAMMER: INSERT DROP DOWN FIELDS

5010902

5010901

5010903

0 BIRTH DATE

Month Day Year

(January-December) (1-31) (2000-2009)

NO RESPONSE M

PROGRAMMER BOX A09

NOTE TO PROGRAMMER:

• DO NOT DISPLAY THE “NO RESPONSE” OPTION ON THE SCREEN.

• PROGRAM DAYS OF MONTH TO CORRESPOND TO THE CORRECT NUMBER OF DAY (FOR EXAMPLE, IF “FEBRUARY” IS SELECTED, THE NUMBER OF DAYS AVAILABLE SHOULD ONLY BE 1-29)

• IF A09_DAY = MISSING AND {CFNAME}’S A09_MONTH = MONTH(INTERVIEW_DATE), THEN ROUND {CFNAME’S} B02_A (AGE) UP

ASK IF A09 IS NOT MISSING

5010905

A09CONFIRM. Just to confirm, is {CFNAME} {AGE IN YEARS} years old?

 Yes 1 A10

 No 0 A09A

PROGRAMMER BOX A09CONFIRM

{AGE IN YEARS} TO BE CALCULATED USING THE DATE OF BIRTH PROVIDED IN A09.

If A09_ IF A09_MONTH = BLANK OR IF A09_YEAR = BLANK

CFNAME= Child’s first name

A09a. How old is {CFNAME}?

PROGRAMMER: INSERT DROP DOWN FIELDS

▼

5010904

0 YEARS OLD

(7-15)

NO RESPONSE M

PROGRAMMER BOX A09A

NOTE TO PROGRAMMER: SOFT CHECK: IF NO RESPONSE, “Please provide {CFNAME}’s age in years. If you don’t know the exact age, please use your best guess.”

ALL

CFNAME= Child’s first name

A10. Please check that the current home address for {CFNAME} is right.

WEB: INSERT

Street addres1: [CADDRESS1]

Street address 2: [CADDRESS2]

City: [CCITY]

State: [CSTATE]

Zip: [CZIP]”

If the current home address is not right, please fix it below. If the current home address is right, press Next.

5011011

a Street address1: [___________________](STRING 255)

5011012

b Street address2: [___________________](STRING 255)

5011013

c City: [___________________](STRING 255)

5011014

d State: [___________________]

5011015

e Zip code: [___________________](STRING 5)

PROGRAMMER BOX A10

NOTE TO PROGRAMMER:

• INSERT DROP DOWN MENU WITH ALL 50 STATES and DC..

ALL

IF A03=1 and A10 NE Missing; A11e-i should not display

A11. Please provide up-to-date contact information for yourself

5010011

a. Primary phone:

5010012

b. Alternate phone (if available):

5010013

c. Primary email:

5010014

d. Alternate email (if available):

5010015

e. Street address 1:

5010016

f. Street address 2:

5010017

g. Zip code:

5010018

h. City:

5010019

i. State:

B. Family Roster

Now, we have a few questions about you and the other members of your household. We are only interested in knowing about people who normally live in your household. Please do not include anyone staying with you temporarily, such as someone visiting the household who usually lives somewhere else.

ALL

CFNAME= Child’s first name

B01. In addition to you and {CFNAME}, does anyone else live in the household?

5021000

 Yes 1 B01b

 No 2 B02a

ALL

CFNAME= Child’s first name

B01b.

First name	Last name	Suffix
{RFNAME} 5021001	{RLNAME} 5021002	{RSUFFIX} 5021003
{CFNAME} 5021101	{CLNAME} 5021102	{CSUFFIX} 5021103
{HH3FNAME} 5021201	{HH3LNAME} 5021202	{HH3SUFFIX} 5021203

Who else lives in the household?

We are only interested in knowing about people who normally live in your household. Please do not include anyone staying with you temporarily, such as someone visiting the household who usually lives somewhere else.

First Name	Last Name	Suffix	Age

SOFT CHECK: IF B01 ONLY HAS A FIRST NAME OR LAST NAME ENTERED, “Please enter both a first name and last name. If you want, you can enter just an initial and not a full name. For example, instead of entering John Doe, you can enter J. Doe or John D. This will help you keep track of who later questions are asking about.”

B01b_2. In addition to those shown above, does anyone else live in the household?

Recall that we are only interested in knowing about people who normally live in your household. Please do not include anyone staying with you temporarily, such as someone visiting the household who usually lives somewhere else.

 Yes 1 B01b

 No 2 B02a

PROGRAMMER BOX B01

AFTER COMPLETING THE PROCESS OF ADDING HOUSEHOLD MEMBERS, When a respondent clicks “No” (FP0B01b_2=2) AND the “Next” button, a pop-up should appear:

Is this everyone in the household?

[LIST OF HOUSEHOLD MEMBERS]

Please be sure to include anyone who usually lives here, but may be temporarily away from home on business or living in a dorm at school, or any babies, small children, grandparents, or other adults living in the household.

a “Change answer” and “Keep answer and continue” button should be on the pop-up with “Keep answer and continue” advancing the respondent through the survey, and “Change answer” returning TO the family roster data.

ALL

FILL from A04a or A04b: RFNAME= Respondent’s first name; RLNAME= Respondent’s last name

FILL from A07: CFNAME= Child’s first name; CLNAME= Child’s last name.

B02. Please tell us a little bit about the members of your household. If you are not sure of something, your best guess is fine.

Please answer the following questions about: {FIRST NAME} {LAST NAME} ({SUFFIX})

	[RFNAME] [RLNAME]	[CFNAME] [CLNAME]	[HH3FNAME] [HH3LNAME]
What is [your/{CFNAME}’s/{HHNAME}’s] age?	5022001 Select age…	5022101 Select age…	5022201 Select age…
What is [your/{CFNAME}’s/{HHNAME}’s] sex?	5022002 Select sex…	5022102 Select sex…	5022202 Select sex… …
[Are you/Is {CFNAME}/IS {HHNAME}] Hispanic or Latino/Latina?	5022003 Select…	Select… 5022103	5022203 Select… …
Which of the following choices describes [your/{CFNAME}’s/{HHNAME}’s] race? You may choose more than one.	5022004 Select race…	5022104 Select race…	5022204 Select race…
1. Which of the following best describes [you/{CFNAME}/{HHNAME}]?	5022005 Select…	5022105 Select…	5022205 Select… …
2. Which of the following best describes [you/{CFNAME}/{HHNAME}]?	5022015 Select…	5022115 Select…	5022215 Select… …
What is [your/{HHNAME}’s] relationship to [CFNAME]?	5022006 Select relationship…	5022106 Select relationship…	5022206 Select relationship…
Which of the following best describes this relationship with [CFNAME]?	5022007 Select specific relationship…	5022107 Select specific relationship…	5022207 Select specific relationship…
What is [your/{HHNAME}’s] marital status?	5022008 Select marital status…	5022108 Select marital status…	5022208 Select marital status…
What is the highest level of education [you have/{HHNAME} has] completed?	5022009 Select education…	5022109 Select education…	5022209 Select education…
During the past week did [you/{HHNAME}] work at a job for pay?	5022010 Select…	5022110 Select…	5022210 Select…
In which country [were you/was {HHNAME}] born?	5022011 Select country…	5022111 Select country…	5022211 Select country…
In what year did [you/{HHNAME}] move to the United States permanently?	5022012 Select year…	5022112 Select year…	5022212 Select year…

SOFT CHECK: IF B02A THROUGH B02L IS BLANK FOR EITHER THE RESPONDENT ([RFNAME], OR CHILD [CFNAME] OR HH MEMBER [HH3FNAME], PLEASE POP UP : List of people living in your household: “You have left one or more items in the family roster blank. These items are important for the rest of the survey. Please complete the items that you have left blank.”

PROGRAMMER BOX B02

THE B02 LOOP SHOULD ASK QUESTIONS ACCORDING TO THE B01 MEMBER TYPE ORDERING.

1. RESPONDENT

2. CHILD

3. HH MEMBER #1

4. HH MEMBER #2, ETC.

Row a-d will be asked for everyone, although row a and row b should already be filled out for the child based on responses to a08 and a09. All other responses will be recorded using drop down boxes, so each of the responses listed below will appear as drop down boxes in the table.

row a will have the following values for responses from 0 through “99 or older”, with one response option of “don’t know” offered.

row b will have the following response options:

1. Male

2. Female

FOR ROW B: Don’t ask B02b when A08=1 or 0 and B02 is asked in regards to THE focus child.

row c will have the following response options:

1. Yes, this person is Hispanic or Latino/Latina

2. No, this person is not Hispanic or Latino/Latina

row D will have the following response options:

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

PROGRAMMER NOTE (for Row D): “add an information icon next to each of these response categories which would be the link to the help text but not activate the check box.  This would mean if the respondent clicked on the word “White” it would still check the box, but not deploy the help text.  If they clicked the information icon, it would take them to the help text but will not automatically check the response.”

White: A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American: A person having origins in any of the black racial groups of Africa.

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.

Native Hawaiian or other Pacific Islander: A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.

American Indian or Alaskan 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.

row e1 and e2 will be populated based on responses to row c and row d. If a person is reported to be hispanic/latino/latina, have response options in e1 for the specifc Hispanic group the respondent belongs to:

1. Mexican, Mexican-American, or Chicano

2. Cuban

3. Dominican

4. Puerto Rican

5. Central American

6. South American

7. Other (please specify)

the response option “central american” should have a HYPERLINK TO THE BELOW HELP TEXT:

By Central American, we mean, for example, people who describe themselves as Guatemalan, Salvadoran, Nicaraguan, Costa Rican, Panamanian, or Honduran.

the response option “south american” should have a HYPERLINK TO THE BELOW HELP TEXT:

By South American, we mean, for example, people who describe themselves as Colombian, Argentine, or Peruvian.

if an individual choses “other (please specify)” a pop-up box should appear asking the respondent to type in the hispanic group they identify with.

If a person is reported to be Asian in row d, then row e2 will have response options for the specifc asian group the respondent belows to:

1. Asian Indian

2. Chinese

3. Filipino

4. Japanese

5. Korean

6. Vietnamese

7. Other (please specify)

if an individual choses “other (please specify)” a pop-up box should appear asking the respondent to type in the asian group they identify with.

row f will be asked of every member in the household, with the response for child prefilled. Other response options for row f include:

1. Mother/Female guardian

2. Father/Male guardian

3. Sister

4. Brother

5. Girlfriend or partner of [CFNAME]’s parent/guardian

6. Boyfriend or partner of [CFNAME]’s parent/guardian

7. Grandmother

8. Grandfather

9. Aunt

10. Uncle

11. Cousin

12. Other relative (please specify)

13. Other non-relative

14. Focus child

programmer note: row f - When asking B02 question SERIES for [CFNAME] [CLNAME] , automatically code B02f as 13(focus child). Do not display the Bo2f question.

row G will be populated based on responses to row f. if row f=1, row g will be:

1. Biological or birth mother

2. Adoptive mother

3. Step mother

4. Foster mother or female guardian

5. Other female parent or guardian (please specify)

PLEASE MAKE THE RESPONSE CATEGORY “Birth Mother” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Biological or Birth Mother: Child's female biological parent. This may be the birth mother, but could also apply to a mother who used a surrogate mother to have her biological child.

PLEASE MAKE THE RESPONSE CATEGORY “adoptive mother” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Adoptive Mother: The female who has taken the child into her own family by legal process to raise as her own child.

PLEASE MAKE THE RESPONSE CATEGORY “step mother” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Step Mother: The female other than the child's mother who is married to the child's father.

PLEASE MAKE THE RESPONSE CATEGORY “FOSTER MOTHER OR FEMALE GUARDIAN” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Foster Mother: The female with whom the child is placed temporarily, usually through a social service agency and/or a court.

Female Guardian: The female legally placed in charge of the affairs of the child.

PLEASE MAKE THE RESPONSE CATEGORY “other female parent or guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Other Female Parent or Guardian: This person acts as the mother of the child, but does not fit into one of the other categories. For example, in a household with two mothers, one of the mothers may not classify herself as biologically related and she may not be legally in charge of the affairs of the child even though she is another parent to the child. This category may also be used if a mother has a child through a surrogate mother, or with a donated egg, and does not classify the child as biologically related or adopted through a legal process.

if row f=2, row g will be:

1. Biological or birth father

2. Adoptive father

3. Step father

4. Foster father or male guardian

5. Other male parent or guardian (please specify)

PLEASE MAKE THE RESPONSE CATEGORY “Birth FATHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Biological or Birth Father: Child's male biological parent. This could also apply to a father who used a surrogate mother to have his biological child.

PLEASE MAKE THE RESPONSE CATEGORY “adoptive FATHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Adoptive Father: The male who has taken the child into his own family by legal process to raise as his own child.

PLEASE MAKE THE RESPONSE CATEGORY “step FATHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Step Father: The male other than the child's father who is married to the child's mother.

PLEASE MAKE THE RESPONSE CATEGORY “FOSTER FATHER OR MALE GUARDIAN” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Foster Father: The male with whom the child is placed temporarily, usually through a social service agency and/or a court.

Male Guardian: The male legally placed in charge of the affairs of the child.

PLEASE MAKE THE RESPONSE CATEGORY “other MALE parent or guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Other Male Parent or Guardian: This person acts as the father of the child, but does not fit into one of the other categories. For example, in a household with two fathers, one of the fathers may not classify himself as biologically related and he may not be legally in charge of the affairs of the child even though he is another parent to the child. This category may also be used if a father has donated sperm, and does not classify the child as biologically related or adopted through a legal process.

if row f=3, row g will be:

1. Full sister

2. Half sister

3. Step sister

4. Adoptive sister

5. Foster sister

PLEASE MAKE THE RESPONSE CATEGORY “FULL SISTER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Full Sister: A female with whom the child shares the same biological parents.

PLEASE MAKE THE RESPONSE CATEGORY “HALF SISTER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Half Sister: A female with whom the child shares one biological parent.

PLEASE MAKE THE RESPONSE CATEGORY “step SISTER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Step Sister: A female to whom the child is unrelated except by the marriage of one biological parent.

PLEASE MAKE THE RESPONSE CATEGORY “ADOPTIVE SISTER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Adoptive Sister: A female to whom the child is unrelated except that they are in the same family in which she or the child has been legally adopted by the family.

PLEASE MAKE THE RESPONSE CATEGORY “FOSTER SISTER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Foster Sister: A female to whom the child is unrelated except that they are in the same family in which she or the child have been taken into the home on a temporary basis and the parents have legal responsibility for the child.

if row f=4, row g will be:

1. Full brother

2. Half brother

3. Step brother

4. Adoptive brother

5. Foster brother

PLEASE MAKE THE RESPONSE CATEGORY “FULL BROTHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Full Brother: A male with whom the child shares the same biological parents.

PLEASE MAKE THE RESPONSE CATEGORY “HALF BROTHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Half Brother: A male with whom the child shares one biological parent.

PLEASE MAKE THE RESPONSE CATEGORY “step BROTHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Step Brother: A male to whom the child is unrelated except by the marriage of one biological parent.

PLEASE MAKE THE RESPONSE CATEGORY “ADOPTIVE BROTHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Adoptive Brother: A male to whom the child is unrelated except that they are in the same family in which he or the child has been legally adopted by the family.

PLEASE MAKE THE RESPONSE CATEGORY “FOSTER BROTHER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Foster Brother: A male to whom the child is unrelated except that they are in the same family in which he or the child have been taken into the home on a temporary basis and the parents have legal responsibility for the child.

if row f=13, row g will be:

1. Girlfriend or partner of [CFNAME]’s parent/guardian

2. Boyfriend or partner of [CFNAME]’s parent/guardian

3. Female guardian

4. Male guardian

5. Daughter/son of [CFNAME]’s parent’s partner

6. Other relative of [CFNAME]’s parent’s partner (please specify)

7. Other non-relative (please specify)

PLEASE MAKE THE RESPONSE CATEGORY “Girlfriend or Female Partner of CHILD's Parent/Guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Girlfriend or Female Partner of CHILD's Parent/Guardian: The female who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship.

PLEASE MAKE THE RESPONSE CATEGORY “Boyfriend or Male Partner of CHILD's Parent/Guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Boyfriend or Male Partner of CHILD's Parent/Guardian: The male who has a "partner-like" relationship with one of the child's parents or guardians. "Living as married" is another way of describing the relationship.

PLEASE MAKE THE RESPONSE CATEGORY “Female Guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Female Guardian: The female legally placed in charge of the affairs of the child.

PLEASE MAKE THE RESPONSE CATEGORY “Male Guardian” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Male Guardian: The male legally placed in charge of the affairs of the child.

PLEASE MAKE THE RESPONSE CATEGORY “Daughter/son of CHILD's Parent's Partner” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Daughter/son of CHILD's Parent's Partner: The child of the person who has a "partner-like" relationship with one of the child's parents or guardians.

PLEASE MAKE THE RESPONSE CATEGORY “Other Relative of CHILD's Parent's Partner” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Other Relative of CHILD's Parent's Partner: Some other relative of the person who has a "partner-like" relationship with one of the child's parents or guardians.

PLEASE MAKE THE RESPONSE CATEGORY “Other Non-relative” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Other Non-relative: If one of the codes for non-relative above does not better describe the relationship of the person to the child, and there is no family relationship through blood, marriage, adoption, or partnership (i.e., living together as married), use this code.

row h will only be active (i.e., responses can only be provided) for individuals whose age is >=16 (based on responses in row a). response options for row h will be:

1. Married

2. Separated

3. Divorced

4. Widowed

5. Domestic partnership or civil union

6. Cohabiting or living together

7. Dating but not living together

8. Single, never married

row I will only be active (i.e., responses can only be provided) for individuals whose age is >=18 (based on responses in row a). response options for row i will be:

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.)

14. Do not know

row J will only be active (i.e., responses can only be provided) for individuals whose age is >=16 (based on responses in row a). response options for row J will be:

1. Yes

2. No

row K will be asked of all members of the household. A list will be generated detailing a presumably exhausted list of countries and territories from around the world. The list will be searchable by typing in the first few letters, although “United States” should appear at the top of the list, along with the response option “don’t know”, and at the bottom of the list should be the option “Other (please specify)”. STRING FOR “OTHER - SPECIFY”=255

row l will only be asked of persons who were reported to be born somewhere other than the United states. Response options will be populated with the first response option equalling the value reported in row a and all years between then and the current year will be options, with the final category being “don’t know”. If row a is blank, populate row l with values of year starting with 1950 through to the current year and the final response option “don’t know”.

Programmer note: include a confirmation screen at the end when all information has been added for all household members. this screen will list all household members’ responses for each person and will allow respondents to edit the information on the screen if needed. also include a question to confirm that the screen has listed all household members. if respondent would like to add another person, he/she will be routed through the loop again. at the end of the loop, the confirmation screen with all household members information is re-displayed and respondents will be able to make changes for all members of the household and could add another person if needed, and loop again.

ASK for each member of the household WHO is 16 years old or older (B02a=16 or greater) AND [HH1FNAME] [HH1LNAME] NE CFNAME

CFNAME= Child’s first name

[HH1FNAME] [HH1LNAME]= First and last name of the respondent and each member of the household who is 16 years old or older

B02m. Who is a parent, guardian, or primary caregiver for [CFNAME]?

5020200

Select all that apply.

 [HH1FNAME] [HH1LNAME] 1

 [HH#FNAME] [HH#LNAME] #

PROGRAMMER BOX b02m

populate response options with the first and last name of the respondent and each member of the household WHO is 16 years old or older.

if respondent selects more than 2 members of the household, retain answers but have a pop-up appear with the following text:

Please select the two members of the household most responsible for providing care to [CFNAME]. If more than two household members provide equal amounts of care to the child, please select the two members that you know the most about.

 [HH1FNAME] [HH1LNAME] 1

 [HH#FNAME] [HH#LNAME] #

 [HH#FNAME] [HH#LNAME] #

The total number of names to appear in the pop-up list is dependent on the number of household members selected in b02m. If the respondent continues to respond with more than two individuals as the primary parents in the household, the selection logic will be applied according to the following rules: 1) if a household member identified as mother is selected as one of the primary parents they will be set to be primary parent 1 regardless of who else is selected; 2) if a household member identified as father is selected as one of the primary parents they will be set to be primary parent 2 regardless of who else is selected; 3) if a household member identified as mother is selected and no household member is identified as father then primary parent 2 should be assigned to the household member according to their relationship type with the following priority order a) another mother, b) boyfriend/girlfriend, c) grandmother/grandfather, d) aunt/uncle, e) other relative/non-relative over age 18. If no other family member meets one of these criteria, then primary parent 2 set to missing; 4) if a household member identified as father is selected and no household member is identified as mother then primary parent 1 should be assigned to the household member according to their relationship type with the following priority order a) another father, b) boyfriend/girlfriend, c) grandmother/grandfather, d) aunt/uncle, e) other relative/non-relative over age 18. If no other family member meets one of these criteria, then household member identified as father becomes primary parent 1 and primary parent 2 set to missing.

if two or fewer household members are selected in b02m, the following rules apply for designating primary parent 1 and primary parent 2: 1) for households with two individuals of the opposite sex selected, the female will be primary parent 1 and the male will be primary parent 2; 2) for households with two individuals of the same sex selected, the individual identified as “mother” will be set as primary parent 1 (if two females) and the individual identified as “father” will be set as primary parent 2 (if two males); 3) for households with two individuals of the same sex who have both identified as mother or father, primary parent 1 will be assigned to the member that has the lowest value for b02g—the other member will be assigned primary parent 2; 4) for households with two individuals of the same sex who have both identified as mother or father and who have equal values on b02g, primary parent 1 will be assigned TO the member that is based on family roster number—the other household member will be assigned primary parent 2.

information from this item will be used to create ‘pointers’ for the primary adults in the household and assist with the marital status and employment questions.

the number or pound sign (#) implies that responses will be coded to coRrespond to a household member’s location in the family roster.

SOFT CHECK: B02m= IF RESPONDENT SELECTS MORE THAN 2 MEMBERS OF THE HOUSEHOLD; Please select the two members of the household most responsible for providing care to [CFNAME]. If more than two household members provide equal amounts of care to [CFNAME], please select the two members that you know the most about.

SOFT CHECK: IF B02m=NO RESPONSE; Your response is important for this survey. Please provide an answer for this question.

ASK IF B02H = 1

FILL: HH#FNAME HH#LNAME with B02H = 1

B03a. Is [HH#FNAME HH#LNAME with B02H = 1] married to someone in the household?

5020301

 Yes 1

 No 2

ASK IF B03a = 1

FILL: HH#FNAME HH#LNAME with B02H = 1

5020302

B03b. Who is [HH#FNAME HH#LNAME with B02H = 1] married to?

 [HH#FNAME HH#LNAME] 1

 [HH#FNAME HH#LNAME] 2

PROGRAMMER BOX B03b

populate response options with the first and last name of each member of the household WHO is 16 years old or older (and has not been selected in a previous loop of b03a and b03b) AS well as a ‘None of the above’ option.

if any b02a = m then list HH#FNAME HH#LNAME FOR B03B.

loop b03a and b03b for all household members WHO have not already been matched based on prior loops of b03a and b03b.

ASK IF B02H = 5

FILL: HH#FNAME HH#LNAME with B02H = 5

5020401

B04a. Is [HH#FNAME HH#LNAME with B02H = 5] in a domestic partnership or civil union with someone in the household?

 Yes 1

 No 2

ASK IF B04a = 1

FILL: HH#FNAME HH#LNAME with B02H = 5

5020402

B04b. Who is [HH#FNAME HH#LNAME with B02H = 5] in a domestic partnership or civil union with?

 [HH#FNAME HH#LNAME] 1

 [HH#FNAME HH#LNAME] 2

PROGRAMMER BOX B04

populate response options with the first and last name of each member of the household WHO is 16 years old or older (and has not been selected previously in B03a, b03b or b04a or an earlier loop of b04b) AS well as a ‘None of the above’ option.

if any b02a = m then list HH#FNAME HH#LNAME FOR B04B.

loop b04a and b04b for all household members WHO have not already been matched based on prior loops of b04a and b04b.

ASK IF B02H = 6

FILL: HH#FNAME HH#LNAME with B02H = 6

5020501

B05a. Who is [HH#FNAME HH#LNAME with B02H = 6] cohabiting or living with?

 [HH#FNAME HH#LNAME] 1

 [HH#FNAME HH#LNAME] 2

PROGRAMMER BOX B05

populate response options with the first and last name of each member of the household WHO is 16 years old or older (and has not been selected previously in b03b, b04b, or an earlier loop of b05a) AS well as a ‘None of the above’ option.

if any b02a = m then list HH#FNAME HH#LNAME FOR B05A.

loop b05a for all household members WHO have not already been matched based on prior loops of b05a.

C. FAMILY AND PARENT BACKGROUND

All

Thank you for telling us about each member of your household. Now we have some questions about the household as a whole. First, we would like to know about languages used in your home.

5030100

C01. Is English the primary language used in your home?

 Yes 1 C02a

 No 2 C03a

NO RESPONSE M C02a

ASK IF C01=1 OR M

5030201

C02a. Is any language other than English used in your home?

 Yes 1 C02b

 No 2 C04a

NO RESPONSE M C04a

ASK IF C02A=1

C02B. Please select the language(s) other than English that are used in your home from the

alphabetical list below. You may select more than one.

5032201

Select all that apply.

5032202

 a. Arabic 1

5032203

 b. Chinese language/dialect 2

 c. Farsi 3

5032205

5032204

 d. Filipino language 4

5032206

 e. French 5

5032207

 f. German 6

5032208

 g. Greek 7

 h. Hmong 8

5032209

 i. Italian 9

5032210

5032211

 j. Japanese 10

 k. Korean 11

5032213

5032212

 l. Polish 12

 m. Portuguese 13

5032215

5032214

 n. Sign Language 14

 o. Spanish 15

5032216

5032217

 p. Vietnamese 16

 q. Some other language 99

Specify (STRING (50))

NO RESPONSE M C04a

ASK IF C01=2, AND MORE THAN ONE OPTION IS SELCTED IN C02B

C03A. What is the primary language used in your home?

5033100

Select one only.

 a. Arabic 1

 b. Chinese language/dialect 2

 c. Farsi 3

 d. Filipino language 4

 e. French 5

 f. German 6

 g. Greek 7

 h. Hmong 8

 i. Italian 9

 j. Japanese 10

 k. Korean 11

 l. Polish 12

 m. Portuguese 13

 n. Sign Language 14

 o. Spanish 15

 p. Vietnamese 16

 q. Some other language 99

Specify (STRING (50))

 r. More than one language used equally 17

NO RESPONSE M

	PROGRAMMER BOX C03A display languages that were selected in c02b as response options here.
ASK IF C01=2

5030302

C03B. Is any other language used in your home?

 Yes 1 C03c

 No 2 C04

NO RESPONSE M C04

ASK IF C03B=1

Fill = LANGUAGE LISTED IN C03A

C03C. Please select the language(s) [other than [LANGUAGE LISTED IN C03A]] that are used in your home from the alphabetical list below. Select all that apply.

5033301 to1

5033318

To

PROGRAMMER BOX

if C03A is missing or C03A = More than one language used equally (17), or C03A = 99 and C03A_other is empty,  fill should be empty

Checkbox response options should populate with same list of languages as used in FP0C03A, but should not include the option selected in FP0C03A (whatever was selected in FP0C03A should be hidden). List should include English.

Please program soft check if FP0C03Cr=1, and FP0C03Cr_other is blank:

"You have selected "Some other language", but have not provided a response to the "Please specify" prompt."

ASK IF B02F NE 1 FOR ANY MEMBER OF HOUSEHOLD

CFNAME=Child’s first name

C04a. What is the highest level of education [CFNAME’s] mother completed?

5030401

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

ASK IF B02F NE 2 FOR ANY MEMBER OF HOUSEHOLD

CFNAME=Child’s first name

C04b. What is the highest level of education [CFNAME’s] father completed?

5030402

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

ASK IF B02F NE 7 FOR ANY MEMBER OF HOUSEHOLD AND RESPONDENT’S B02F NE 3 AND NE 4.

5030500

C05. What is the highest level of education your mother completed?

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

ASK IF B02F NE 8 FOR ANY MEMBER OF HOUSEHOLD AND RESPONDENT’S B02F NE 3 AND NE 4.

5030600

C06. What is the highest level of education your father completed?

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

ASK IF B02F NE 7 FOR ANY MEMBER OF HOUSEHOLD AND RESPONDENT’S B02F NE 3 AND NE 4 AND RESPONDENT’S MARITAL STATUS IS CONNECTED TO OTHER HOUSEHOLD MEMBER BASED ON NON-MISSING B03B, B04B, or B05A.

HH#FNAME HH#LNAME = autofilled based on the first and last name of the individual from B03b, B04b, or B05a who is linked with the respondent

IF B03B = M OR B04B = M OR B05A = M THEN GO TO D01

IF B02F = M THEN GO TO D01

5030700

C07. What is the highest level of education [HH#FNAME HH#LNAME]’s mother completed?

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

PROGRAMMER BOX

hh#fname and hh#lname will be autofilled based on the first and last name of the individual from b03b, b04b, or b05a who is linked with the respondent.

ASK IF B02F NE 8 FOR ANY MEMBER OF HOUSEHOLD AND RESPONDENT’S B02F NE 3 AND NE 4 AND RESPONDENT’S MARITAL STATUS IS CONNECTED TO OTHER HOUSEHOLD MEMBER BASED ON NON-MISSING B03B, B04B, or B05A.

ASK IF RESPONDENT LEAVES B02H = M BUT RESPONDENT IS CONNECTED TO OTHER HOUSEHOLD MEMBER BASED ON NON-MISSING B03B, B04B, OR B05A.

HH#FNAME HH#LNAME = autofilled based on the first and last name of the individual from B03b, B04b, or B05a who is linked with the respondent. (same name as appears in c07).

IF B03B = M OR B04B = M OR B05A = M THEN GO TO D01

IF B02F = M THEN GO TO D01

5030800

C08. What is the highest level of education [HH#FNAME HH#LNAME]’s father completed?

Select one only.

 8th grade or lower 1

 9th to 11th grade 2

 12th grade but no diploma 3

 High school diploma or equivalent 4

 Vocational/technical program after high school but no vocational/technical diploma 5

 Vocational/technical diploma after high school 6

 Some college but no degree 7

 Associate’s degree 8

 Bachelor’s degree 9

 Graduate or professional school but no degree 10

 Master’s degree (MA, MS) 11

 Doctorate degree (Ph.D, Ed.D) 12

 Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; law/JD/LLB; etc.) 13

 Do not know 14

PROGRAMMER BOX

hh#fname and hh#lname will be autofilled based on the first and last name of the individual from b03b, b04b, or b05a who is linked with the respondent (same name as appears in c07).

D. HOME LIFE

All

CFNAME=Child’s first name;

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

Great! We really appreciate you taking the time to answer all of our questions about people living in your household. The study doesn’t happen without you. Let’s keep moving along. Now we have some questions about how much parents and guardians keep an eye on children around this age.

5040001

D00a. How many of {CFNAME}’s friends do you know?

Select one only.

 None 1

 Some 2

 About half 3

 Most 4

 All or almost all 5

D00b. Please think about all of {CFNAME}’s friends. How many parents of {CFNAME}’s friends have you talked to in the last four weeks?

5040002

NUMBER OF PARENTS

D00c. About how many parents of children in {CFNAME}’s school do you talk or text with regularly, either in person, online, or on the phone?

5040003

NUMBER OF PARENTS

D01. How often do you…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)	Never	Rarely	Some-times	Often	Very often	Always
5040101	Know what {CFNAME} does during {his/her} free time?	1 	2 	3 	4 	5 	6 
5040102	Know what type of homework {CFNAME} has?	1 	2 	3 	4 	5 	6 
5040104	Know when {CFNAME} has an exam or paper due at school?	1 	2 	3 	4 	5 	6 
5040105	Know what {CFNAME}'s grades are in different subjects at school?	1 	2 	3 	4 	5 	6 
5040106	Know where {CFNAME} goes after school?	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

“His/her”: fill will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

D01f. How often do you know what {CFNAME} spends {his/her} money on?

1. 

   5040103

   Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

6. Always

g. Not applicable, child does not have own money.

All

CFNAME=Child’s first name;

“His/her”: fill will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

How often does {CFNAME} tell you about…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)	Never	Rarely	Some-times	Often	Very often	Always
5041101	{His/Her} friends without you asking (for example, which friends {he/she} hangs out with and how {his/her} friends feel about things)?	1 	2 	3 	4 	5 	6 
5041102	School without you asking (for example, how each subject is going or {his/her} relationships with teachers)?	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

“His/her”; ”he/she”: fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

D01h. How often does {CFNAME} keep secrets from you about what {he/she} does during {his/her} free time?

1. 

   5041201

   Never

2. Rarely

3. Sometimes

4. Often

5. Very Often

6. Always

7. Don’t know

All

CFNAME=Child’s first name;

D01j. Does your family have rules about…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)		Yes	No
5040111	who {CFNAME} can text, message, video chat, email, or play online games with?		1 	2 
5040112	b. when [CFNAME] can text, message, video chat, email, or play online games?		1 	2 
5040113	c. how much time [CFNAME] can spend using technology (for example, a limit on “screen time” hours per day)?		1 	2 

All

CFNAME=Child’s first name;

“His/her”; ”he/she”: fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

Next, we’d like to ask you some questions about things children sometimes do around this age.

D02. Have any of the following things happened to {CFNAME}? Has {he/she}…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)		Yes	No
5040201	Gotten involved with the wrong kinds of people?		1 	2 
5040202	Ever used drugs (for example, marijuana, cocaine, ecstasy, or 'bath salts')?		1 	2 
5040203	Ever used alcohol?		1 	2 
5040204	Gotten in trouble with the police?		1 	2 
5040205	Beaten up other people?		1 	2 
5040206	Been beaten up by other people?		1 	2 
5040207	Run away?		1 	2 

All

The next set of questions is about the neighborhood in which you live.

D03. How true are the following statements about your neighborhood?

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)	Not at all true	A little bit true	Somewhat true	True	Very true
5040301	I worry about people with guns and knives in this neighborhood.	1 	2 	3 	4 	5 
5040302	People in this neighborhood do not get along with each other.	1 	2 	3 	4 	5 
5040303	Drug dealers are a problem in this neighborhood.	1 	2 	3 	4 	5 
5040304	I worry about the kind of people my children will meet in this neighborhood.	1 	2 	3 	4 	5 
5040305	This neighborhood is safe for children during the daytime.	1 	2 	3 	4 	5 
5040306	This neighborhood is safe for children during the nighttime.	1 	2 	3 	4 	5 
5040307	There are lots of run down homes in this neighborhood.	1 	2 	3 	4 	5 

PROGRAMMER BOX D03

PLEASE MAKE THE ITEM TEXT “run down homes” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

By “run down homes” we mean houses in very bad condition because of age or lack of care.

E. CHILD'S SCHOOL EXPERIENCES

All

CFNAME=Child’s first name;

The information you have provided so far is extremely helpful. Thanks! The next set of questions is about your involvement with {CFNAME}'s school and contact you may have had with the school about {CFNAME}'s behavior or performance.

E01. Indicate how much you agree or disagree with each of the following statements. Please think about the current school year as you consider each statement.

PROGRAMMER: CODE ONE PER ROW

	Please select one response per row.	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
5050101	I make it my business to stay on top of things at school.	1 	2 	3 	4 	5 	6 
5050102	I like to spend time at {CFNAME}'s school when I can.	1 	2 	3 	4 	5 	6 
5050103	It's important that I let the teachers know about things that concern {CFNAME}.	1 	2 	3 	4 	5 	6 
5050104	I find it helpful to talk with {CFNAME}'s teachers.	1 	2 	3 	4 	5 	6 
5050105	{CFNAME}'s teachers know me.	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

E02. Indicate how often you have done the following during this school year.

PROGRAMMER: CODE ONE PER ROW

	Please select one response per row.	Never	Once or twice	About once a month	Once every two weeks	Once a week	Daily
5050201	I contacted {CFNAME}'s teachers with questions about schoolwork.	1 	2 	3 	4 	5 	6 
5050202	I exchanged phone calls or notes with {CFNAME}'s teachers for questions not related to schoolwork.	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

IF B02h NE 1 OR 5 INSERT “you”; IF B02h=1 OR 5 INSERT “you or your spouse/partner”

E03. Since the start of the school year, how many times have you or someone else in your household had contact with the school about…

PROGRAMMER: CODE ONE PER ROW

	Please select one response per row.	None	Once or twice	Three or four times	More than four times
5050301	{CFNAME}'s school schedule for this year?	1 	2 	3 	4 
5050302	{CFNAME} missing too many days of school?	1 	2 	3 	4 
5050303	{CFNAME}'s positive or good behavior in school?	1 	2 	3 	4 
5050304	Information on how to help {CFNAME} at home with specific skills or homework?	1 	2 	3 	4 
5050305	{CFNAME}'s plans after leaving high school?	1 	2 	3 	4 
5050306	{CFNAME}'s course selection for entry into college or vocational/technical school after completing high school?	1 	2 	3 	4 

All

CFNAME=Child’s first name;

The next questions are about disciplinary actions {CFNAME}'s school may have taken.

5050400

E04. Since starting kindergarten, how many times has {CFNAME} ever been suspended or expelled from school? Do not count detentions.

PROGRAMMER: INSERT DROP DOWN FIELDS

▼

NO RESPONSE M

PROGRAMMER BOX

INSERT DROP DOWN: R=0-10 or more, Don’t know

IF E04=0 GOTO E7.

ASK IF E04. >0

IF E04>1 INSERT “most recent”; DO NOT DISPLAY E05Ak IF E04= Don’t know

E05A. What was the reason for the [IF E04>1 INSERT “most recent”] suspension or expulsion?

5050501

Select all that apply.

5050502

 a. Repeated violation of the school rules 1

5050503

 b. Use of profanity (swearing) 2

5050504

 c. Threatening students or teachers 3

5050505

 d. Defacing or destroying school property 4

5050506

 e. Bringing a weapon to school 5

5050507

 f. Fighting with another student 6

5050508

 g. Ganging up (with one or more other students) on another student 7

5050509

 h. Threatening to use or making a false report of the use of an explosive device at school 8

 i. Assaulting a teacher, principal, or other school personnel 9

5050510

 j. Other 10

Specify (STRING (50))

5050511

 k. Don’t know 11

NO RESPONSE M

ASK IF E04. >0

CFNAME=Child’s first name;

IF E04>1 INSERT “most recent”

E06. How many days was the [IF E04>1 INSERT “most recent”] suspension or expulsion?

5050600

Days for most recent suspension or expulsion

Check this box if {CFNAME} was expelled permanently 2

All

CFNAME=Child’s first name;

The next questions are about grade levels your child may have repeated or skipped.

5050700

E07. What grades, if any, has {CFNAME} repeated since starting school?

Select all that apply.

 Has not repeated any grade levels 1

 Kindergarten 2

 Grade 1 3

 Grade 2 4

 Grade 3 5

 Grade 4 6

 Grade 5 7

 Grade 6 8

NO RESPONSE M

All

CFNAME=Child’s first name;

5050800

E08. What grade level, if any, has {CFNAME} skipped since starting school?

Select all that apply.

 Has not skipped any grade levels 1

 Kindergarten 2

 Grade 1 3

 Grade 2 4

 Grade 3 5

 Grade 4 6

 Grade 5 7

 Grade 6 8

NO RESPONSE M

All

CFNAME=Child’s first name;

The following questions are about programs {CFNAME} may participate in at school.

5050900

E09. Has {CFNAME} ever been enrolled in a program for English language learners (ELLs) such as English as a Second Language (ESL), English immersion, or bilingual education?

 Yes 1 E10

 No 2 E11

NO RESPONSE M E11

ASK IF E09. = 1

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5051000

E10. Is {he/she} currently enrolled in a program for English language learners (ELLs) such as English as a Second Language (ESL), English immersion, or bilingual education?

 Yes 1

 No 2

All

CFNAME=Child’s first name;

5051100

E11. Does {CFNAME} receive free or reduced-price meals at school?

 Yes 1 E12

 No 2 E13a

ASK IF E11. = 1

5051200

E12. Are these meals free or reduced-price?

 Free 1

 Reduced price 2

PROGRAMS THAT CHILD PARTICIPATES IN

All

5051301

E13a. During the current school year, has {CFNAME} taken a field trip focused on science, for example to a science museum or center, a science lab, a planetarium, or a nature center?

 Yes 1 E13b

 No 2 E13c

 Don’t know 3 E13c

ASK IF E13a=1

5051302

E13b. During the current school year, how many times did {he/she} take a field trip focused on science, for example to a science museum or center, a science lab, a planetarium, or a nature center?

PROGRAMMER: INSERT DROP DOWN FIELDS

NUMBER OF TIMES

 Do not know 91

NO RESPONSE M

All

5051303

E13c. Other than school field trips, how many times did {CFNAME} visit a science museum or center, a science lab, a planetarium, or a nature center during the current school year?

PROGRAMMER: INSERT DROP DOWN FIELDS

NUMBER OF TIMES

 Do not know 91

NO RESPONSE M

F. CHILD HEALTH AND WELL-BEING

Thank you for answering all of our questions about {CFNAME}'s educational experiences. Now, we would like to ask you about {CFNAME}'s health.

All

CFNAME=Child’s first name;

5060100

F01. In general, would you say that {CFNAME}'s health is...

Select one only.

 Excellent 1

 Very good 2

 Good 3

 Fair 4

 Poor 5

All

CFNAME=Child’s first name;

5060300

F03. Has a doctor, nurse, or other medical professional ever told you that {CFNAME} has had a concussion?

 Yes 1 F04

 No 2 F05

ASK IF F03. = 1

CFNAME=Child’s first name;

F04. How many times has {CFNAME} been diagnosed by a doctor, nurse, or other medical professional as having had a concussion?

5060400

|_|_| Number of times

(RANGE: 1- 20)

All

CFNAME=Child’s first name;

F05. Has a doctor, nurse, or other medical professional ever told you that {CFNAME} has asthma?

5060500

 Yes 1 F06

 No 2 F07

ASK IF F05. = 1

CFNAME=Child’s first name;

5060600

F06. Has {CFNAME} ever been taken to an emergency room or hospitalized for at least one night because of asthma?

 Yes 1

 No 2

All

CFNAME=Child’s first name;

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

The next set of questions is about professional evaluations {CFNAME} may have had in the past.

F07. Has {CFNAME} ever been evaluated by a professional because of an issue with...

		Yes	No
5060701	Independently taking care of {himself/herself}?	1 	2 
5060702	Paying attention?	1 	2 
5060703	Learning, thinking, or solving problems?	1 	2 
5060704	Difficulty coordinating or moving {his/her} whole body, arms, or legs?	1 	2 
5060705	Behaving or relating to other children?	1 	2 
5060706	Behaving or relating to adults?	1 	2 
5060707	{His/Her} activity level?	1 	2 
5060708	{His/Her} emotional or mental health issues?	1 	2 
5060710	Anxiety or fear?	1 	2 
5060709	Harming {himself/herself}?	1 	2 
5060711	Over-sensitivity or under-sensitivity to touch, sound, or temperature?	1 	2 
5060712	Communicating or understanding what is said in {home language}?	1 	2 
5060714	Eating too much or eating too little?	1 	2 
5060715	Sleeping too much or sleeping too little?	1 	2 
5060713	Chronic health problem (e.g., asthma, seizure, sickle cell anemia)?	1 	2 

PROGRAMMER BOX

IF F07a=1 OR F07b=1 OR F07c=1 OR F07d=1 OR F07e=1 OR F07f=1 OR F07g=1 OR F07h=1 OR f07i=1 OR f07j=1 OR f07k=1 OR f07l=1 OR f07m=1 OR f07n1=1 OR f07o1=1, GO TO F08.

ELSE IF F07a NE 1 AND F07b NE 1 AND F07c NE 1 AND F07d NE 1 AND F07e NE 1 AND F07f NE 1 AND F07g NE 1 AND F07h NE 1 AND F07i NE 1 AND F07j NE 1 AND F07k NE 1 AND F07l NE 1 AND F07m NE 1 AND F07n NE 1 AND F07o NE 1, GO TO F16.

PROGRAMMER BOX F07

PLEASE MAKE THE ITEM TEXT “PROFESSIONAL” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Professional: This includes health and mental health professionals such as doctors, pediatricians, nurse practitioners, optometrists, ophthalmologists, school or other psychologists, psychiatrists, social workers, speech-language pathologists, physical therapists, etc. Do not include teachers, principals or guidance counselors.

ASK IF ANY OF F07A-O = 1.

CFNAME= Fill text from any items in F07A-O=1Child’s first name;

5060800

F08. You reported that {CFNAME} was evaluated by a professional because of an issue with the following:

{TEXT FROM F07A-O}

Have you obtained a diagnosis or diagnoses for these issues from a professional?

 Yes 1 F09

 No 2 F16

PROGRAMMER BOX

{TEXT FROM F07A-O} : Insert ALL options selected from F07 as a list (IF ANY OF F07A-O= 1). Only display F08 once.

PROGRAMMER BOX F08

PLEASE MAKE THE ITEM TEXT “PROFESSIONAL” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Professional: This includes health and mental health professionals such as doctors, pediatricians, nurse practitioners, optometrists, ophthalmologists, school or other psychologists, psychiatrists, social workers, speech-language pathologists, physical therapists, etc. Do not include teachers, principals or guidance counselors.

ASK IF F08.=1.

F09. What was the diagnosis?

If you don’t see [CFNAME]’s diagnosis in the list below, please select “Other” and type it in the “Please Specify” box.

5060902

Select all that apply.

5060903

 a. Learning disability LD -- Reading disability (or dyslexia) 2 F13b

 b. Learning disability LD -- Math disability 3 F13b

5060904

5060901

 c. Learning disability (LD) - other 1 F13b

5060905

 d. Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) 4 F13b

• e. Autism Spectrum Disorder (ASD); Autistic Disorder/Asperger’s Disorder/Pervasive Developmental Disorder (PDD)…………………………………………………… 5 F13b

• 

  5060907

  5060906

  f. Speech or language disorder 6 F13b

 g. Intellectual disability* (severe cognitive disability) 7 F13b

5060908

 h. Health impairment (such as seizures, asthma, diabetes)……………………………………………….8 F13b

5060909

5060910

 i. Physical disability (such as cerebral palsy, spina bifida, amputee, contractures) 9 F13b

 j. Sensory impairment (such as hypersensitivity; sensory processing problems; sensory integration problems; sensory deficit, or sensory organization problems) 10 F13b

5060912

5060911

 k. Emotional disturbance 11 F13b

5060913

 l. Conduct disorder or oppositional defiant disorder 12 F13b

5060914

 m. Panic disorder 13 F13b

5060915

 n. Anxiety disorder or phobia 14 F13b

5060916

 o. Obsessive compulsive disorder (OCD) 15 F13b

 p. Eating disorder 16 F13b

5060917

 q. Depression 17 F13b

5060918

 r. Bipolar disorder 18 F13b

5060919

5060920

 s. Tourette’s syndrome 19 F13b

 t. Traumatic brain injury 20 F13b

5060921

 u. Diagnosis not yet determined 21 F16

5060922

 v. Other 99 F13b

Please specify (STRING (50))

NO RESPONSE M F16

*Previously called “mental retardation”

PROGRAMMER BOX F09

PLEASE MAKE THE RESPONSE CATEGORY “Learning disability” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Learning disability involves problems with one or more of the basic processes used in understanding or in using language (spoken or written), listening, thinking, reading, writing, spelling, or solving problems in math. This may be referred to as a reading disability or math disability. In some cases a child with a learning disability can perform at grade level with special help.

PLEASE MAKE THE RESPONSE CATEGORY “READING DISABILITY” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Reading disability is a learning disability that affects a child’s ability to read and often also affects his or her writing.

PLEASE MAKE THE RESPONSE CATEGORY “MATH DISABILITY” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Math disability Math disability is a learning disability that affects the child’s ability to understand and solve math problems.

PLEASE MAKE THE RESPONSE CATEGORY “Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD)” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD): ADD and ADHD are health impairments that make it hard for a child to focus and pay attention. With ADHD, a child is also often hyperactive (always on the go) and may have trouble being patient. A child may act without thinking, and struggle to sit still (more than is appropriate for his or her age).

PLEASE MAKE THE RESPONSE CATEGORY “Autism” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Autism Spectrum Disorder (ASD) or autism: ASD or autism affects a child’s ability to communicate (verbally and nonverbally) and interact socially. A child with autism has difficulty understanding emotions and the perspective of others. The characteristics may include a lack of responsiveness to other people, facial expressions that do not seem appropriate for the situation, responding in other socially inappropriate ways, and repetitive activities and movements (such as hand-flapping or rocking). A child with autism may show resistance to change and hypersensitivity to sensory experiences such as the texture of some clothes for example. A child with autism may be advanced or gifted in one or more areas. Autism Spectrum Disorder (ASD) includes children with Asperger’s syndrome and pervasive developmental disorder (PDD).

PLEASE MAKE THE RESPONSE CATEGORY “SPEECH OR LANGUAGE DISORDER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Speech or language impairment refers to a communication disorder. A child with a speech disorder may have voice disorders, stutter, or have problems distinguishing sounds. Speech disorders range from difficulty with using a particular sound (for example, the “th” sound in this) to difficulty with speaking loudly. A child with a language impairment may have difficulty understanding and forming sentences, using words correctly, finding words for what she or he wants to say, or his or her ability to repeat information just heard.

PLEASE MAKE THE RESPONSE CATEGORY “Intellectual or Severe cognitive disability” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Intellectual disability (Severe cognitive disability): A child's mental development is noticeably behind what is expected for a child of his or her age. A child with an intellectual disability also has difficulty with performing some daily life activities or functions on his or her own. A child’s learning in school is very slow and far behind other children of that age.

PLEASE MAKE THE RESPONSE CATEGORY “HEALTH IMPAIRMENT” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Health impairment includes health issues that cause problems with strength, vitality, and alertness. A child with a health condition may function intellectually or cognitively as well as his or her peers, but have difficulty “keeping up” in general. Health impairments include problems such as epilepsy or other seizure disorder, asthma, diabetes, sickle cell anemia, or hemophilia.

PLEASE MAKE THE RESPONSE CATEGORY “PHYSICAL DISABILITY” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Physical disability affects a child’s ability to move or balance. Disabling physical problems can include for example, cerebral palsy, amputations, bone tuberculosis, polio, and contractures (difficulty straightening a joint such as knees, elbows, and fingers).

PLEASE MAKE THE RESPONSE CATEGORY “SENSORY DISORDERS” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Sensory impairments involve being hypersensitive (overly responsive) to touch, sound, movement, or temperature; or very under responsive to those sensory input. Sensory impairments may also involve a lack of control over what sensory information to pay attention to. A child may have an increased alertness to very small changes in the environment making it difficult to maintain attention to what she or he is supposed to be learning.

PLEASE MAKE THE RESPONSE CATEGORY “Serious Emotional Disturbance or SED” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Emotional Disturbance (ED) involves difficulty with emotions over a long period of time that hurts a child's school performance. ED may include (a) difficulty learning that cannot be explained by other factors; (b) difficulty with interpersonal relationships (i.e., getting along) with peers and teachers; (c) behavior or feelings that do not match what is happening; d) a general mood of unhappiness or depression; and/or (e) a tendency to develop physical symptoms or fears associated with personal or school problems. Emotional disturbance includes bipolar disorder and schizophrenia. It does not apply to a child who is socially maladjusted (extreme behavior problems), unless he or she also has an emotional disturbance.

PLEASE MAKE THE RESPONSE CATEGORY “CONDUCT DISORDER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Conduct disorder involves a pattern of behavior that is frequently defiant, angry, hostile, and disrespectful, and disrupts child’s normal functioning. Before the age of ten, a child exhibiting these negative behaviors is usually diagnosed with oppositional defiant disorder. If behavioral symptoms after age ten are not severe, a child may also be diagnosed with oppositional defiant disorder.

PLEASE MAKE THE RESPONSE CATEGORY “Panic Disorder” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Panic Disorder involves the sudden onset of several different physical signs, such as rapid heart rate, shaking, sweating, nausea, dizziness, and difficulty breathing when the child is not in danger. A panic disorder may make a child think that something horrible is about to happen.

PLEASE MAKE THE RESPONSE CATEGORY “Anxiety Disorder” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Anxiety Disorders: A child who has an anxiety disorder worries much more than other children and may worry all the time. She or he may worry about nothing in particular or themselves, other’s safety, her or his health, and/or the world. She or he often has physical signs of anxiety such as headache, abdominal pain, cramps, diarrhea, vomiting, and dizziness. Anxiety disorders include generalized anxiety disorder, posttraumatic stress disorder (PTSD), social anxiety disorder (also called social phobia), and other specific phobias that interfere with a child’s ability to function.

PLEASE MAKE THE RESPONSE CATEGORY “Obsessive Compulsive Disorder” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Obsessive Compulsive Disorder: A child must have obsessions or compulsions or both to have this disorder, and these obsessions and/or compulsions must be disabling to the child. Obsessions are thoughts that occur over and over and cause distress. A child spends so much time on the thoughts that she or he has a hard time taking care of herself or himself or relating to others. Compulsions are acts that a child feels driven to repeat over and over, such as a need to clean or organize excessively, to keep everything the same.

PLEASE MAKE THE RESPONSE CATEGORY “EATING DISORDER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Eating disorders may involve eating too little and an obsession with staying thin (anorexia) or binge eating (gorging food). A child may make his or herself throw-up (vomit) after binge eating and/or taking laxatives (bulimia) or a child may vomit without trying after overeating.

PLEASE MAKE THE RESPONSE CATEGORY “DEPRESSION” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Depression is a general or pervasive mood of sadness or unhappiness. It includes feeling helpless, hopeless, and worthless. Depression lasts for many days to weeks keeping a child from functioning normally.

PLEASE MAKE THE RESPONSE CATEGORY “BIPOLAR DISORDER” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Bipolar Disorder (also known as manic depressive disorder or manic depression) causes unusual swings in mood, energy, and activity levels in a child. This disability can make it difficult to carry out day-to-day tasks and can lead to poor decisions. The intense emotional swings are often unrelated to life events.

PLEASE MAKE THE RESPONSE CATEGORY “TOURETTE’S SYNDROME” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Tourette’s syndrome is a nervous system disorder that involves movements or vocalizations that are repetitive and involuntary (not under the control of the child). These involuntary movements and vocalizations are called tics. Some examples include repeated facial grimaces, eye blinking, throat clearing, or grunting. Tics often get worse if a child is excited or anxious. Early symptoms are often first noticed between 3 and 9 years of age.

PLEASE MAKE THE RESPONSE CATEGORY “Traumatic Brain Injury” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Traumatic Brain Injury (TBI) is an injury to the brain from an impact to the head such as a bad fall or a car accident. A TBI makes it hard for a child to learn and may affect day to day functioning. TBI applies to open or closed head injuries that lead to difficulties in one or more areas, such as understanding; memory; attention; reasoning; abstract thinking; judgment; problem-solving; language; sensory, perceptual, and motor abilities; social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are there or that occur at birth, or that grow worse over time.

ASK IF F09=1-20 OR IF F09=99

CFNAME=Child’s first name;

IF F09=1-20 INSERT ITEM TEXT; IF F09 = 99 INSERT TEXT ENTERED AT F09_specify

F13B. How old was {CFNAME} when {he/she} received the diagnosis or diagnoses?

5061303

DIAGNOSIS	AGE OF FIRST DIAGNOSIS	DON’T KNOW
[FILL BASED ON F09]		    Do not know
		    Do not know
		    Do not know

PROGRAMMER BOX F13B

Under diagnosis, list all response options selected in f09 (i.e., for all f09=1-22 OR 99).

PROGRAMMER NOTE: PROGRAM SO EITHER An “age of first diagnosis” or the “don’t know” response is selected. can not do both.

ASK IF F09.=1-91

CFNAME=Child’s first name;

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5061400

F14. Is {CFNAME} now taking any prescription medicine for the condition related to any of {his/her} diagnosis?

 Yes 1

 No 2

NO RESPONSE M

ASK IF F09. = 4 AND F14.= 1

CFNAME=Child’s first name;

5061401

F14a. Is {CFNAME} now taking prescription medication for ADD or ADHD?

 Yes 1 F14b

 No 2 F16

NO RESPONSE M F16

ASK IF F14a.= 1

CFNAME=Child’s first name;

F14b. Is {CFNAME} medicated for ADD or ADHD at school, at home, or both?

5061500

 At school 1

 At home 2

 Both at school and at home 3

All

CFNAME=Child’s first name;

Now we would like to ask about experiences {CFNAME} and your family may have had with a 504 Plan or an Individualized Education Program (IEP).

All

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5061600

F16. Does {CFNAME} currently have a 504 plan based on section 504 of the Rehabilitation Act that describes accommodations to support {his/her} learning?

 Yes 1

 No 2

 Don’t know 3

PROGRAMMER BOX F16

PLEASE MAKE THE ITEM TEXT “Section 504 plan” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Section 504 plan: A written plan to provide appropriate services to a child with a disability, whether or not the disability is judged to affect the child’s educational performance. Speech therapy services may often be specified as part of a Section 504 plan.

All

CFNAME=Child’s first name;

5061700

F17. Has {CFNAME} ever had an Individualized Education Program (IEP)?

 Yes 1 F18

 No 2

 Don’t know 3

PROGRAMMER

IF F17 = 2, 3, or M GO TO PROGRAMMER BOX BEFORE SECTION G.

PROGRAMMER BOX F17

PLEASE MAKE THE ITEM TEXT “Individualized Education Program (IEP)” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Individualized Education Program (IEP) is a written statement for each student with a disability that sets goals for the student in school, says how progress will be measured, describes the special education and related services the school will provide, how much the student will be in the regular class with nondisabled students, and lists accommodations or modifications needed to measure what the student knows through tests.

ASK IF F17.=1

CFNAME=Child’s first name;

5061800

F18. Does {CFNAME} still have an IEP?

 Yes 1 F20

 No 2 F19a

 Don’t know 3 F20

NO RESPONSE M F20

PROGRAMMER BOX F18

PLEASE MAKE THE ITEM TEXT “Individualized Education Program (IEP)” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Individualized Education Program (IEP) is a written statement for each student with a disability that sets goals for the student in school, says how progress will be measured, describes the special education and related services the school will provide, how much the student will be in the regular class with nondisabled students, and lists accommodations or modifications needed to measure what the student knows through tests.

ASK IF F18.=2

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

F19A. Why does {he/she} no longer have an IEP?

Select all that apply.

5061902

5061901

 a. {CFNAME} no longer needs special education services 1

5061903

 b. {CFNAME} met IEP goals 2

5061904

 c. {CFNAME} was declassified, school says {he/she} no longer needs services 3

5061905

 d. {CFNAME} is no longer eligible, doesn’t qualify 4

• 

  5061906

  e. School doesn’t have the programs {CFNAME} needs …………………………... 5

5061907

 f. I don't want {CFNAME} in special education 6

5061908

 g. {CFNAME} did not want to be in special education 7

5061909

 h. {CFNAME} now has a 504 Plan 8

 i. Other 99

Specify (STRING (50))

NO RESPONSE M

PROGRAMMER

FOR ANY RESPONSE AT F19, GO TO PROGRAMMER BOX AFTER F28.

ASK IF F18.=1.

CFNAME=Child’s first name;

5062000

F20. In the last 12 months, has there been an IEP meeting about {CFNAME}'s special education program or services?

 Yes 1 F21

 No 2 F23

 Don’t know 3 F23

NO RESPONSE M F23

ASK IF F20.=1

5062100

F21. Did you or another adult in the household go to the meeting?

 Yes 1

 No 2

 Don’t know 3

ASK IF F20.=1

CFNAME=Child’s first name;

5062200

F22. Did {CFNAME} go to the meeting?

 Yes 1

 No 2

 Don’t know 3

ASK IF F18.=1

CFNAME=Child’s first name;

F23. Who came up with the goals on {CFNAME}'s IEP?

5062301

Select all that apply.

5062302

 a. School staff 1

• 

  5062303

  b. Me or other parent/family member ………………………………………………... 2

 c. {CFNAME} 3

5062304

5062305

 d. Another person 4

 e. Don’t know 5

Specify (STRING (50))

NO RESPONSE M F25

ASK IF F18.=1

CFNAME=Child’s first name;

5062400

F24. Of the people who came up with the IEP goals, who came up with the most goals?

Select one only.

 School staff 1

 Me or another parent/family member 2

 {CFNAME} 3

 Another person 4

Specify (STRING (50))

• Not applicable; everyone came up with the same number of goals. 5

• Don’t know. 6

PROGRAMMER BOX F24

If only one choice selected in F23 (1 OR 2 OR 3 OR 4), skip to F25. Do not ask F24.

Else if multiple persons are selected on F23 (1 or 2 or 3 or 4), administer F24, but only display those response options that were selected on F23.

ASK IF F18.=1

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5062500

F25. How active was {CFNAME} in developing {his/her} IEP? For example, did {CFNAME} participate in discussions about {his/her} disability, {his/her} strengths, {his/her} needs, the accommodations that would help {him/her}achieve in class, {his/her}goals for the future, and the goals {he/she}feels are most important for {him/her}to work on?

Select one only.

 Very active; took a leadership role in IEP development 1

 Active; participated regularly in IEP development 2

 Somewhat active; participated occasionally in IEP development 3

 Not active; did not participate in IEP development 4

 Don’t know 5

ASK IF F18.=1

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5062600

F26. Overall, how satisfied are you with the progress {CFNAME} has made towards {his/her} IEP goals this year? Are you...

Select one only.

 Completely satisfied 1

 Very satisfied 2

 Fairly satisfied 3

 Somewhat dissatisfied 4

• Very dissatisfied. 5

ASK IF F18.=1

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5062800

F27. During the past 12 months, has {CFNAME} received any services to help {him/her}  with academics, social and emotional skills, or behavior that are paid for by you or someone other than the school?

 Yes 1

 No 2

 Don’t Know 3

PROGRAMMER BOX

PLEASE MAKE THE RESPONSE CATEGORY “OTHER THAN THE SCHOOL” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Other than the school  could include community mental health, your medical insurance, free clinics, other family members, or the military.

ASK IF F18.=1

CFNAME=Child’s first name;

His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

F28. How often have you discussed the following topics with staff at {CFNAME}'s school about how

{CFNAME} can...

		Never	Rarely	Sometimes	Often	Very often
5062801	Develop self-determination and self-advocacy skills?	1 	2 	3 	4 	5 
5062802	Expand social and community support networks?	1 	2 	3 	4 	5 
5062803	Learn “soft” employment skills (such as appropriate dress, working well in a group, following instructions)?	1 	2 	3 	4 	5 
5062804	Practice skills in handling money such as counting money, making change, saving money for a desired object or event?	1 	2 	3 	4 	5 
5062805	Prepare for change?	1 	2 	3 	4 	5 

All SECTION G ITEMS WILL LOOP WITH SHIFTING FILLS TO CAPTURE RESPONDENT AND/OR CHILD’S MOTHER AND FATHER (IF THEY LIVE IN THE HOUSEHOLD) BASED ON RESPONSES TO B02g (mother’s relationship to CFNAME), B02h (marital status), AND B03a, B04a, B05a (spouse or partner in the household). PROGRAM ITEMS WILL INCLUDE A LOOP FOR EACH SCENARIO POSSIBILITY.

G. EMPLOYMENT AND INCOME

Now we have a few questions about jobs and work people in the household do for a living.

Programmer Box G02

If (B02f=1 or2) and (B02j=2)

ELSE

If (B02f NE 1 or 2) and (B02j=2) and (B02H = 1 or 5 or 6), GO TO G02.

loop g02 through g12 for any member of household with b02f = 1 or b02f = 2 and if no household member has b02f = 1 and no household member has b02f = 2 for respondent and household member linked to respondent through marital status (b03b, b04b, b05a).

Include this loop even if G02 is missing.

If (B02f=1 or 2) and B02j= 1

ELSE

IF (B02f NE 1 or 2 and B02j = 1 and (B02h=1 or 5 or 6) and household member linked to the respondent through marital status (B03B, B04B, and B05a), GO TO G07.

G02 FILL: When the respondent is answering about himself, FILL "Were you", ELSE FILL "Was [HH#FNAME] {HH#LNAME]

5070200

G02. During the past week, [were you/was [HH#FNAME] [HH#LNAME]] on leave or vacation from a job?

 Yes 1 G07

 No 2 G03

NO RESPONSE M G03

ASK IF B02J = 2 AND G02 = 2

G03 FILL: When the respondent is answering about himself, FILL "Have you", ELSE FILL "Has [HH#FNAME] {HH#LNAME]

5070300

G03. [Have you/Has [HH#FNAME] [HH#LNAME]] been actively looking for work in the past 4 weeks?

 Yes 1 G04

 No 2 G05

NO RESPONSE M G05

PROGRAMMER BOX

please note hh#fname and hh#lname will be filled according to first and last names filled in G02.

ASK IF B02J = 2 AND G02 = 2 AND G03 = 1

G04 FILL: When the respondent is answering about himself, FILL "Have you", ELSE FILL "Has [HH#FNAME] {HH#LNAME]

G04. What [have you/has [HH#FNAME] [HH#LNAME]] been doing in the past 4 weeks to find work?

5070401

Select all that apply.

5070402

 a. Checked with public employment agency 1

5070403

 b. Checked with private employment agency 2

 c. Checked with employer directly/sent resume 3

5070404

5070405

 d. Checked with friends and relatives 4

• e. Placed or answered ads/sent resume/applications 5

• 

  5070407

  5070406

  f. Contacted school/university employment center 6

 g. Checked a union register or professional register 7

5070409

5070408

 h. Attended a job training 8

5070410

 i. Read want-ads/internet search 9

 j. Something else 10

Specify (STRING (50))

5070411

 k. Don’t know 11

PROGRAMMER BOX

please note hh#fname and hh#lname will be filled according to first and last names filled in G02.

SOFT CHECK: IF G04=10 (Something else) is checked and the specify other text is BLANK: “[What {have you/has [HH#FNAME] [HH#LNAME]} been doing the past 4 weeks to find work]?

ASK IF B02J = 2 AND G02 = 2

G05 FILL: When the respondent is answering about himself, FILL " you", ELSE FILL "was [HH#FNAME] {HH#LNAME]

5070510

G05. Could {you/[HH#FNAME] [HH#LNAME]} have taken a job last week if one had been offered?

 Yes 1

 No 2

 NO RESPONSE M

ASK IF G03. = 2

G05 FILL: When the respondent is answering about himself, FILL "were you", ELSE FILL "was [HH#FNAME] {HH#LNAME]

5070500

G06. What was [HH#FNAME] [HH#LNAME] doing most of last week? Would you say…

 Keeping house or caring for children 1

 Going to school 2

 Retired 3

 Unable to work 4

 Something else? 91

NO RESPONSE M

ASK IF G05a. = 91

G06 FILL: When the respondent is answering about himself, FILL "you were", ELSE FILL "[HH#FNAME] {HH#LNAME] was"

G06_other. Please enter what [HH#FNAME] [HH#LNAME] doing most of last week.

5070600

PROGRAMMER: INSERT TEXT BOX

(STRING (100)) G12a

NO RESPONSE M

If (B02f=1 or 2) and B02j= 1

ELSE

IF (B02J=2 and G02=1)

ELSE

IF (B02f NE 1 or 2 and B02j = 1 and (B02h=1 or 5 or 6) and household member linked to the respondent through marital status (B03B, B04B, and B05a), GO TO G07.

ELSE go to G12a

G07 FILL: When the respondent is answering about himself, FILL "do you", ELSE FILL "does [HH#FNAME] {HH#LNAME]"

5070700

G07. How many jobs [do you/does [HH#FNAME] [HH#LNAME]] have now?

|___|___| Number of jobs

NO RESPONSE M

PROGRAMMER BOX

please note hh#fname and hh#lname will be filled according to first and last names filled in G02 for b02j = 2 and according to b01 for b02j = 1.

ASK IF B02J. = 1 OR (BO2J = 2 AND G02=1)

G08 FILL: When the respondent is answering about himself, FILL "do you", ELSE FILL "does [HH#FNAME] {HH#LNAME]"

5070800

G08. About how many total hours per week does [HH#FNAME] [HH#LNAME] usually work for pay?

|___|___| Enter number of weekly hours

NO RESPONSE M

PROGRAMMER BOX

please note hh#fname and hh#lname will be filled according to first and last names filled in G02 for b02j = 2 and according to b01 for b02j = 1.

ASK IF B02j. = 1

5071001

G09. What {is/was} the title of this job?

PROGRAMMER: INSERT TEXT BOX

Enter job title (STRING (100))

G11 FILL: When the respondent is answering about himself, FILL "you", ELSE FILL "[HH#FNAME] {HH#LNAME]"

G11. What did [HH#FNAME] [HH#LNAME] do in that job?

5071111

PROGRAMMER: INSERT TEXT BOX

Enter job duties (STRING (100))

NO RESPONSE M

SOFT CHECK: IF G11 = BLANK, Your response is important for this survey. Please provide an answer for this question.

PROGRAMMER BOX

please note hh#fname and hh#lname will be filled according to first and last names filled in G02 for b02j = 2 and according to b01 for b02j = 1.

PROGRAMMER NOTE: AFTER THE RESPONDENT ENTERS THEIR DUTIES AND CLICKS THE “next” BUTTON, A LIST OF AVAILABLE OCCUPATIONAL CODING OPTIONS WILL APPEAR IN A POPUP WINDOW. NEXT TO EACH OPTION IS A “SELECT” BUTTON THAT WILL ENABLE A POPUP MODAL. THIS MODAL BOX WILL ASK THE USER TO CONFIRM THEIR RESPONSE BY CLICKING THE “KEEP ANSWER AND CONTINUE” BUTTON. ONCE THAT IS CLICKED THE SURVEY WILL CONTINUE WHILE THE “CHANGE ANSWER” BUTTON WILL JUST CLOSE THE MODAL BOX.

ASK IF B02J. = 1 OR (BO2J = 2 AND G02=1)

G012a FILL: When the respondent is answering about himself, FILL "do you", ELSE FILL "does [HH#FNAME] {HH#LNAME]"

G12a. Since {CFNAME} was born}, {have you/has {[HH#FNAME] [HH#LNAME]}} served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

Active duty does not include training for the Reserves or National Guard, but does include activation, for

example, for the war in Afghanistan.

5071203

 Yes 1

 No 2

 NO RESPONSE M

ASK IF G12a. NE 2

G12B FILL: When the respondent is answering about himself, FILL "you", ELSE FILL " [HH#FNAME] {HH#LNAME]"

G12b [he/she] FILL: When the respondent is answering about himself, FILL "you", ELSE FILL " he or she"

G12b. {Are you/Is {[HH#FNAME] [HH#LNAME]} currently on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

Active duty does not include training for the Reserves or National Guard, but DOES include

activation, for example, for the war in Afghanistan.

5071204

 Yes 1

 No 2

 NO RESPONSE M

All

In studies like this, households are sometimes grouped according to income.

G13. 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?

PROGRAMMER: INSERT DROP DOWN MENU

▼

5071300

NO RESPONSE M

PROGRAMMER BOX G13

INSERT DROPDOWN MENU WITH THE FOLLOWING CATEGORIES:

0 Select Household Income

1 $5,000 or less

2 $5,001 to $10,000

3 $10,001 to $15,000

4 $15,001 to $20,000

5 $20,001 to $25,000

6 $25,001 to $30,000

7 $30,001 to $35,000

8 $35,001 to $40,000

9 $40,001 to $45,000

10 $45,001 to $50,000

11 $50,001 to $55,000

12 $55,001 to $60,000

13 $60,001 to $ 65,000

14 $65,001 to $70,000

15 $70,001 to $75,000

16 $75,001 to $80,000

17 $80,001 to $85,000

18 $85,001 to $90,000

19 $90,001 to $95,000

20 $95,001 to $100,000

21 $100,001 to $110,000

22 $110,001 t0 $120,000

23 $120,001 to $130,000

24 $130,001 to $140,000

25 $140,001 to $150,000

26 $150,001 to $160,000

27 $160,001 to $170,000

28 $170,001 to $180,000

29 $180,001 to $190,000

30 $190,001 to $200,000

31 $200,001 to $225,000

32 $225,001 to $250,000

33 $250,001 to $275,000

34 $275,001 to $300,000

35 $300,001 to $325,000

36 $325,001 to $350,000

37 $350,001 to $375,000

38 $375,001 to $400,000

39 $400,001 to $425,000

40 $425,001 to $450,000

41 $450,001 to $475,000

42 $475,001 to $500,000

43 $500,001 or more

All

CFNAME=Child’s first name

G14. Which of the following have you or members of your household done to financially prepare for {CFNAME}'s education after high school?

5071401

Select all that apply.

5071402

 a. Started a savings account 1

5071403

 b. Bought an insurance policy 2

5071404

 c. Bought U.S. savings bonds 3

5071405

 d. Made investments in stocks or real estate 4

5071406

 e. Set up a college investment fund (such as a mutual fund) 5

5071407

 f. Started working another job and/or more hours 6

 g. Established another form of savings 7

5071411

5071412

 h. Planned to re-mortgage your property or take out a home equity loan 8

5071413

 i. Had your child put aside earnings 9

5071414

 j. Participated in a state-sponsored college savings program (such as a 529 plan) 10

 k. Other (please specify) 11

Specify (STRING (50))

5071415

5071416

 l. Have not started planning yet 12 H01

 m. Do not expect child to receive any education after high school 13 H01

NO RESPONSE M H01

SOFT CHECK: IF G14_14 (Other) is checked and the specify other text is BLANK: “Please specify what other thing you have done to financially prepare for {CFNAME}'s education after high school?

PROGRAMMER BOX G14

If G14 (item #15) OR G14 (item

#16) is checked, disable the response options 1-14.

ASK IF G14.<=11

[CFNAME]'s = Child’s first name

G15. About how much money has been set aside for [CFNAME]'s future educational needs?

5071500

Select one only.

 None 1

 $2,000 or less 2

 $2,001‐$5,000 3

 $5,001‐$10,000 4

 $10,001‐$15,000 5

 $15,001‐$25,000 6

 $25,001‐$35,000 7

 $35,001‐$60,000 8

• More than $60,000. 9

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

H. MOBILITY

The next questions ask about how often {CFNAME} has moved since {CFNAME} started kindergarten.

H01. How long has {CFNAME} lived in {his/her} current residence?

5080100

 Less than 1 year 0

 1 year 1

 2 years 2

 3 years 3

 4 years 4

 5 years 5

 6 years 6

 7 years 7

• 8 years. 8

• 9 years 9

• 10 years 10

• 11 years 11

• 12 years 12

• 13 years 13

• 14 years 14

• 15 years 15

• More than 15 years 16

• Don’t know 17

NO RESPONSE M

PROGRAMMER BOX H01

Insert dropdown menu including options from < 1 years to > 15 years. Hide any years greater than the child’s age (as calculated from A09 or A09a).

If H01< 5, ASK H02, ELSE GOTO H03a

CFNAME=Child’s first name

H02. Since {CFNAME} started kindergarten, how many different places has {CFNAME} lived for four months or more?

5080200

▼

Select number of places

NO RESPONSE M

PROGRAMMER BOX H02

Insert dropdown menu including options from 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more, Don’t know

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5080301

H03A. How many times has {CFNAME} changed schools since {he/she} started kindergarten as a

result of grade promotion?

▼

Select number of times

NO RESPONSE M

PROGRAMMER BOX H03a

PLEASE MAKE THE ITEM TEXT “GRADE PROMOTION” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Grade promotion would include moving to a different school because the prior school did not teach students in higher grades, such as a move from an elementary school to a middle school or from a middle school to a junior high school in the same district.

Insert dropdown menu including options from 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more, Don’t know

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5080302

H03B. How many times has {CFNAME} changed schools since {he/she} started kindergarten for a reason other than grade promotion?

▼

Select number of times

NO RESPONSE M

PROGRAMMER BOX H03b

Insert dropdown menu including options from 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more, Don’t know

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

5080400

H04. Is {CFNAME} attending a different school this year than the one {he/she} attended last school year?

 Yes 1

 No 2

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

All

H05. Will {CFNAME} be attending [SCHNAME] next year?

5010056

 Yes 1

 No 2 H06

H05=2

5010057

501058

H06. What is the name of the school you expect (CFNAME) to be attending next year?

1 School Name: [ ] (STRING 255)

5010060

5010059

2 School Street address1: [___________________](STRING 255)

5010061

3 School Street address2: [___________________](STRING 255)

4 School City: [___________________](STRING 255)

5010062

5 School State: [___________________]

6 School Zip code: [___________________](STRING 5)

5010063

 Don’t know

I. PARENTAL DISCUSSIONS WITH CHILD

The final section asks about your expectations for {CFNAME}'s future and conversations you may have had with {CFNAME} about school or {his/her} future plans.

I01. Since the start of this school year, how often have you discussed the following with {CFNAME}?

Please select one response per row.

		Never	Rarely	Sometimes	Often	Very often
5090101	Selecting a math course to take next school year	1 	2 	3 	4 	5 
5090102	Selecting courses other than math to take next school year	1 	2 	3 	4 	5 
5090103	Preparing for college entrance exams such as the ACT, SAT, or ASVAB	1 	2 	3 	4 	5 
5090104	Applying to college or other schools after high school	1 	2 	3 	4 	5 
5090105	Careers {CFNAME} might be interested in	1 	2 	3 	4 	5 

All

CFNAME=Child’s first name

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A08: if A08=1 all gender fills are masculine, if A08=0 all gender fills are feminine

I02. How far in school do you expect {CFNAME} to go? Would you say you expect {he/she} …

5090200

Select one only.

 Won’t finish high school? 1

 Will graduate from high school, but won’t go any further? 2

 Will go to a technical or trade school after high school? 3

 Will attend college? 4

 Will graduate from college? 5

 Will attend a higher level of school after graduating from college? 6

 You don’t know? 7

ALL

I03. Finally, a very important part of this study is learning about how students do over time, so we want to make sure we are able to get in touch with you and your family next year. To help us be able to do that, please provide the name, email address, street address, and telephone number of a relative or close friend who does not live with you, but will know how to get in touch with you.

5010041

a. First name

5010042

b. Last name

5010043

c. Primary email

5010044

d. Primary phone

5010045

e. Street 1

5010046

f. Street 2

5010047

g. City

5010048

h. State

5010049

i. Zip code

IF INCENTIVE_FILL NE $10-50, GO TO THANK

IF INCENTIVE FILL = $10- 50, GO TO INCENTIVE_ADDRESS.

INCENTIVE_ADDRESS.

You’re finished! Last thing we need to know is where you want us to send the ${10-50} check for completing the survey. If the address below is right, press Next. If this address below is not right, please fix it, and then press Next.

5010050

5010051

1 Name: [ ] (STRING 255)

5010052

2 Street address1: [___________________](STRING 255)

5010053

3 Street address2: [___________________](STRING 255)

5010054

4 City: [___________________](STRING 255)

5010055

5 State: [___________________]

6 Zip code: [___________________](STRING 5)

All

THANK. Thank you very much for participating in MGLS:2017! We appreciate you taking the time to complete the survey. Press “Submit” to complete and close the survey.

(SUBMIT)

Appendix OFT1-U3. Mathematics Teacher Survey Specifications

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 20 minutes for the teacher-level information and 10 minutes per study student, including the time to review instructions, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

ALL

A00a. SURVEY INFORMATION

You have received an invitation to complete this questionnaire because one or more students you teach have been selected to participate in the MGLS:2017 field test study. To enhance the information provided by your students and their parents, we need you to complete this survey.

After confirming whether you teach the students selected for MGLS:2017, the survey will ask questions about your classroom(s) and about specific student(s) who are participating in our study. The survey will also ask some background questions about yourself and your school. The classroom- and student-specific portions of the survey will be repeated if you teach multiple study students, as applicable.

Taking part in the study is voluntary, and you can skip questions you do not want to answer. We realize you are very busy, but urge you to complete the questionnaire as completely and accurately as possible. Your answers are very important to the study’s success. You will receive $20 for completing the parts about you and your classroom, plus an additional $7 for each individual student about whom you answer questions.

NOTE: there are [FILL NUMBER OF STUDENTS] MGLS:2017 student[s] that we will ask you to confirm.

Please click below to start the survey.

PROGRAMMER BOX 1

Next

PROGRAMMER BOX 1a

“Log out” should be in the top left corner of each screen, as in the math assessment.

A. Introduction

ALL

Notes to programmers:

1. Question numbers appear in the specs for programming purposes (i.e., routing, skip logic, etc.) but will be displayed in small font in upper right corner of screen.

2. All questions will generally have the same soft check message

Time Out error message [if idle more than 30 minutes]:

We’re very sorry!

Your session has been idle for more than 30 minutes. Please close this window and then log back into the survey.

PROGRAMMER BOX 1b

Next

User Name:

Password: ____________________________

Welcome back [if respondent returning to online survey for second or higher order time]:

Welcome back [teacher’s first name], thanks for participating in our survey. Here are a few things to remember before you begin…

You can stop the survey at any time by clicking the 'Logout' link at the upper left corner of the screen. When you log in again, you can resume where you left off.”

(IF CASE INDICATED AS ALREADY COMPLETE)

Our records indicate that you have finished your survey. Thank you for your participation; you do not need to log in again.

If you think you are receiving this message in error, or have questions about the study, please call 1-855-500-1432 or send an email to [email protected] and include the contact information you were provided.

ALL

A00c. How to Complete the Survey

Thank you very much for participating! Before you get started, here are a few helpful hints.

• To answer the questions, select the answer on the screen that matches your response.

• Answer each question as accurately as possible; if you need to estimate an answer that is okay.

• Press the "Next" button to save your responses and move forward.

• Press the "Previous" button to go back.

• Some questions offer text to help you understand the question or the response options. Click on the HELP icon at the top of the screen or the help icon in the survey to see the help text.

• If you need to take a break and leave the interview at any time, click the "LOG OUT" button in the top left-hand corner of your screen. When you log back in, the survey will start from the screen you were on when you logged out.

• To protect your data, you will be logged off if you are idle for more than 30 minutes.

PROGRAMMER BOX 2

Next

A00C2. Welcome to the Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) Math Teacher Questionnaire. This is the information we have on record about your school, math classes, and name. Press “Next” to continue.

School: [SCHOOL NAME]

Teacher: [TEACHER NAME]

Class(es): [CLASS NAME(S), PERIOD(S)]

SCINTRO

This first section will ask you to confirm whether you teach math to the [student/students] selected for MGLS:2017.

ALL

SC01 WILL BEGIN A SHORT CONFIRMATION LOOP WHICH IS TO INCLUDE AN ITERATION FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT.

SC01. Do/did you teach math to [FILL PRELOADED STUDENT NAME] during this school year (2016-2017)?

 Yes, and I am the current math teacher for [FILL PRELOADED STUDENT NAME] 1 [SKIP TO SC01b]

 Yes, although I am not the current math teacher for [FILL PRELOADED STUDENT NAME] 2 [SKIP TO SC01a]

 No 3 [SKIP TO SC02]

NO RESPONSE M

HARD CHECK: IF SC01=NO RESPONSE; Please provide an answer to this question and then click “Next”.

SC01 = 2

SC01a. In what month and year did you last teach math to [FILL PRELOADED STUDENT NAME]?

• Month

• Year

Go to SC01b.

SC01 = 1,2

SC01b. Do/did you teach [FILL PRELOADED STUDENT NAME] in [FILL PRELOADED CLASS/PERIOD]?

 Yes 1 [SEE BELOW]

 No 2 [SKIP TO SC01c]

NO RESPONSE M [SKIP TO SC01c]

IF SC01b=1 then do:

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING A01).

ELSE TEACHER IS INELIGIBLE; GOTO SC05.

SC01b in (2,M)

EACH PRELOADED CLASS/PERIOD ASSOCIATED WITH THE TEACHER RESPONDENT WILL BE LISTED AS A RESPONSE OPTION FOR THIS QUESTION.

EACH CLASS/PERIOD SELECTED BY THE RESPONDENT WILL THEN BE ASKED ABOUT IN SECTION A.

SC01c. In which of the following classes do/did you teach [FILL PRELOADED STUDENT NAME]?

• First preloaded class/period

• Second preloaded class/period

• Third preloaded class/period

• Etc.

• Etc.

• Other (specify)

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01=YES FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING A01).

ELSE TEACHER IS INELIGIBLE; GOTO SC05.

Hard check: You have selected "Other", but have not provided a response to the "Please specify" prompt.";

SC01 =32

FILL PRELOADED STUDENT FIRST NAME AND LAST NAME

SC02. Did anyone else at your school teach math to [FILL PRELOADED STUDENT NAME] during this school year (2016-2017)?

 Yes 1 [SKIP TO SC03]

 No 2 [SEE BELOW]

NO RESPONSE M [SEE BELOW]

SOFT CHECK: IF SC02=NO RESPONSE;

Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

PROGRAMMER BOX 12a

If SC02 in (2, M) then do:

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING A01).

ELSE TEACHER IS INELIGIBLE; GOTO SC05.

SC02 = 1

FILL PRELOADED STUDENT NAME

SC03. You indicated that [FILL PRELOADED STUDENT NAME] has a different math teacher. What is the name of this student’s math teacher?

NAME (STRING (50))

NO RESPONSE M

SOFT CHECK: IF SC03=NO RESPONSE; Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING A01).

ELSE TEACHER IS INELIGIBLE; GOTO SC05.

SC05. Thank you for taking the time to answer our questions! Since you are not the math teacher for any MGLS:2017 students, it is not necessary for you to answer any other questions.

Press “Finish” to finish.

[Programmer Note: Exit and Status.]

PROGRESS SUMMARY SCREEN

THIS SCREEN APPRISES THE RESPONDENT OF THEIR PROGRESS BY LISTING THE CLASSES/STUDENTS FOR WHOM THE RESPONDENT HAS ALREADY ANSWERED QUESTIONS (IF APPLICABLE), AS WELL AS THE REMAINING CLASSES/STUDENTS FOR WHOM THE RESPONDENT WILL STILL BE ASKED QUESTIONS.

Now we have some additional questions about the classes and students you are currently teaching or have taught this school year (2016-2017). 


We have some questions for you about the following:

• [STUDENT NAME FILL 1, CLASS NAME 1]

• [STUDENT NAME FILL 2, CLASS NAME 2]

• [STUDENT NAME FILL 3, CLASS NAME 3]

• [STUDENT NAME FILL 4, CLASS NAME 4]

GO TO A01.

[ClassName, Period]

ALL ELIGIBLE RESPONDENTS (SC01 = 1 or 2 FOR AT LEAST ONE STUDENT)

[ASK ONCE FOR EACH CLASSROOM SELECTED IN SC01b/SC01c.]

CLASS NAME, PERIOD = FILL FROM PRELOAD

A01. {This section asks specific questions}/ {Now we would like to know} about your [CLASS NAME, PERIOD] class.

6010101

How many students are enrolled in this class?

STUDENTS

(RANGE 1-50)

NO RESPONSE M

HARD CHECK: IF A01 = 0. You entered that 0 students are in this class. Adjust the number of students then click the “Next” button.

SOFT CHECK: IF A01 > 50; You entered that [A01 RESPONSE] students are in this class. Select “Edit”to adjust the number of students or select “Next” if this is correct.

PROGRAMMER BOX 3

If this is the first iteration for the class, display: “This section asks specific questions about your [class name, PERIOD] class.

if this is a subsequent class, display “Now we would like to know about your [class name, PERIOD] class”

PROGRAMMER NOTE: RANGE (1-50)

PROGRAMMER NOTE: TEACHERS SHOULD COMPLETE SURVEY SECTIONS A and b. THEN TSR ITEMS FOR STUDENTS IN THE CLASS FOR WHICH THEY ANSWERED SECTIONS A and B in the survey. IF MORE THAN ONE CLASSROOM, THEN LOOP SURVEY SECTIONS A-B FOR EACH CLASSROOM. WITHIN EACH CLASSROOM LOOP, INCLUDE TSRs FOR THAT CLASSROOM. After all classrooms and tsrs within are complete, move to sections c and d.

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

6010102

A01a. Please provide some information about your [CLASS NAME, PERIOD] class.

Which of the following best describes this mathematics course?

 Grade 6 general mathematics 1

 Grade 6 honors mathematics 2

 Grade 6 remedial mathematics 3

 Grade 7 general mathematics 4

 Grade 7 honors mathematics 5

 Grade 7 remedial mathematics 6

 Grade 8 general mathematics 7

 Grade 8 honors mathematics 8

 Grade 8 remedial mathematics 9

 Introduction to algebra/ pre-algebra 10

 Algebra 11

 Algebra II 12

 Geometry 13

 Other 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF A01a=99 and no response entered; You have selected "Other", but have not provided a response to the "Please specify" prompt."

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

A02. What percentage of students in this [CLASS NAME, PERIOD] class…

If none, enter “0.”

PROGRAMMER: RANGE FOR GRID IS 0 – 100 for each.

		PERCENTAGE
6010201	a. Are below grade level in their mathematics skills?
6010202	b. Are about on grade level in their mathematics skills?
6010203	c. Are above grade level in their mathematics skills?

SOFT CHECK: IF A02a+A02b+A02c NE 100; Please make sure your answers add to 100 percent.

SOFTCHECK: If letter, decimal, or special character entered; Please only enter whole numbers between 0-100.

ALL

6010300

A03. At this point in the school year, how would you rate the behavior of the students in this [CLASS NAME, PERIOD] class?

 Group misbehaves very frequently and is almost always difficult to handle. 1

 Group misbehaves frequently and is often difficult to handle. 2

 Group misbehaves occasionally. 3

 Group behaves well. 4

 Group behaves exceptionally well. 5

NO RESPONSE M

[Class Name, Period]: Content and teaching practices

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

B01. This section focuses on the content you cover in this [CLASS NAME, PERIOD] class, as well as your teaching practices.

The curriculum used for this [CLASS NAME, PERIOD] is...

6020101

Select all that apply.

6020102

 a. Locally or district-designed 1

6020103

 b. State-designed 2

6020104

 c. Nationally-designed 3

 d. Other 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF B01=99 and no response specified; "You have selected "Other", but have not provided a response to the "Please specify" prompt."

ALL

6020200

B02. What do you use as your primary basis for instruction for this [CLASS NAME, PERIOD]class?

 Textbook (Print) 1

 E-book 2

 District or state educational content repository 3

 Open educational resources 4

Specify (STRING (120))

 Other 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF B02=4 or =99 and no response specified; "You have selected "Other", but have not provided a response to the "Please specify" prompt."

B02OER. What open educational resources did you use as your primary basis for instruction for this [T_CLASS] class?

Please specify:

Specify

IF BO2= 1 OR 2

6020301

B03. Which one of the following textbooks or e-books do you use in this [CLASS NAME, PERIOD] class as your primary source of instruction?

 Algebra 1; Glencoe / McGraw‐Hill 1

 Algebra 1; McDougal Littell / Houghton Mifflin 2

 Algebra; Prentice Hall 3

 Big Ideas Math Common Core; Houghton Mifflin Harcourt 4

 Connected Mathematics Program (CMP) 2 5

 Connected Mathematics Program (CMP) 3 6

 Contemporary Mathematics in Context; Glencoe / McGraw‐Hill 7

 Everyday Mathematics (UCSMP); Everyday Learning 8

 Geometry; Holt 9

 Glencoe Math Common Core Edition Course 2 10

 Glencoe Math Course 1 11

 Glencoe Mathematics Applications and Concepts Course 1; Glencoe/McGraw-Hill 12

 Glencoe Mathematics Applications and Concepts Course 2; Glencoe/McGraw-Hill 13

 Glencoe Mathematics Applications and Concepts Course 3; Glencoe/McGraw-Hill 14

 Go Math!; Houghton Mifflin Harcourt 15

 Holt Algebra I; Holt, McDougal 16

 Holt Mathematics Course 1; Holt, Rinehart & Winston 17

 Holt Mathematics Course 2; Holt, Rinehart & Winston 18

 Holt Mathematics Course 3; Holt, Rinehart & Winston 19

 Holt McDougal Mathematics Common Core Course 1; Houghton Mifflin Harcourt 20

 Holt McDougal Mathematics Common Core Course 2; Houghton Mifflin Harcourt 21

 Holt McDougal Mathematics Common Core Course 3; Houghton Mifflin Harcourt 22

 Holt Pre-Algebra; Holt, Littell 23

 Holt Pre‐Algebra; Holt, McDougal 24

 Impact Mathematics Course 1; Glencoe/McGraw-Hill 25

 Impact Mathematics Course 2; Glencoe/McGraw-Hill 26

 Impact Mathematics Course 3; Glencoe/McGraw-Hill 27

 Integrated Mathematics; McDougal Littell / Houghton Mifflin 28

 Math Connects Common Core Edition Course 2 29

 Math Investigations; Pearson/TERC 30

 Math; Harcourt, Brace, Jovanovich 31

 Math; Scott Foresman 32

 Pre-Algebra; Glencoe/McGraw-Hill 33

 Prentice Hall Mathematics Common Core; Pearson 34

 Saxon Math 35

 Trailblazers; Kendall Hunt 36

 Other 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF B03=99 and no response specified; "You have selected "Other", but have not provided a response to the "Please specify" prompt."

PROGRAMMER BOX 4

format b03 as drop-down. list responses alphabetically, with exception of “other,” which should appear at the bottom of the drop-down list.

IF B02=1 OR =2 and B03 is not missing

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

FILL TEXTBOOK NAME from B03

6020302

B03a. Please indicate the publication year of your primary textbook, [FILL TEXTBOOK NAME from B03].

PUBLICATION YEAR

(RANGE 1990-2017)

NO RESPONSE M

PROGRAMMER BOX 5

format b03a as drop-down ranging from 1990 to 2017. Note the upper range of year may need to be updated accordingly.

IF B02=1 OR =2 and B03 is not missing

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

FILL TEXTBOOK NAME from B03

6020303

B03b. Please indicate the grade level of your primary textbook [FILL TEXTBOOK NAME from B03].

 Grade 5 1

 Grade 6 2

 Grade 7 3

 Grade 8 4

 Grade 9 5

 Not applicable 6

NO RESPONSE M

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

B04. Which of the following do you use to supplement your primary basis for instruction for this [CLASS NAME, PERIOD] class?

Select all that apply.

6020401

 a. Textbook (Print) 1

6020403

6020402

 b. E-book 2

 c. District or state educational content repository 3

6020404

 d. Open educational resources 4

6020405

Specify (STRING (120))

 e. Other 99

6020406

Specify (STRING (120))

 f. I do not use additional resources to supplement instruction 5

NO RESPONSE M

SOFT CHECK: IF B04=4 You have selected "Open educational resources", but have not provided a response to the "Please specify" prompt."

IF B04 =99 and no response specified; You have selected "Other", but have not provided a response to the "Please specify" prompt.

PROGRAMMER BOX 6

PROGRAMMING NOTE: If select option 5, should not be able to select other responses.

IF B04 = 1 or = 2

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

B05. What additional textbooks or e-books do you use to supplement your instruction?

6025010

Select all that apply.

6025020

 a. Algebra 1; Glencoe / McGraw‐Hill 1

6025030

 b. Algebra 1; McDougal Littell / Houghton Mifflin 2

6025040

 c. Algebra; Prentice Hall 3

6025050

 d. Big Ideas Math Common Core; Houghton Mifflin Harcourt 4

 e. Connected Mathematics Program (CMP) 2 5

6025070

6025060

 f. Connected Mathematics Program (CMP) 3 6

6025080

 g. Contemporary Mathematics in Context; Glencoe / McGraw‐Hill 7

6025090

 h. Everyday Mathematics (UCSMP); Everyday Learning 8

6025100

 i. Geometry; Holt 9

6025110

 j. Glencoe Math Common Core Edition Course 2 10

6025120

 k. Glencoe Math Course 1 11

 l. Glencoe Mathematics Applications and Concepts Course 1; Glencoe/McGraw-Hill 12

6025130

 m. Glencoe Mathematics Applications and Concepts Course 2; Glencoe/McGraw-Hill 13

6025140

 n. Glencoe Mathematics Applications and Concepts Course 3; Glencoe/McGraw-Hill 14

6025160

6025150

 o. Go Math!; Houghton Mifflin Harcourt 15

 p. Holt Algebra I; Holt, McDougal 16

6025180

6025170

 q. Holt Mathematics Course 1; Holt, Rinehart & Winston 17

6025190

 r. Holt Mathematics Course 2; Holt, Rinehart & Winston 18

6025200

 s. Holt Mathematics Course 3; Holt, Rinehart & Winston 19

 t. Holt McDougal Mathematics Common Core Course 1; Houghton Mifflin Harcourt 20

6025210

 u. Holt McDougal Mathematics Common Core Course 2; Houghton Mifflin Harcourt 21

6025220

 v. Holt McDougal Mathematics Common Core Course 3; Houghton Mifflin Harcourt 22

6025240

6025230

 w. Holt Pre-Algebra; Holt, Littell 23

6025250

 x. Holt Pre‐Algebra; Holt, McDougal 24

6025260

 y. Impact Mathematics Course 1; Glencoe/McGraw-Hill 25

6025270

 z. Impact Mathematics Course 2; Glencoe/McGraw-Hill 26

6025280

 aa. Impact Mathematics Course 3; Glencoe/McGraw-Hill 27

 ab. Integrated Mathematics; McDougal Littell / Houghton Mifflin 28

6025300

6025290

 ac. Math Connects Common Core Edition Course 2 29

6025310

 ad. Math Investigations; Pearson/TERC 30

6025320

 ae. Math; Harcourt, Brace, Jovanovich 31

6025330

 af. Math; Scott Foresman 32

6025340

 ag. Pre-Algebra; Glencoe/McGraw-Hill 33

6025350

 ah. Prentice Hall Mathematics Common Core; Pearson 34

6025360

 ai. Saxon Math 35

6025370

 aj. Trailblazers; Kendall Hunt 36

6025380

 ak. Other (Please specify) 97

6025390

 al. Other (Please specify) 98

 am. Other (Please specify) 99

• None of the above

NO RESPONSE M

SOFT CHECK: IF B05=97, 98, or 99 and no response specified; "You have selected "Other", but have not provided a response to the "Please specify" prompt."

IF B04 = 1 or = 2 and B05 is not missing.

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT] [ASK FOR EACH SELECTED BOOK IN B05]

FILL TEXTBOOK NAME(S) FROM B05.

B05A. Please indicate the publication year of your supplemental textbook, [SUPPLEMENTARY TEXTBOOK].

6020501

PUBLICATION YEAR

(1990-2017)

NO RESPONSE M

PROGRAMMER BOX 6a

format b05a as drop-down ranging from 1990 to 2017. Note the upper range of year may need to be updated accordingly.

IF B04 = 1 or = 2 and B05 is not missing.

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT][ASK FOR EACH SELECTED RESPONSE IN B05]

FILL SUPPLEMENTAL TEXTBOOK NAME from B05

6020502

B05B. Please indicate the grade level of your supplemental textbook, [FILL SUPPLEMENTAL TEXTBOOK NAME from B05].

 Grade 5 1

 Grade 6 2

 Grade 7 3

 Grade 8 4

 Grade 9 5

 Not applicable 6

PROGRAMMER BOX 7

PROGRAMMING NOTE: Please loop B05A and B05B together for each response selected in B05, except for cases where B04 = 1 or = 2 and B05=97, 98, or 99, and the specify field is left blank.

NO RESPONSE M

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

6020600

B06. The next questions ask about how much time is scheduled for this [CLASS NAME, PERIOD] class.

How many weeks per year is the [CLASS NAME, PERIOD] class held?

WEEKS

(RANGE (1-52))

NO RESPONSE M

SOFT CHECK: IF 0 < B06 < 9 or B06 > 40; Just to confirm You entered [B06 RESPONSE] weeks per year for this class. Press "Edit" to return to this screen or press "Next" to continue.

HARD CHECK: IF B06 = 0. You entered 0 weeks. Adjust the number of weeks then click the “Next” button.

HARDCHECK IF B06>52 OR NOT A NUMBER: Please enter a number between 1 and 52.

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

6020700

B07. How many days per week is the [CLASS NAME, PERIOD] class typically held?

 One day 1

 Two days 2

 Three days 3

 Four days 4

 Five days 5

 Six days 6

NO RESPONSE M

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

6020800

B08. How many minutes per day is the [CLASS NAME, PERIOD] class typically held?

NUMBER OF MINUTES

(RANGE (1-200))

NO RESPONSE M

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

B09. The purpose of this item is to obtain a description of the specific mathematic content areas you covered or plan to cover in your course this academic year.

Following is a list of content areas covering materials that may be taught in grade 6. Please respond to the entire list so that we may obtain an indication of the topics covered in your class that is as complete and accurate as possible. (Note: Not all areas are necessarily appropriate for your class).

For each listed content area, indicate the approximate number of class periods during this school year when the content area was or will be a primary focus for your [CLASS NAME, PERIOD] class.

How many full class periods have you or will you teach the following topics in this course during this school year? Indicate the number of class periods.

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		None	One or less than one full class	2 to 5	6 to 10	11 to 15	More than 15
6020901	a. Understand ratio concepts and use ratio reasoning to solve problems.	0 	1 	2 	3 	4 	5 
6020902	b. Analyze proportional relationships and use them to solve real-world and mathematical problems.	0 	1 	2 	3 	4 	5 
6020903	c. Apply and extend previous understandings of multiplication and division to divide fractions by fractions.	0 	1 	2 	3 	4 	5 
6020904	d. Compute fluently with multi‐digit numbers and find common factors and multiples.	0 	1 	2 	3 	4 	5 
6020905	e. Apply and extend previous understandings of numbers to the system of rational numbers.	0 	1 	2 	3 	4 	5 
6020906	f. Apply and extend previous understandings of operations with fractions to add, subtract, multiply, and divide rational numbers.	0 	1 	2 	3 	4 	5 
6020907	g. Know that there are numbers that are not rational and approximate them by rational numbers.	0 	1 	2 	3 	4 	5 
6020908	h. Define, evaluate, and compare functions.	0 	1 	2 	3 	4 	5 
6020909	i. Use functions to model relationships between quantities.	0 	1 	2 	3 	4 	5 

B09. (continued)

The purpose of this item is to obtain a description of the specific mathematic content areas you covered or plan to cover in your course this academic year.

Following is a list of content areas covering materials that may be taught in grade 6. Please respond to the entire list so that we may obtain an indication of the topics covered in your class that is as complete and accurate as possible. (Note: not all areas are necessarily appropriate for your class).

For each listed content area, indicate the approximate number of class periods during this school year when the content area was or will be a primary focus for your [CLASS NAME, PERIOD] class.

To what extent have you or will you teach each of the following topics in this course during this school year?

Indicate the number of class periods.

PROGRAMMER: CODE ONE PER ROW

Select one answer for eachrow.

		None	One or less than one full class	2 to 5	6 to 10	11 to 15	More than 15
6020910	j. Apply and extend previous understandings of arithmetic to algebraic expressions.	0 	1 	2 	3 	4 	5 
6020911	k. Reason about and solve one‐variable equations and inequalities.	0 	1 	2 	3 	4 	5 
6020912	l. Represent and analyze quantitative relationships between dependent and independent variables.	0 	1 	2 	3 	4 	5 
6020913	m. Use properties of operations to generate equivalent expressions.	0 	1 	2 	3 	4 	5 
6020914	n. Solve real‐life and mathematical problems using numerical and algebraic expressions and equations.	0 	1 	2 	3 	4 	5 
6020915	o. Work with radicals and integer exponents.	0 	1 	2 	3 	4 	5 
6020916	p. Understand the connections between proportional relationships, lines, and linear equations.	0 	1 	2 	3 	4 	5 
6020917	q. Analyze and solve linear equations and pairs of simultaneous linear equations.	0 	1 	2 	3 	4 	5 

ALL

CLASS NAME, PERIOD = FILL FROM PRELOAD

B10. These next questions ask about the teaching practices you use in this classroom.

How often do the students in this [CLASS NAME, PERIOD] class...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Almost every day	Once or twice a week	Once or twice a month	Never or hardly ever
6021001	a. Explain how to solve a mathematics problem (either verbally or in writing)?	1 	2 	3 	4 
6021002	b. Work on problems for which there is no immediate solution?	1 	2 	3 	4 
6021003	c. Practice solving routine items to develop or maintain fluency?	1 	2 	3 	4 

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

B11. Please indicate the extent to which the following statements are true for students in this [CLASS NAME, PERIOD] class.

PROGRAMMER: CODE ONE PER ROW

Select one answer for eachrow.

		Not at all true	A little bit true	Somewhat true	Mostly true	Very true
6021101	a. I try to give students a lot of choices about classroom assignments.	1 	2 	3 	4 	5 
6021102	b. I have to lead students through their schoolwork step by step.	1 	2 	3 	4 	5 
6021103	c. I can't afford to let students decide too many things about schoolwork for themselves.	1 	2 	3 	4 	5 
6021104	d. I let students make a lot of their own decisions regarding schoolwork.	1 	2 	3 	4 	5 
6021105	e. It's better not to give too many choices to students.	1 	2 	3 	4 	5 
6021106	f. I find myself telling students every step to make when it comes to schoolwork.	1 	2 	3 	4 	5 
6021107	g. I can't let students do things their own way.	1 	2 	3 	4 	5 
6021108	h. When it comes to assignments, I'm always having to tell students what to do.	1 	2 	3 	4 	5 
6021109	i. My general approach with students is to give them as few choices as possible.	1 	2 	3 	4 	5 

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

B12. Next we would like to know about how you use technology in your teaching.

Please indicate if the following technology devices are available for your use in the classroom.

Select all that apply.

6021201

6021202

 a. Desktop or laptop 1

 b.Tablet 2

6021203

 c. Smartboard, or interactive whiteboard 3

60212041

 d. Interactive TV monitor 4

6021206

6021205

 e. LCD or DLP projector 5

 f. Smartphone 6

6021207

 g. Apps 7

6021208

 h. Digital camera 8

6021210

6021209

 i. Digital video recorder 9

6021211

 j. Graphing calculators 10

 k. Student or audience response system for polling 11

6021213

6021212

 l. Other (Please specify) 95

6021214

 m. Other (Please specify) 96

 n. Other (Please specify) 97

6021215

 o. Other (Please specify) 98

6021217

6021216

 p. Other (Please specify) 99

 q. No technology devices are available for teacher use in the classroom 12

NO RESPONSE M

SOFT CHECK: IF B12=95-99 and no response specified; You have selected "Other" one or more times, but have not provided a response to the corresponding "Please specify" prompt(s)."

PROGRAMMER BOX 7

PROGRAMMER NOTE: If select option 12, should not be able to select other responses.

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

B13. Please indicate if the following technology devices are available for student use in the classroom.

6021301

Select all that apply.

6021302

 a. Desktop or laptop 1

6021303

 b. Tablet 2

6021304

 c. Smartboard, or interactive whiteboard 3

6021305

 d. Interactive TV monitor 4

6021306

 e. LCD or DLP projector 5

6021307

 f. Smartphone 6

6021308

 g. Apps 7

6021309

 h. Digital camera 8

 i. Digital video recorder 9

6021311

6021310

 j. Graphing calculators 10

6021312

 k. Student or audience response system for polling 11

6021313

 l. Other (Please specify) 95

6021314

 m. Other (Please specify) 96

6021315

 n. Other (Please specify) 97

 o. Other (Please specify) 98

6021316

 p. Other (Please specify) 99

6021317

 q. No technology devices are available for student use in the classroom 12

NO RESPONSE M

SOFT CHECK: IF B13=95-99 and no response specified; You have selected "Other" one or more times, but have not provided a response to the corresponding "Please specify" prompt(s)."

PROGRAMMER BOX 8

PROGRAMMER NOTE: If select option 12, should not be able to select other responses.

B13=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =95-99

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

B14. In this [CLASS NAME, PERIOD] class this year, how often do your students use technological resources to do each of the following?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Never	Rarely	Monthly	Weekly	Daily
6021401	a. Practice or review mathematics topics.	1 	2 	3 	4 	5 
6021402	b. Show work to the class in real time.	1 	2 	3 	4 	5 
6021403	c. Research a mathematics topic.	1 	2 	3 	4 	5 
6021404	d. Play games.	1 	2 	3 	4 	5 
6021405	e. Create projects.	1 	2 	3 	4 	5 
6021406	f. Collect and analyze data.	1 	2 	3 	4 	5 
6021407	g. Conduct or watch simulations.	1 	2 	3 	4 	5 
6021408	h. Submit assignments online.	1 	2 	3 	4 	5 
6021409	i. Edit others' work or give others feedback.	1 	2 	3 	4 	5 
6021410	j. Share or post their work for others to view at any time.	1 	2 	3 	4 	5 
6021411	k. Extend mathematics learning with enrichment activities.	1 	2 	3 	4 	5 
6021412	l. Participate in online discussions.	1 	2 	3 	4 	5 
6021413	m. Fill free time.	1 	2 	3 	4 	5 

PROGRAMMER BOX 9

PROGRAMMER NOTE: PLEASE INCLUDE THE FOLLOWING AS HELP TEXT via a hyperlink in the words “technological resources”: Examples of technological resources would be tablets, e-readers, computers, smartphones, digital cameras, Smartboards and interactive whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

B13=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =95-99

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

SOFT CHECK: 
If all items are left blank: 
" Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

6020301

B14A. Please list any other ways students in your class use technological resources and indicate how often they use technological resources in this way.

If there are fewer other uses than the number of blank spaces provided, please leave any extra spaces empty and click “Next.”

If there are no other uses, then please click “Next.”

		Rarely	Monthly	Weekly	Daily
6021421	a. Other use 1 (Please specify)	2 	3 	4 	5 
6021422	b. Other use 2 (Please specify)	2 	3 	4 	5 
6021423	c. Other use 3 (Please specify)	2 	3 	4 	5 
6021424	d. Other use 4 (Please specify)	2 	3 	4 	5 
6021425	e. Other use 5 (Please specify)	2 	3 	4 	5 

NO RESPONSE M

SOFT CHECK: 

If respondent specifies an “other use” but does not indicate frequency, display the following soft check:

You have indicated other ways students use technological resources, but have not responded to how often. Please select “Edit” to provide the missing answers, or select "Next" to continue without providing additional responses.

If respondent indicates a frequency without specifying the “other use”, display the following soft check:

You have selected how often the students use technological resources, but have not filled in the associated text box. Please select “Edit” to provide the missing answers, or select "Next" to continue without providing additional responses.

PROGRAMMER BOX 9a

PROGRAMMER NOTE: PLEASE INCLUDE THE FOLLOWING AS HELP TEXT via a hyperlink in the words “technological resources”: Examples of technological resources would be tablets, e-readers, computers, smartphones, digital cameras, Smartboards and interactive whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

B12=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =95-99

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

B15. In this [CLASS NAME, PERIOD] class this year, how often do you use technological resources to do each of the following?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Never	Rarely	Monthly	Weekly	Daily
6021510	a. Collaborate with other teachers.	1 	2 	3 	4 	5 
6021520	b. Encourage student participation in class.	1 	2 	3 	4 	5 
6021530	c. Collect and analyze data for classroom examples and activities.	1 	2 	3 	4 	5 
6021540	d. Collect and analyze assessment data for grading.	1 	2 	3 	4 	5 
6021550	e. Send reminders or class information to students.	1 	2 	3 	4 	5 
6021560	f. Provide homework help or learning support outside of class.	1 	2 	3 	4 	5 
6021570	g. Develop videos of classroom instruction.	1 	2 	3 	4 	5 
6021580	h. Compile links to external resources.	1 	2 	3 	4 	5 
6021590	i. Distribute study tools and self-assessments.	1 	2 	3 	4 	5 

PROGRAMMER BOX 10

PROGRAMMER NOTE: PLEASE INCLUDE THE FOLLOWING AS HELP TEXT via a hyperlink in the words “technological resources”: Examples of technological resources would be tablets, e-readers, computers, smartphones, digital cameras, Smartboards and interactive whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Soft check if all items are left blank:

“Your responses are very important. Please answer as many questions as possible. Press “Edit” to return to this screen or press “Next” to continue.

B12=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =95-99

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

B15A. Please list any other ways you use technological resources in this class and indicate how often you use them in this way.

If there are fewer other uses than the number of blank spaces provided, please leave any extra spaces empty and click “Next.”

If there are no other uses, then please click “Next.”

		Rarely	Monthly	Weekly	Daily
6021521	a. Other use 1 (Please specify)	2 	3 	4 	5 
6021522	b. Other use 2 (Please specify)	2 	3 	4 	5 
6021523	c. Other use 3 (Please specify)	2 	3 	4 	5 
6021524	d. Other use 4 (Please specify)	2 	3 	4 	5 
6021525	e. Other use 5 (Please specify)	2 	3 	4 	5 

NO RESPONSE M

SOFT CHECK: 

If respondent specifies an “other use” but does not indicate frequency, display the following soft check:

You have indicated other ways students use technological resources, but have not responded to how often. Please select “Edit” to provide the missing answers, or select "Next" to continue without providing additional responses.

If respondent indicates a frequency without specifying the “other use”, display the following soft check:

You have selected how often the students use technological resources, but have not filled in the associated text box. Please select “Edit” to provide the missing answers, or select "Next" to continue without providing additional responses.

PROGRAMMER BOX 10a

PROGRAMMER NOTE: PLEASE INCLUDE THE FOLLOWING AS HELP TEXT via a hyperlink in the words “technological resources”: Examples of technological resources would be tablets, e-readers, computers, smartphones, digital cameras, Smartboards and interactive whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

ALL

6021561

B16. How easily can you access the internet in your classroom?

 Cannot access 1

 Inconsistently, often a poor connection 2

 Easily, usually a good connection 3

 Very easily, a strong and consistent connection 4

NO RESPONSE M

ALL

6021562

B17. How easily can your students access the internet in your classroom?

 Cannot access 1

 Inconsistently, often a poor connection 2

 Easily, usually a good connection 3

 Very easily, a strong and consistent connection 4

NO RESPONSE M

ALL

6021563

B18. How often do you connect to the internet from your classroom for school-related work?

 Not at all 1

 Rarely 2

 Sometimes 3

 Often 4

NO RESPONSE M

ALL

6021564

B19. How often do your students connect to the internet from your classroom for school-related work?

 Not at all 1

 Rarely 2

 Sometimes 3

 Often 4

NO RESPONSE M

ALL

6021565

B20. How often do you assign homework that requires your students to connect to the internet?

 Not at all 1

 Rarely 2

 Sometimes 3

 Often 4

NO RESPONSE M

PROGRAMMER BOX 11

PROGRAMMER NOTE: STATUS HERE FOR CLASSROOM LEVEL QUESTIONS.

CONTINUE TO SC00a.

ALL

FILL CLASS NAME, PERIOD FROM SC01b OR SC01c.

Student information

SC00a. Those are all of the questions we have about your [CLASS NAME, PERIOD] class.

Now we would like to ask some questions about the student who is participating in the MGLS:2017 and is in your [CLASS NAME, PERIOD] class. This section includes questions about each student’s math skills, social skills, and other behaviors at school.

Press the "Next" button to proceed.

[FILL PRELOADED STUDENT NAME]: Student skills and behaviors

ALL

ADMINISTER THE FOLLOWING SET OF QUESTIONS FOR EACH PRELOADED STUDENT WHERE SC01 = YES.

[FOR SECOND AND FOLLOWING STUDENTS IN A GIVEN CLASS, IF MORE THAN ONE STUDENT IN THAT CLASS]

Now we have questions about [FILL PRELOADED STUDENT NAME]. The following questions ask about the skills and abilities [FILL PRELOADED STUDENT NAME] demonstrates in your [CLASS NAME, PERIOD] class.

A01aTSR. Please rate [FILL PRELOADED STUDENT NAME] 's skills in the following areas, as exhibited in your class.

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Outstanding	Very good	Good	Fair	Poor	Not applicable or not observed
6110101	a. Ability to apply mathematical concepts to "real world" problems	1 	2 	3 	4 	5 	6 
6110102	b. Ability to complete or conduct proofs or demonstrations of [his/her] mathematical reasoning	1 	2 	3 	4 	5 	6 
6110103	c. Ability to talk about [his/her] reasoning or thinking in solving a problem	1 	2 	3 	4 	5 	6 
6110104	d. Ability to explain [his/her] reasoning in solving a problem in writing	1 	2 	3 	4 	5 	6 
6110105	e. Ability to use representations to model mathematical ideas	1 	2 	3 	4 	5 	6 
6110106	f. Ability to use a calculator to solve problems	1 	2 	3 	4 	5 	6 
6110107	g. Ability to fluently apply math facts and procedures	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

6110110

A02aTSR. Have you taught [FILL PRELOADED STUDENT NAME] math before this year?

 Yes 1

 No 2

NO RESPONSE M

ALL

6110111

A03aTSR. Have you taught [FILL PRELOADED STUDENT NAME]in other academic areas before this year?

 Yes 1

 No 2

NO RESPONSE M

ALL

STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM SC01

B01aTSR. For each item below, please think about [FILL PRELOADED STUDENT NAME]’S behavior during the past month. Decide how often the student demonstrates the behavior described.

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Never	Sometimes	Often	Very often	Always	No opportunity to observe this behavior
6120101	a. Organizes work	1 	2 	3 	4 	5 	6 
6120102	b. Appears motivated to learn new things	1 	2 	3 	4 	5 	6 
6120103	c. Works well independently	1 	2 	3 	4 	5 	6 
6120104	d. Adapts to changes in plans, requirements, or routines	1 	2 	3 	4 	5 	6 
6120105	e. Persists in completing tasks	1 	2 	3 	4 	5 	6 
6120106	f. Pays attention well	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

FILL: HIS OR HER FROM SEX IN PRELOAD

B02aTSR. The following are some statements that describe behaviors many students exhibit. For each item below, please think about [FILL PRELOADED STUDENT]’s behavior during the past three months.

Describe how often this student demonstrates the behavior.

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Never	Some-times	Often	Very often	Always
6120201	a. Manipulates others or lies	1 	2 	3 	4 	5 
6120202	b. Bullies or is cruel or mean to others	1 	2 	3 	4 	5 
6120203	c. Disobeys rules	1 	2 	3 	4 	5 
6120204	d. Has sudden changes in mood or feeling	1 	2 	3 	4 	5 
6120205	e. Argues too much	1 	2 	3 	4 	5 
6120206	f. Is stubborn, sullen, or irritable	1 	2 	3 	4 	5 
6120207	g. Has a strong temper or loses [his/her] temper easily	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM SC01

B03aTSR. Next are some questions about [FILL PRELOADED STUDENT NAME]'s interactions with other students.

During this school year, how often have other students...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Never	Some-times	Often	Very often	Always
6120301	a. Teased, made fun of, or called this student names	1 	2 	3 	4 	5 
6120302	b. Pushed, shoved, slapped, hit, or kicked this student	1 	2 	3 	4 	5 
6120303	c. Told lies or untrue stories about this student	1 	2 	3 	4 	5 
6120304	d. Intentionally excluded or left out this student from socializing with them	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

FILL: HIS OR HER FROM SEX IN PRELOAD

B04aTSR. Please rate each of the listed behaviors according to how well it describes [FILL PRELOADED STUDENT NAME] PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Not at all	A little	Moderately well	Well	Very well
6120401	a. Resolves peer problems on [his/her] own	1 	2 	3 	4 	5 
6120402	b. Is helpful to others	1 	2 	3 	4 	5 
6120403	c. Can give suggestions and opinions without being bossy	1 	2 	3 	4 	5 
6120404	d. Acts friendly toward others	1 	2 	3 	4 	5 
6120405	e. Understands others	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM SC01

FILL: HE OR SHE FROM SEX IN PRELOAD

These questions ask about how [FILL PRELOADED STUDENT NAME] behaves in your classroom.

C01aTSR. Please indicate the extent to which each of the following statements is true for [FILL PRELOADED STUDENT NAME].

PROGRAMMER: CODE ONE PER ROW

Select one answer foreach row.

		Not at all true	A little bit true	Somewhat true	Mostly true	Very true
6130101	a. In my class, this student works as hard as [he/she] can.	1 	2 	3 	4 	5 
6130102	b. When working on classwork in my class, this student appears involved.	1 	2 	3 	4 	5 
6130103	c. When I explain new material, this student listens carefully.	1 	2 	3 	4 	5 
6130104	d. In my class, this student does more than required.	1 	2 	3 	4 	5 
6130105	e. When this student doesn't do well, [he/she] works harder.	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

Next are some questions about [FILL PRELOADED STUDENT NAME] attendance.

C02aTSR. Over the last month, how often has [FILL PRELOADED STUDENT NAME]been...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		0 times	1-2 times	3-6 times	7-9 times	10-12 times	13 or more times
6130201	a. Late to your class.	1 	2 	3 	4 	5 	6 
6130202	b. Absent from your class.	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

C03aTSR. Over the last month, how often did [FILL PRELOADED STUDENT NAME]...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		0 times	1-2 times	3-6 times	7-9 times	10-12 times	13 or more times
6130301	a. Come to class without completing prior assignments or homework.	1 	2 	3 	4 	5 	6 
6130302	b. Come to class without class materials (such as pencils, paper, tablet, books, or calculator).	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

[FILL PRELOADED STUDENT NAME]: Student services

ALL

STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM Q. SC01

This last section asks about any special supports or opportunities [FILL PRELOADED STUDENT NAME] receives at school.

D01aTSR. How often does [FILL PRELOADED STUDENT NAME]receive instruction and/or related services in any of the following types of programs in your school during the day?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Daily	2-4 times per week	Weekly	Less than once a week	This student does not receive this service	Program or service not provided to students in this school
6140101	a. Individual tutoring in mathematics	1 	2 	3 	4 	5 	6 
6140102	b. Small group pull-out instruction in mathematics	1 	2 	3 	4 	5 	6 
6140103	c. Gifted and talented program in mathematics	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

6140200

D02TSR. Have you recommended [FILL PRELOADED STUDENT NAME]for academic honors, advanced placement, or honors classes?

 Yes 1

 No 2

 Not applicable (no such honor available) 3

NO RESPONSE M

END 1

Thank you. These are all the questions we have about this student at this time. Please press the “Next” button to continue.

PROGRAMMER BOX 15A

PROGRAMMER NOTE: STATUS HERE FOR EACH TSR.

IF ADDITIONAL STUDENTS WHERE SC01 in (1,2) ARE IN THIS CLASS, LOOP BACK TO A01aTSR.

ELSE IF ADDITIONAL STUDENTS WHERE SC01 in (1,2), BUT THEY ARE IN A DIFFERENT CLASS, LOOP BACK TO THE PROGRESS SUMMARY SCREEN (immediately preceding A01).

ELSE GO TO C01 (i.e. the “Your School and Teaching” section).

ENDCLASS

Thank you. These are all the questions we have about the students in this class at this time. Please press the “Next” button to continue.

Your school and your teaching

ALL

C01. This section asks questions about [FILL SCHOOL NAME] and your teaching.

6030100

Which statement best describes the way your mathematics classes at [FILL SCHOOL NAME] are organized?

 You instruct several classes of different students all or most of the day in one or more subjects (sometimes called departmentalized instruction). 1

 You instruct the same group of students all or most of the day in multiple subjects (sometimes called a self-contained class). 2

 You instruct a small number of selected students released from or in their regular classes in specific skills or to address specific needs (sometimes called a "pull-out" class or "push-in" instruction). 3

NO RESPONSE M

IF PRELOAD GRADES TAUGHT = 6

C02_6. In this school, how important is each of the following factors in placing a typical sixth-grade student into a mathematics course?

Select one answer for each row.

		Not at all important	A little important	Somewhat important	Very important	N/A
6030261	a. Counselor recommendation	1 	2 	3 	4 	5 
6030262	b. Prior teacher recommendation	1 	2 	3 	4 	5 
6030263	c. Courses taken previously	1 	2 	3 	4 	5 
6030264	d. Achievement in previous courses	1 	2 	3 	4 	5 
6030265	e. Results of district or state end-of-year or end-of-course exams	1 	2 	3 	4 	5 
6030266	f. Results of placement tests	1 	2 	3 	4 	5 
6030267	g. Results of standardized tests	1 	2 	3 	4 	5 
6030268	h. Student career or education plan	1 	2 	3 	4 	5 
6030269	i. Student and/or parent or guardian selection	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

C03. Please indicate how confident you are for each of the following statements about your teaching.

I am confident that I can...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Not at all confident	A little confident	Somewhat confident	Mostly confident	Very confident
6030301	a. Answer students’ mathematics-related questions	1 	2 	3 	4 	5 
6030302	b. Explain to students how to do complex mathematics problems	1 	2 	3 	4 	5 
6030303	c. Skillfully teach all the concepts covered in the mathematics curriculum	1 	2 	3 	4 	5 
6030304	d. Help students master difficult concepts in mathematics	1 	2 	3 	4 	5 
6030305	e. Help all students make significant improvements in mathematics	1 	2 	3 	4 	5 
6030306	f. Design lessons that enable all my students to master the material in mathematics	1 	2 	3 	4 	5 
6030307	g. Help students who have failed math in the past make significant progress	1 	2 	3 	4 	5 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

6030310

C03A. How many hours of professional development did you receive this year that was focused on math?

Please enter whole numbers only.

NUMBER OF HOURS

NO RESPONSE M

HARDCHECK:”Please enter a whole number."

ALL

6030311

C03AA. As part of your professional development, how many times this year did you observe another teacher?

 Never 1

 Once 2

 2 times 3

 3 or 4 times 4

 More than 4 times 5

NO RESPONSE M

ALL

6030312

C03AB. How many times this year were you observed by a coach, mentor, or peer?

 Never 1

 Once 2

 2 times 3

 3 or 4 times 4

 More than 4 times 5

NO RESPONSE M

ALL

6030313

C03AC. How many times this year were you observed as part of a teacher evaluation?

 Never 1

 Once 2

 2 times 3

 3 or 4 times 4

 More than 4 times 5

NO RESPONSE M

ALL

6030331

C03B. How often do you communicate with the special education provider about the students in your math classes?

 Daily 1

 Weekly 2

 Monthly 3

 Rarely. 4

 Never. 5

 Not applicable. 6

NO RESPONSE M

ALL

C03C. The next set of questions is about use of assessment data in [FILL SCHOOL NAME].

Please indicate the extent to which you disagree or agree with each of the following statements:

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030391	a. Teachers in this school regularly use assessment data to inform instructional decisions	1 	2 	3 	4 	5 	6 
6030392	b. I use assessment data to keep track of my struggling students	1 	2 	3 	4 	5 	6 
6030393	c. I regularly use assessment data to inform my instruction	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

C04. Next, we would like to know more about your school's principal or administrator. How much do you disagree or agree with each of the following statements?

The principal at this school...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030401	a. Makes clear to the staff his or her expectations for meeting instructional goals	1 	2 	3 	4 	5 	6 
6030402	b. Communicates a clear vision for our school	1 	2 	3 	4 	5 	6 
6030403	c. Sets high standards for teaching	1 	2 	3 	4 	5 	6 
6030404	d. Understands how students learn	1 	2 	3 	4 	5 	6 
6030405	e. Sets high standards for student learning	1 	2 	3 	4 	5 	6 
6030406	f. Presses teachers to implement what they have learned in professional development	1 	2 	3 	4 	5 	6 
6030407	g. Carefully tracks student academic progress	1 	2 	3 	4 	5 	6 
6030408	h. Knows what's going on in my classroom	1 	2 	3 	4 	5 	6 
6030409	i. Actively monitors the quality of teaching in this school	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

The next set of questions asks about the teaching climate at [FILL SCHOOL NAME]..

C05. How much do you disagree or agree with each of the following statements about math teachers at your school?

Math teachers at your school...

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030501	a. Believe all students can do well	1 	2 	3 	4 	5 	6 
6030502	b. Have given up on their students	1 	2 	3 	4 	5 	6 
6030503	c. Care only about the smart students	1 	2 	3 	4 	5 	6 
6030504	d. Expect very little from students	1 	2 	3 	4 	5 	6 
6030505	e. Work hard to make sure all students are learning	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue..

ALL

C06. To what extent do you disagree or agree with the following statements about teaching at [FILL SCHOOL NAME]?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030601	a. Curriculum, instruction, and learning materials are well coordinated across the different grade levels at this school.	1 	2 	3 	4 	5 	6 
6030602	b. There is consistency in curriculum, instruction, and learning materials among teachers in the same grade level at this school.	1 	2 	3 	4 	5 	6 

ALL

C07. How much do you disagree or agree with each of the following statements about [FILL SCHOOL NAME]?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030701	a. The level of student misbehavior (for example, noise, horseplay, or fighting in the halls or cafeteria) in this school interferes with my teaching.	1 	2 	3 	4 	5 	6 
6030702	b. Many of the students I teach are not capable of learning the material I am supposed to teach them.	1 	2 	3 	4 	5 	6 
6030703	c. I feel accepted and respected as a colleague by most staff members.	1 	2 	3 	4 	5 	6 
6030704	d. Teachers in this school are continually learning and seeking new ideas.	1 	2 	3 	4 	5 	6 
6030705	e. Routine administrative duties and paperwork interfere with my job of teaching. Paperwork includes items associated with Response to Intervention, alignment with the Common Core State Standards, or other initiatives.	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

C08. Indicate the extent to which you disagree or agree with each of the following statements about [FILL SCHOOL NAME].

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
6030801	a. I feel safe at this school.	1 	2 	3 	4 	5 	6 
6030802	b. This school's security policies and practices are sufficient.	1 	2 	3 	4 	5 	6 
6030803	c. The students get along well with teachers.	1 	2 	3 	4 	5 	6 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

The next two questions ask about your school’s technology policies and practices.

6030900

C09. Does [FILL SCHOOL NAME]lend or provide computers, tablets, or similar devices to individual students?

 Yes 1

 No 2

NO RESPONSE M

ALL

6031000

C10. Thinking about students, is this a bring your own device (BYOD) school?

 Yes 1

 No 2

NO RESPONSE M

Educational background

ALL

The next several questions ask about your educational background.

6040100

D01. What is the highest level of education you have completed?

 Did not complete high school 1

 High school diploma or equivalent/GED 2

 Some college or technical or vocational school 3

 Associate’s degree 4

 Bachelor’s degree 5

 Master’s degree 6

 Advanced professional degree beyond a master’s degree (for example, Ph.D., Ed.D.) 7

NO RESPONSE M

“If D01 = 2 or =3 or =4 or =5 or =6 or=7, go to D02; Else go to D05.

FILL = D01 RESPONSE if D01 = 2 or =4 or =5 or =6 or =7; FILL = “college or technical or vocational school training” if D01 =3

6040200

D02. In what year did you receive your [FILL WITH HIGHEST DEGREE LISTED IN D01]?

YEAR HIGHEST DEGREE RECEIVED

(1945-2017)

NO RESPONSE M

PROGRAMMER BOX 18

format D02 as drop-down ranging from 1945 to 2017. Note the upper range of year may need to be updated accordingly.

IF D01 >= 3, go to D03; Else go to D05.

D03. Did you have a major, minor, or special emphasis in any of the following subjects as part

of your undergraduate or graduate coursework?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		Yes, a major	Yes, a minor or special emphasis	No
6040301	a. Elementary education	1 	3 	2 
6040302	b. Secondary education	1 	3 	2 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

IF D01 >= 3, go to D04, Else go to D05.

D04. How many college-level classes have you taken in the following branches of mathematics?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.

		None	One or two	Three or four	Five or more
6040401	a. Algebra such as abstract algebra, linear algebra, or groups, rings, and fields	0 	1 	2 	3 
6040402	b. Applied mathematics such as dynamical systems, game theory, information theory, mathematical modeling, or mathematical physics	0 	1 	2 	3 
6040403	c. Calculus, analysis, or differential equations	0 	1 	2 	3 
6040404	d. Discrete mathematics, combinatorics, or graph theory	0 	1 	2 	3 
6040405	e. Foundations, philosophy, history of mathematics, or logic	0 	1 	2 	3 
6040406	f. Geometry, trigonometry, or topology	0 	1 	2 	3 
6040407	g, Number theory	0 	1 	2 	3 
6040408	h. Probability or statistics	0 	1 	2 	3 
6040409	i. Teaching mathematics	0 	1 	2 	3 

SOFT CHECK: 
If all items are left blank: 
Your responses are very important. Please answer as many questions as possible. Press "Edit" to return to this screen or press "Next" to continue.

ALL

D05. Including this school year, how many years have you taught the following grades at any school...

Please estimate to the nearest year.

If you have been working for less than one year, enter 1.

		NUMBER OF YEARS
6040501	a. Grade K-12 in any subject?	(RANGE 0.0-50.0)
6040502	b. Grade K-5 math?	(RANGE 0.0-50.0)
6040503	c. Grade 6-8 math?	(RANGE 0.0-50.0)
6040504	d. Grade 9-12 math?	(RANGE 0.0-50.0)

HARD CHECK: IF D05 a, b, c, or d are non-numeric; Please enter a numeric value that is 0 or greater.

HARD CHECK: IF D05 < 0; Please enter a value that is 0 or greater.

SOFT CHECK: IF ANY D05 >40; You entered [D05 a, b, c, or d RESPONSE] years. Select “Edit" to adjust the number of students or select “Next" if this is correct

PROGRAMMER BOX 18A

Programmer note: Omit blanks from soft check.

ALL

6040600

D06. Which of the following best describes the teaching certificate you currently hold?

 Regular or standard state certificate or advanced professional certificate 1

 Certificate issued after satisfying all requirements except the completion of a probationary teaching period 2

 Certificate that requires some additional coursework or passing a test 3

 Certificate issued to persons who must complete a certification program in order to continue teaching 4

 I do not hold any of these certifications 5

 Other (Please specify) 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF D06=99 and no response specified; You have selected "Other", but have not provided a response to the "Please specify" prompt." 

D6 NE 5 OR NE M

D07. In which grades does this certificate allow you to teach math?

Select all that apply.

6040701

6040714

 n. This certificate does not allow me to teach math 14

 a. Kindergarten 1

6040703

6040702

 b. Grade 1 2

6040704

 c. Grade 2 3

 d. Grade 3 4

6040706

6040705

 e. Grade 4 5

6040707

 f. Grade 5 6

6040708

 g. Grade 6 7

6040709

 h. Grade 7 8

 i. Grade 8 9

6040710

6040711

 j. Grade 9 10

 k. Grade 10 11

6040712

 l. Grade 11 12

6040713

 m. Grade 12 13

NO RESPONSE M

ALL

6040800

D08. Have you taken the exam for National Board Certification?

 Not taken 1

 Taken and passed 2

 Taken and awaiting results 3

 Taken and have not yet passed 4

NO RESPONSE M

D08=2

D09. In what content area(s) do you hold a National Board for Professional Teaching certificate?

6040901

Select all that apply.

6040902

 a. Generalist, Early Childhood 1

6040903

 b. Generalist, Middle Childhood 2

6040904

 c. Mathematics, Early Adolescence 3

6040905

 d. Mathematics, Adolescence and Young Adulthood 4

 e. Other (Please specify) 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF D09=99 and no response specified; You have selected "Other", but have not provided a response to the "Please specify" prompt." 

ALL

6041000

D10. Did you enter teaching through an alternative certification program? An alternative certification program is a program that is designed to expedite the transition of non-teachers to a teaching career, for example, a state, district, or university alternative certification program.

 Yes 1

 No 2

NO RESPONSE M

ALL

This set of questions asks about you and your background.

6041100

D11. In what year were you born?

YEAR BORN

(RANGE 1925-1997)

NO RESPONSE M

PROGRAMMER BOX 19

format D11 as drop-down ranging from 1925 to 1997. Note the upper range of year may need to be updated accordingly.

ALL

6041200

D12. What is your sex?

 Male 1

 Female 2

NO RESPONSE M

ALL

6041300

D13. Are you of Hispanic or Latino/Latina origin?

 Yes 1

 No 2

NO RESPONSE M

PROGRAMMER BOX 20

Help text for D13 QUESTION TEXT (hyperlink the words “hispanic or latino/latina in question text):

Hispanic or Latino/LaTina Origin: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultures or origin (or descent), regardless of race.

ALL

D14. Which of the following best describes your race?

6041401

Select all that apply.

6041402

 a. American Indian or Alaska Native 1

6041403

 b. Asian 2

6041404

 c. Black or African American 3

6041405

 d. Native Hawaiian or other Pacific Islander 4

 e. White 5

NO RESPONSE M

PROGRAMMER BOX 21

Help text for D14 QUESTION TEXT (each response option should include an information icon to its corresponding definition): (ONE HELP TEXT BOX CURRENTLY DISPLAYS WITH INFORMATION ABOUT ALL OF THE RACES WHEN ANY OF THE ABOVE RACES ARE CLICKED ON)

American Indian or Alaskan 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..

INCENTADDR

To show our appreciation for completing the survey today, we would like to send you a [FILL CHECK AMOUNT] check. Please provide the address to which you would like the check mailed.

(Allow 4 weeks for delivery.)

Name:

Street Address:

ZIP Code:

City:

State:

END 3

These are all the questions we have for you. We appreciate your taking the time to complete the survey.

Thank you very much for participating in MGLS:2017!

Press “Finish to complete and close the survey.

OR, if ineligible

Thank you for taking the time to answer our questions! Since you are not the math teacher for any MGLS:2017 students, it is not necessary for you to answer any other questions. 



Press “END” to finish.

Appendix OFT1-U4. Special Education Teacher Survey Specifications

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 10 minutes for the teacher-level information and 25 minutes per study student, including the time to review instructions, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

Note: the special education teacher survey specifications are presented in order of administration. The section and item letters and numbers do not reflect that order.

SURVEY INFORMATION

You have received an invitation to complete this questionnaire because one or more students you teach or provide services to have been selected to participate in the MGLS:2017 field test study. To enhance the information provided by your students and their parents, we need you to complete this survey.

After confirming whether you teach (or provide services to) the students selected for MGLS:2017, the survey will ask questions about these specific students. The survey will also ask questions about you and your instructional practices.

Taking part in the study is voluntary, and you can skip questions you do not want to answer. We realize you are very busy, but urge you to complete the questionnaire as completely and accurately as possible. Your answers are very important to the study’s success. You will receive $20 for completing the parts about you and your instructional practices, plus an additional $7 for each individual student about whom you answer questions.

NOTE: There are [FILL NUMBER OF STUDENTS] MGLS:2017 student[s] that we will ask you to confirm.

Please click below to start the survey.

ALL

(WELCOME BACK)

[IF RESPONDENT RETURNING TO ONLINE SURVEY OR HIGHER ORDER TIME]

PROGRAMMER: THE MESSAGE BELOW WILL APPEAR ON A TRANSITION PAGE BETWEEN THE EXISTING LOGIN SCREEN AND THE RETURNING USER’S SCREEN LAST LEFT OFF AT: SO, THE PAGE ORDER FOR RETURNING USERS IS:

1. LOG IN PAGE

2. WELCOME BACK TRANSITION PAGE

3. PAGE RETURNING USERS LAST LEFT OFF

Welcome back [teacher’s first name], thanks for participating in our survey. Here are a few things to remember before you begin.

NEXT

(COMPLETED SURVEY)

[IF RESPONDENT ATTEMPTS TO LOGIN TO A COMPLETED SURVEY]

Our records indicate that you have finished your survey. Thank you for your participation; you do not need to login again.

If you think you are receiving this message in error, or have questions about the study, please call 1-855-500-1432 or send an email to [email protected] and include the contact information you were provided.

ALL

A00c.

How to Complete the Survey

Thank you for taking the time to complete this survey. Before you get started, here are a few helpful hints.

• Please record your answers by checking the box next to the appropriate answer or entering information as directed.

• Answer each question as accurately as possible; if you need to estimate an answer that is okay.

• Press the "Next" button to move forward.

• Press the "Previous" button to go back.

• The “Log out” link can be used to save your responses and finish later.

• To protect your answers, your responses will be automatically saved and you will be logged off if you are idle for more than 30 minutes.  

Please click on the “Next” button below to continue with the survey.

Welcome to the Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) Special Education Teacher/Service Provider Questionnaire. This is the information we have on record about your school and name.

School: [SCHOOL FILL]

Teacher: [TEACHER FILL]

SCREENER

aLL

7010100

A01. First we would like to ask you some questions about your current position or assignment. Which of the following best describes your current position in this school?

 Special education teacher 1

 Special education teacher consultant 2

 General education teacher 3

 Special education classroom aide/paraprofessional 4

 Speech - language pathologist 5

 Physical therapist 6

 Physical therapy assistant or aide 7

 Occupational therapist 8

 Occupational therapy assistant or aide 9

 School psychologist 10

 School counselor 11

 School social worker 12

 Other (please specify) 99

Specify (STRING ( default 255))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; Your responses are very important. Please answer as many questions as possible. Press “Edit” to return to this screen or press “Next” to continue.”

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

aLL

7010201

A02. How do you classify your main assignment at this school, that is, the activity at which you spend most of your time during this school year?

 Regular full-time teacher 1

 Regular full-time service provider 2

 Regular part-time teacher (at one school) 3

 Regular part-time service provider (at one school) 4

 Itinerant teacher (i.e., your assignment requires you to provide instruction/related services at more than one school) 5

 Itinerant related services consultant (e.g., speech and language therapist, social worker, psychologist, behavior specialist. Your assignment requires you to provide instruction/related services at more than one school). 6

 Long-term substitute 7

 Teacher aide or paraprofessional 8

 Other (please specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

PROGRAMMER BOX

If A01 = 4 OR A02 = 8, Go to SUBMIT2

ALL

SC00a.

Now we would like to ask some questions about each of your students who are participating in MGLS:2017. This section includes questions about individual student’s IEP and primary disability, special education services received, and goals and expectations. First, however, we would like you to confirm whether you do in fact teach (or provide services to) student(s) at your school who were selected to participate in MGLS:2017.

Press the "Next" button to proceed.

ALL

<<FILL STUDENT NAME>>

SC01. Have you served as the teacher or special education provider for [STUDENT NAME] at any point during this school year (2016-17)?

 Yes, and I am the current teacher or special education provider for [STUDENT NAME] 1 [SEE BELOW]

 Yes, although I am not currently the teacher or special education provider for [STUDENT NAME] 2 [SKIP TO SC01a]

 No 3 [SKIP TO SC02]

HARD CHECK: IF Q#=NO RESPONSE; Please provide an answer to this question and then click “Next.”

IF SC01=1 then do:

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding D01).

ELSE TEACHER IS INELIGIBLE; GOTO SUBMIT2.

SC01 = 2

<<FILL STUDENT NAME>>

RESPONSE OPTIONS WILL BE PRESENTED AS DROPDOWN LISTS.

SC01a. In what month and year did you last serve as the teacher or special education provider for [STUDENT NAME]?

• Month

• Year

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding D01).

ELSE TEACHER IS INELIGIBLE; GOTO SUBMIT2.

SC01 = 3

<<FILL STUDENT NAME>>

SC02. Has anyone else at your school served as the teacher or special education provider for [STUDENT NAME] at any point during this school year (2016-17)?

 Yes 1 [SKIP TO SC03]

 No 2 [SEE BELOW]

SOFT CHECK: IF Q#=NO RESPONSE; Your responses are very important. Please answer as many questions as possible. Press “Edit” to return to this screen or press “Next” to continue.”

IF SC02=1/YES THEN GO TO SC03.ELSE IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding D01).

ELSE TEACHER IS INELIGIBLE; GOTO SUBMIT2.

SC02=1 or M

<<FILL STUDENT NAME>>

SC03. What is the name of the teacher or special education provider for [STUDENT NAME]?

NAME

(STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; Your responses are very important. Please answer as many questions as possible. Press “Edit” to return to this screen or press “Next” to continue.”

PROGRAMMER BOX

IF SC01 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO SC01 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF SC01 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND SC01 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding D01).

ELSE TEACHER IS INELIGIBLE; GOTO SUBMIT2.

D. STUDENT INFORMATION

PROGRESS SUMMARY SCREEN

THIS SCREEN APPRISES THE RESPONDENT OF THEIR PROGRESS BY LISTING THE STUDENTS FOR WHOM THE RESPONDENT HAS ALREADY ANSWERED QUESTIONS (IF APPLICABLE), AS WELL AS THE REMAINING STUDENTS FOR WHOM THE RESPONDENT WILL STILL BE ASKED QUESTIONS.

We have additional questions for you about this/these students:

• [PRELOADED STUDENT 1 NAME]

• [PRELOADED STUDENT 2 NAME]

• [PRELOADED STUDENT 3 NAME]

GO TO D01.

SC01 in (1,2)

<<FILL STUDENT NAME>>

7040100

D01. The next questions are about [STUDENT NAME]'s IEP status and grade.

Is [STUDENT NAME] currently receiving gifted/talented services or has [STUDENT NAME] received such services during this school year?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SC01 in (1,2)

<<FILL STUDENT NAME>>

7040200

D02. Is [STUDENT NAME] currently receiving special education services through an IEP, due to a disability, or has [STUDENT NAME] received such services during this school year?

 Yes 1

 No 2

NO RESPONSE M

PROGRAMMER BOX

If D02 = 2 OR M, Go to CONFIRM

D02=1

<<FILL STUDENT NAME>>

D03. In what capacity or capacities do you teach or provide services to [STUDENT NAME]? Do you…

Select all that apply.

7040301	 a. Provide instruction directly to the student? 1
7040302	 b. Provide related services directly to the student? 2
7040303	 c. Provide consultation services directly to the student? 3
7040304	 d. Provide indirect consultation services (e.g., consultation to the student's teacher)? 4
7040305	 e. Provide case management? 5
7040306	 f. Other (please specify)? 99
	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

7040400

D04. In which grade is [STUDENT NAME] enrolled?

 Sixth grade 1

 This is an ungraded classroom 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7040500

D05. When did [STUDENT NAME] first have an IEP?

 Before sixth grade 1

 During sixth grade 2

 Don’t know d

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1 AND (D04 +1 > OR = D05)

D06. Is this [STUDENT NAME]'s first year enrolled at this school?

7040600

 Yes 1

 No 2 [SKIP TO D09]

 Don’t know d [SKIP TO D09]

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D06=1, M, go to D07; Else, skip to D09.

<<FILL STUDENT NAME>>

7040700

D07. To what extent were you involved in planning the transition from the previous school's special education program for [STUDENT NAME]?

 Not at all 1 [SKIP TO D09]

 Somewhat 2

 Extensively 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D07=2, 3, M

<<FILL STUDENT NAME>>

FILL HIS OR HER FROM SEX IN PRELOAD

7040800

D08. To what extent did you communicate with the person who provided special education for [STUDENT NAME] at [HIS/HER] previous school?

 Not at all 1

 Somewhat 2

 Extensively 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

If D05=1, go to FE0D09; Else, go to FE0E01.

<<FILL STUDENT NAME>>

7040900

D09. Have you reviewed [STUDENT NAME]’s records related to special education services provided before this school year?

 Yes 1

 No, I do not have access to the records 2

 No, I have access to the records, but have not reviewed them. 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

E. SERVICES RECEIVED

D02=1

<<FILL STUDENT NAME>>

<<FILL HE/SHE>>

FILL HIS OR HER FROM SEX IN PRELOAD

E01. Next we would like to know about this student’s disability and the services [HE/SHE] may receive.

For which of the following disabilities has [STUDENT NAME] received special education or related services this school year, whether for [HIS/HER] primary disability or another of [HIS/HER] disabilities?

Select all that apply.

7050101	 a. Speech or language impairment 1
7050102	 b. Specific learning disability 2
7050103	 c. Emotional disturbance 3
7050104	 d. Intellectual disability 4
7050105	 e. Visual impairment (including blindness) 5
7050106	 f. Hearing impairment (including deafness) 6
7050107	 g. Orthopedic impairment 7
7050112	 h. Other health impairment (specify: Please specify the other health impairment(s) for which the student receives services. ) 8
	(STRING (255 default))
7050108	 i. Autism 9
7050109	 j. Traumatic brain injury 10
7050110	 k. Deaf-blindness 11
7050111	 l. Multiple disabilities (students included in this category should be those who have more than one severe disability which does not include deaf-blindness) (specify: Please specify the other multiple disabilities for which the student receives services. ) (SPECIFY) 99
	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1; IF E01>1, GO TO E02; ELSE GO TO E03.

<<FILL STUDENT NAME>>

FILL HIS OR HER FROM SEX IN PRELOAD

7050200

E02. What is [STUDENT NAME]’s primary disability as identified on [HIS/HER] IEP?

 Speech or language impairment 1

 Specific learning disability 2

 Emotional disturbance 3

 Intellectual disability 4

 Visual impairment (including blindness) 5

 Hearing impairment (including deafness) 6

 Orthopedic impairment 7

 Other health impairment (please specify) 8

(STRING (255 default))

 Autism 9

 Traumatic brain injury 10

 Deaf-blindness 11

 Multiple disabilities (students included in this category should be those who have more than one primary disability which does not include deaf-blindness) 99

(please specify) (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “Please specify.”

D02=1

7050300

E03. Has [STUDENT NAME] received any special education or related services because of Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

E04. Consider the IEP goals for [STUDENT NAME] during this school yea

Select all of the areas in which this student has IEP goals.

.

Academics

7050402

7050419

 a. Reading 1

7050403

 b. Mathematics 2

 c. Language Arts 3

7050404

 d. Science 4

7050405

 e. Social Studies 5

Speech and Language

7050408

7050407

 f. Auditory processing 6

7050409

 g. Listening comprehension 7

7050410

 h. Oral expression 8

7050411

 i. Voice/speech articulation, quality, or fluency 9

 j. Language pragmatics 10

7050413

Social-Emotional

 k. Social skills 11

7050414

 l. Behavior regulation 12

7050415

 m. Emotional or mood regulation 13

Life Skills

7050417

 n. Adaptive behavior or self-help skills 14

7050418

 o. Transition and postsecondary goals 15

7050420

 p. Organizational and planning skills 16

Physical/Mobility

7050422

 q. Fine motor skills 17

7050423

 r. Gross motor skills 18

7050424

 s. Orientation and mobility 19

Other

7050425

 t. Other (Please specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

E05. Which of the following related services have been provided through the school to [STUDENT NAME] during this school year?

Select all that apply.

7050501	 a. Audiology 1
7050502	 b. Counseling services 2
7050503	 c. Occupational therapy 3
7050504	 d. Physical therapy 4
7050505	 e. Psychological services 5
7050506	 f. Health services 6
7050507	 g. Social work services 7
7050508	 h. Special transportation 8
7050509	 i. Speech or language therapy 9
7050510	 j. Orientation services 10
7050511	 k. Mobility services 11
7050512	 l. Rehabilitation services 12
7050513	 m. Other (please specify) 99
	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

E06. Has [STUDENT NAME] received any of the following?

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Yes	No
7050601	a. Adaptive physical education	1 	2 
7050602	b. Assistance from classroom aides or paraprofessionals (e.g., teacher aide, behavioral assistant, special education aide)	1 	2 
7050603	c. Interpreter for the deaf or hard of hearing (oral or sign)	1 	2 
7050604	d. Materials provided in Braille or Nemeth code to support learning/instruction	1 	2 
7050605	e. Student was taught how to use Braille and/or the Nemeth code	1 	2 
7050606	f. Instruction provided in American Sign Language	1 	2 
7050607	g. Student was taught how to use American Sign Language	1 	2 
7050608	h. Instruction provided in Manual English	1 	2 
7050609	i. Student was taught how to use Manual English	1 	2 
7050610	j. Instruction provided in Cued Speech	1 	2 
7050611	k. Student was taught how to use Cued Speech	1 	2 
7050612	l. Mental health services, personal/group counseling, therapy, or psychiatric care provided to the student	1 	2 
7050613	m. Tutoring/remediation from special education teacher	1 	2 
7050614	n. Training, counseling, and other supports/services provided to this student's family	1 	2 
7050615	o. Assistive technology	1 	2 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

F. INSTRUCTIONAL SETTINGS AND MATERIALS

D02=1

<<FILL STUDENT NAME>>

7060100

F01. Now we have a few questions about where and how this student receives instruction.

Which of the following best describes [STUDENT NAME]’s classroom placement?

 In general education classroom 80% of the time or more. 1

 In general education classroom 40% to 79% of the time. 2

 In general education classroom less than 40% of the time. 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7060201

F02A. In what setting does [STUDENT NAME] primarily receive mathematics instruction?

 General education classroom 1

 Special education classroom 2

 Resource room 3

 Some other setting (specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

7060202

F02AB. Does [STUDENT NAME] receive mathematics instruction in any additional setting or settings?

 Yes 1

 No 2 GO TO F03

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

F02AB=1

<<FILL STUDENT NAME>>

<<HIDE RESPONSE TO F02A>>

F02B. In what additional setting or settings does [STUDENT NAME] receive mathematics instruction?

Select all that apply.

7060203

7060204

 a. General education classroom 1

 b. Special education classroom 2

7060205

 c. Resource room 3

7060206

 d. Some other setting (specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

F03. On average, how many hours per week of direct special education and related services has [STUDENT NAME] received this school year?

7060300

Please include hours for any services in which you or another professional staff member at your school provided services directly to [STUDENT NAME], and also hours for any services [STUDENT NAME] received through a referral to another professional. Do not include paraprofessional services.

HOURS PER WEEK

(NUMBER RANGE ALLOW 0 – 70 AND UP TO ONE DECIMAL PLACE)

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

7060400

F04. Of the hours of direct special education and related services reported above, approximately how many of those hours per week were the instruction/services provided outside of a general education classroom but within the school setting?

HOURS PER WEEK

(NUMBER RANGE ALLOW 0 – 70 AND UP TO ONE DECIMAL PLACE)

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

HARD CHECK: IF F04>F03; Your answer is greater than the number of hours you reported in the previous question. Go back if you would like to change your answer to the previous question OR change your answer to this question, and then click “Next.”

D02=1

<<FILL STUDENT NAME>>

F05. What teaching practices and methods have you and/or other special education service providers used with [STUDENT NAME]?

Select all that apply.

7060501			a. One-on-one instruction 1
7060502			b. Small-group instruction 2
7060503			c. Large-group instruction 3
7060504			d. Cooperative learning 4
7060505			e. Peer tutoring 5
7060506			f. Computer-based instruction 6
7060507			g. Direct instruction 7
7060508			h. Cognitive strategies 8
7060509			i. Self-management 9
7060510			j. Behavior management 10
7060511			k. Instruction received through a sign interpreter 11
7060512			l. Video-based instruction 12
7060513			m. Audio-recorded texts or lessons 13
7060514			n. Use of visual organizers or visual models 14
7060515			o. Use of 3-dimensional materials and/or models (e.g., base ten blocks, fraction bars) 15
7060516			p. Student did not receive instruction from me and/or other special education service providers 16
SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.
SOFT CHECK: Please program so respondent can either select “STUDENT DID NOT RECEIVE INSTRUCTION FROM ME AND/OR OTHER SPECIAL EDUCATION SERVICE PROVIDERS” OR ANY OTHER RESPONSE CATEGORY BUT NOT BOTH.

D02=1; F02a=1 OR F02b=1

<<FILL STUDENT NAME>>

F06. Which of the following math curriculum materials were used with [STUDENT NAME] in the general education classroom?

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Yes	No	Don’t know
7060601	a. General education curriculum materials were used without modification	1 	2 	d 
7060602	b. General education curriculum materials were used with some modifications	1 	2 	d 
7060603	c. General education curriculum materials were used with substantial modifications	1 	2 	d 
7060604	d. Specially-designed commercial materials were used	1 	2 	d 
7060605	e. Teacher-designed materials were used	1 	2 	d 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

F07. Which of the following best describes the curriculum materials used with [STUDENT NAME] in the special education classroom/program?

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Yes	No	Don’t know
7060701	a. General education curriculum materials were used without modification	1 	2 	d 
7060702	b. General education curriculum materials were used with some modifications	1 	2 	d 
7060703	c. General education curriculum materials were used with substantial modifications	1 	2 	d 
7060704	d. Specially-designed commercial materials were used	1 	2 	d 
7060705	e. Teacher-designed materials were used	1 	2 	d 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

F08. Which of the following assistive technologies and devices has [STUDENT NAME] used this school year?

Select all that apply.

Mobility aids

7060801

 a. Vans, vehicles 1

7060802

 b. Wheelchairs 2

7060803

 c. White canes 3

Communication aids

7060804

 d. Electronic with voice output (e.g., Touch Talker) 4

7060805

 e. Nonelectronic (e.g., manual printing board or picture exchange system) 5

7060806

Hearing assistance

 f. Hearing aids 6

7060807

 g. FM loops 7

7060808

 h. TTYs/TDDs 8

7060809

 i. Cochlear implants 9

7060810

 j. Real time captioning 10

Visual aids

7060811

 k. Braille texts 11

7060813

7060812

 l. Electronic Braille devices 12

 m. Digital texts 13

7060814

 m. Magnifying devices 14

7060815

 o. Closed Captioned Television (CCTV) 15

7060816

 p. Screen readers 16

7060817

 q. Talking calculators 17

7060818

 r. Abacus 18

Learning aids

7060819

 s. Tape recorder or digital recorder 19

7060820

 t. Calculators 20

7060821

 u. Electronic spelling devices 21

7060822

 v. Dictation software 22

Computer hardware designed or adapted for students with disabilities (e.g., alternate keyboards, switch interface)

7060823

 w. Used solely by individual student 23

7060824

 x. Shared with other students 24

Computer software designed for students with disabilities

7060826

7060825

7060100

 y. Reading 25

 z. Writing 26

7060827

 aa. Mathematics 27

Other

7060829

 ab. Other (please specify) 99

Specify (STRING (255 default))

7060828

Student did not use any assistive technologies

 ac. Student did not use any assistive technologies 28

 ad. Don’t know

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “Please specify.”

PROGRAMMER BOX:

Please program so respondent can either select “STUDENT DID NOT USE ANY ASSISTIVE TECHNOLOGIES” or any other response category but not both.

D02=1

<<FILL STUDENT NAME>>

FILL HIM OR HER FROM SEX IN PRELOAD

7060900

F09. Does [STUDENT NAME] have a computer, laptop, tablet, or word processing device assigned to [HIM/HER] for use full time?

 Yes 1

 No 2

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

G. Communication with teachers and parents

D02=1

<<FILL STUDENT NAME>>

7070100

G01. The following questions ask about your communications with others regarding this student.

On average, how often have you met with general education teacher(s) to discuss [STUDENT NAME]’s IEP or progress during this school year?

 Every day or several times a week 1

 Once a week or several times a month 2

 Once a month 3

 A few times over the school year 4

 Once during this school year 5

 Never during this school year 6 [SKIP TO G03]

 Not applicable to my work with this student 7 [SKIP TO G03]

 Not applicable as student receives all instruction from me 8 [SKIP TO G03]

NO RESPONSE M [SKIP TO G03]

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

G01=1, 2, 3, 4, 5

<<FILL STUDENT NAME>>

7070200

G02. On average, how long were the meetings with the general education teacher(s) to discuss [STUDENT NAME]’s IEP or progress?

 1 to 15 minutes 1

 16 to 30 minutes 2

 31 to 45 minutes 3

 46 to 60 minutes 4

 More than 60 minutes 5

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7070300

G03. Approximately how often have you communicated with [STUDENT NAME]’s parents during this school year about [STUDENT NAME]’s IEP or progress (by phone, in person, or in writing, including email)?

 Every day or several times a week 1

 Once a week or several times a month 2

 Once a month 3

 A few times over the school year 4

 Once during this school year 5

 Never during this school year 6

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

H. GOALS AND EXPECTATIONS

D02=1

<<FILL STUDENT NAME>>

H01. During this school year, has [STUDENT NAME] received formal individual evaluations in any of the following areas for purposes of developing IEP goals?

Select all that apply.

7080101	 a. Psychological 1
7080102	 b. Social work services 2
7080103	 c. Behavioral 3
7080104	 d. Speech/language 4
7080105	 e. Vision 5
7080106	 f. Hearing 6
7080107	 g. Learning style 7
7080108	 h. Motor skills 8
7080109	 i. Academics 9
7080110	 j. Other (please specify) 99
	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

D02=1

<<FILL STUDENT NAME>>

FILL: HIS OR HER FROM SEX IN PRELOAD

7080200

H02. To what extent is [STUDENT NAME] expected to achieve the same general education goals as other students at [HIS/HER] grade level?

 Student is expected to attain grade level achievement for all of the academic content standards. 1

 Student is expected to attain grade level achievement for some of the academic content standards. 2

 Student is expected to attain grade level achievement for only a few of the academic content standards. 3

 Student is not expected to attain grade level achievement for any of the academic content standards. 4

 Don’t know d

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7080400

H04. Which of the following best expresses the likelihood that [STUDENT NAME] will continue to receive some level of special education services (through an IEP) in the next school year?

 Definitely will continue in special education 1

 Very likely to continue in special education 2

 Rather likely to continue in special education 3

 Rather unlikely to continue in special education 4

 Very unlikely to continue in special education 5

 Definitely will not continue in special education (will be dismissed from services) 6

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7080500

H05. To what extent has [STUDENT NAME] participated in any grade-level assessment administered as part of the school’s testing program during the current school year?

 Student did not participate in the school’s testing or assessment program. 1

 Student participated in alternate assessments and no regular assessments. 2

 Student participated in some alternate assessments and some regular assessments. 3

 Student participated fully in the school’s regular testing or assessment program. 4

 There is no testing or assessment program at this grade level. 5

 Don’t know d

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7080600

H06A. Overall, at what grade level is [STUDENT NAME] performing in language and literacy skills?

 Preschool to Grade 2 1

 Grade 3 2

 Grade 4 3

 Grade 5 4

 Grade 6 5

 Grade 7 6

 Grade 8 7

 Grade 9 8

 Grade 10 or higher 9

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

D02=1

<<FILL STUDENT NAME>>

7080601

H06B. Overall, at what grade level is [STUDENT NAME] performing in mathematical skills?

 Preschool to Grade 2 1

 Grade 3 2

 Grade 4 3

 Grade 5 4

 Grade 6 5

 Grade 7 6

 Grade 8 7

 Grade 9 8

 Grade 10 or higher 9

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

<<FILL STUDENT SEX = his or her>>

A00. Thank you for answering our questions about the services [FILL STUDENT NAME] receives!

The next set of questions asks you to please rate [FILL STUDENT NAME]’s reading and mathematics skills as well as [his/her] functional abilities.

All

<<FILL STUDENT SEX = him or her>>

A00a. Please rate the student's skills, knowledge, and behaviors based on your experience with [him/her]. This is NOT a test and should not be administered directly to the student.

Each question includes examples that are meant to help you think of the range of situations in which the student may demonstrate the skills and behaviors. The examples are not exhaustive, but they do indicate the level of proficiency a student should have reached in order to receive the highest ratings.

It may be necessary to consider adaptations for some questions to make them more inclusive for this student's skills and/or use of adaptive equipment. For example, if a student utilizes alternative forms of verbal communication (e.g., sign language, communication boards) or written communication (e.g., word processors, Braille, dictation), please answer the questions with these adaptations in mind.

Each skill, knowledge, or behavior is rated on a five-point scale:

1 Not yet = Student has not yet demonstrated skill, knowledge, or behavior

2 Beginning = Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently

3 In progress = Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence

4 Intermediate = Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient

5 Proficient = Student demonstrates skill, knowledge, or behavior competently and consistently

For students with Limited English Proficiency or English language learners: Please answer the questions based on your knowledge of this student's skills. If the student does not yet demonstrate skills in English but does demonstrate them in his/her native language, please answer the questions with the student's native language in mind. You can also consult with the student’s English language learner teacher or general education teacher to answer any question. If you feel you cannot answer any question, you will also have the option to indicate you are “unable to assess the student.”

I. READING SKILLS AND ABILITIES

all

<<FILL STUDENT NAME>>

FILL HIM OR HER FROM SEX IN PRELOAD

FILL HIS OR HER FROM SEX IN PRELOAD

7090400

I04. In this section, please rate [STUDENT NAME]’s reading-related abilities, including language, literacy, and listening comprehension skills. Let’s begin.

[STUDENT NAME] shows basic comprehension of a story or text read aloud to [him/her}. For example, by retelling a story just read to the group, or telling about why a story ended as it did, or connecting part of the story to [his/her} own life.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

7090700

I07. [STUDENT NAME] reads words with regular vowel sounds. For example, reads “coat,” “junk,” “lent,” “chimp,” “halt,” or “bite.”

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

7090800

I08. [STUDENT NAME] reads words with irregular vowel sounds. For example, reads "through," "point," "enough," or "shower."

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

FILL STUDENT SEX = him or her AND he or she

7090500

I05. [STUDENT NAME] shows advanced comprehension of text read aloud to {him/her}. For example, identifies the author’s purpose, or relates how the story would be different if told from another point of view, or identifies techniques of persuasion.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

7090300

I03. [STUDENT NAME] conveys ideas clearly when speaking. For example, presents a well-organized oral report, or uses precise language to express opinions, feelings, and ideas, or provides relevant answers to questions that summarize classmates’ concerns.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE;see earlier programmer note.

aLL

<<FILL STUDENT NAME>>

7090600

I06. [STUDENT NAME] uses different strategies to read unfamiliar words. For example, examines cues from pictures or context, or uses consonant sounds to read words, or uses prior knowledge in order to make predictions.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

FILL STUDENT GRADE FROM I04; IF I04 = ungraded or missing, fill “grade 6” for OFT and first round of the National study. In subsequent rounds of data collection, the fill should reflect the grade for the majority of students.

7091000

I10. [STUDENT NAME] reads grade [enter grade level] books independently with comprehension. For example, reads most words correctly and answers questions about what was read, makes predictions while reading, and retells the story after reading.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

FILL STUDENT GRADE FROM I04; IF I04 = ungraded or missing, fill “grade 6” for OFT and first round of the National study. In subsequent rounds of data collection, the fill should reflect the grade for the majority of students.

7090900

I09. [STUDENT NAME] reads grade {STUDENT GRADE FILL} books fluently. For example, easily reads words in meaningful phrases rather than reading word by word.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

all

<<FILL STUDENT NAME>>

FILL: HE OR SHE FROM SEX IN PRELOAD

7091100

I11. [STUDENT NAME] reads and comprehends expository text. For example, after reading about how early colonists lived, creates a chart comparing life today with colonial life, or after reading a news story about pollution, [HE/SHE] identifies cause and effect relationships, or summarizes main ideas and the supporting details in a science or social studies selection.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7090200

I02. [STUDENT NAME] contributes relevant information to classroom discussions. For example, during a class discussion, can express an idea or a personal opinion on a topic and the reasons behind the opinion.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7090100

I01.

[STUDENT NAME] uses complex sentence structures. For example, says "If she had brought her umbrella, she wouldn't have gotten wet," or "Yesterday it was raining cats and dogs," or "Why can't we go on the field trip after we finish the assignment that you gave us last week?"

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

J. MATHEMATICS SKILLS AND ABILITIES

ALL

<<FILL STUDENT NAME>>

Now we would like to know about this student's mathematics skills and abilities.

7100300

J03. [STUDENT NAME] shows an understanding of the relationship between quantities. For example, knows that a group of ten small stones is the same quantity as a group of ten larger blocks.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100200

J02. [STUDENT NAME] creates and extends patterns. For example, extends an alternating pattern involving addition and subtraction (+3, -1, +3, -1, +3... or +5, -3, +5, -3,... ) or creates a complex visual pattern (aabc).

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER: (+3, -1, +3, -1, +3… or +5, -3, +5, -3,…) should start at beginning of second line, so that the full pattern is on the same line.

ALL

<<FILL STUDENT NAME>>

7100100

J01. [STUDENT NAME] sorts, classifies, and compares math materials by various rules and attributes. For example, by creating a rule for sorting keys, such as "keys with numbers" in one pile and "keys without numbers" in another pile, or by sorting shapes by several attributes such as "large plastic shapes" and "small wooden shapes."

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100900

J09. [STUDENT NAME] solves problems involving numbers using concrete objects. For example, "Vera has six blocks, George has three, how many blocks are there in all?" or "How many do I need to give George so he will have the same number of blocks as Vera?"

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100400

J04. [STUDENT NAME] demonstrates an understanding of place value to 100. For example, by explaining that fourteen is ten plus four, or using two stacks of ten and five single cubes to represent the number 25.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7101100

J11. [STUDENT NAME] subtracts numbers that require regrouping. For example, 1300 - 579, or 2302 - 947, or 2603 - 1594.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100500

J05. [STUDENT NAME] shows understanding of place value with whole numbers to 100,000. For example, correctly orders the numbers 19,321, 14,999, 9,900, and 20,101 from least to greatest, or correctly regroups when adding and subtracting.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100700

J07. [STUDENT NAME] models, reads, writes, and compares fractions. For example, shows that ½ of the candy bar is ¼ + ¼, or shows that ¼ of 12 is 3.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7100800

J08. [STUDENT NAME] reduces fractions to lowest denominator. For example, reduces 27/63 to 3/7, or 41/6 to 6 5/6.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7101200

J12. [STUDENT NAME] divides a 3-digit number by a 1-digit number. For example, 348÷4 or 228÷6.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

71006000

J06. [STUDENT NAME] shows understanding of place values with decimals. For example, compares decimals to the thousandths place (1.04 > 1.009).

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER: (1.04 > 1.009) should appear on the same line.

ALL

<<FILL STUDENT NAME>>

7101300

J13. [STUDENT NAME] divides multi-digit problems with remainders in the quotient. For example, computes 536÷30 or 6135÷7.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7101000

J10. [STUDENT NAME] uses a variety of strategies to solve math problems. For example, using manipulative materials, using trial and error, making an organized list or table, drawing a diagram, looking for a pattern, acting out a problem, or talking with others.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

FILL HIM OR HER FROM SEX IN PRELOAD

7101400

J14. [STUDENT NAME] demonstrates algebraic thinking. For example, solves for an unknown in an equation such as 16 x A = 48; or expresses a function as a general rule that enables [him/her] to determine any term in the sequence.

 Not yet-Student has not yet demonstrated skill, knowledge, or behavior 1

 Beginning-Student is just beginning to demonstrate skill, knowledge, or behavior but does so very inconsistently 2

 In progress- Student demonstrates skill, knowledge, or behavior with some regularity but varies in level of competence 3

 Intermediate-Student demonstrates skill, knowledge, or behavior with increasing regularity and average competence but is not completely proficient 4

 Proficient-Student demonstrates skill, knowledge, or behavior competently and consistently 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

K. FUNCTIONAL SKILLS AND ABILITIES

ALL

<<FILL STUDENT NAME>>

The next few questions ask about this student's functional abilities.

7110100

K01. Which of the following best describes [STUDENT NAME]’s expressive communication?

 Uses symbolic language to communicate: Student uses verbal or written words, signs, Braille, or language-based augmentative systems to request, initiate, and respond to questions, describe things or events, and express refusal 1

 Uses intentional communication, but not at a symbolic language level: Student uses understandable communication through such modes as gestures, pictures, objects/textures, points, etc., to clearly express a variety of intentions. 2

 Student communicates primarily through cries, facial expressions, change in muscle tone, etc., but no clear use of objects/textures, regularized gestures, pictures, signs, etc., to communicate. 3

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7110200

K02. Does [STUDENT NAME] use an augmentative communication system in addition to or in place of oral speech?

 Yes 1

 No 2

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7110300

K03. Which of the following best describes [STUDENT NAME]’s vision?

 Vision appears to be within normal limits 1

 Corrected vision within normal limits 2

 Low vision; uses vision for some activities of daily living 3

 No functional use of vision for activities of daily living, or unable to determine functional use of vision 4

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7110400

K04. Which of the following best describes [STUDENT NAME]’s hearing?

 Hearing appears to be within normal limits 1

 Corrected hearing loss within normal limits 2

 Hearing loss aided, but still with a significant loss 3

 Profound loss, even with aids 4

 Unable to determine functional use of hearing 5

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7110500

K05. Which of the following best describes [STUDENT NAME]’s motor abilities?

 No significant motor dysfunction that requires adaptations 1

 Requires adaptations to support motor functioning (e.g., walker, adapted utensils, and/or keyboard) 2

 Uses wheelchair, positioning equipment, and/or assistive devices for most activities 3

 Needs personal assistance for most/all motor activities 4

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

ALL

<<FILL STUDENT NAME>>

7110600

K06. Which of the following best describes [STUDENT NAME]’s social interactions?

 Initiates and sustains social interactions 1

 Responds with social interaction, but does not initiate or sustain social interactions 2

 Alerts to others 3

 Does not alert to others 4

NO RESPONSE M

I am unable to assess the student 6

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER BOX

IF STUDENT-SPECIFIC QUESTIONS HAVE BEEN ADMINISTERED FOR EACH STUDENT WHERE SC01 in (1,2), THEN GO TO A03.

ELSE LOOP BACK TO THE PROGRESS SUMMARY SCREEN (immediately preceding D01) TO ADMINISTER STUDENT-SPECIFIC QUESTIONS FOR THE NEXT STUDENT WHERE SC01 in (1,2).

A. YOUR TEACHING ASSIGNMENT AND YOUR SCHOOL

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7010300

A03. You have completed the portion of the survey about your students that are in the study. Thank you.

Now we have some questions about you and your instructional practices.

Do you coteach with another teacher or professional educator?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

IF A03 = 2 OR M, GO TO A05

{A03=1}

7010401

A04. Which of the following models best describes your current coteaching arrangement?

 One teach, one drift (one teacher leads the class and the other moves throughout the classroom to make sure everyone is on track). 1

 Station teaching (class divided into two or more stations; each teacher spends at least half of the period with one group, and then teachers switch). 2

 Alternative teaching (one teacher teaches the large group and the other teacher works with a smaller group of students to reteach any necessary information). 3

 Parallel teaching (both teachers are teaching at the same time, and both lead discussion; class may be divided into groups). 4

 Team teaching (both coteachers balance the responsibilities of the class in such a way that both teach the same amount in front of the classroom). 5

 Other (please specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

A05. During this school year, where have you worked with students with IEPs?

	Select all that apply.
7010501	 a. In a general education classroom 1
7010502	 b. In a special education classroom 2
7010503	 c. In a nonclassroom space (e.g. office, therapy room, small work space, mobile van, etc.) 3
7010504	 d. Other (please specify) 99
	(STRING (255 default))
7010505	 e. I do not work directly with students who have IEPs 4

NO RESPONSE……………………………………………………………..M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “Please specify.”

PROGRAMMER BOX:

Please program so respondent can either select “I DO NOT WORK DIRECTLY WITH STUDENTS WHO HAVE IEPS” or any other response category but not both.

[{IF A01 IS 1 or 2}

7010700

A07A. Do you teach academic content to students who have IEPs?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF A07a = 1 }]

A07B. When teaching academic content to students who have IEPs, how often do you use each of the following instructional strategies?

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Never	Once a month or less	Two or three times a month	Once or twice a week	Three or four times a week	Every day
7010710	a. Provide students with background knowledge and skills	1 	2 	3 	4 	5 	6 
7010711	b. Provide practice for prescribed strategies	1 	2 	3 	4 	5 	6 
7010712	c. Incorporate systematic cumulative reviews of skills and information	1 	2 	3 	4 	5 	6 
7010713	d. Include self-regulation strategies that promote on-task thinking and hard work	1 	2 	3 	4 	5 	6 
7010714	e. Explicitly teach for transfer of skills and strategies	1 	2 	3 	4 	5 	6 
7010715	f. Use validated forms of progress monitoring of student responsiveness to the instruction or intervention	1 	2 	3 	4 	5 	6 
7010716	g. Apply validated decision-making rules with progress monitoring tools to determine when to revise the program	1 	2 	3 	4 	5 	6 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER BOX FOR A07B

HYPERLINK THE WORDS “validated forms of progress monitoring” AND “validated decision-making rules” FOR A07B QUESTION TEXT WITH EACH HYPERLINK CONTAINING ONLY ITS CORRESPONDING DEFINITION

Validated forms of progress monitoring are tools and methods that have been found by research to relate to student performance on more in depth assessments and student outcomes. Validated decision-making rules have been tested by researchers and found to reliably indicate when a change is needed.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}

7010600

A06. Do you teach mathematics to students who have IEPs?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

If FE0A06=1, go to FE0A07;

Else, go to FE0A07C.

A07. When teaching mathematics to students who have IEPs, how often do you use each of the following instructional strategies?

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Never	Once a month or less	Two or three times a month	Once or twice a week	Three or four times a week	Every day
7010701	a. Have students discuss different ways to solve a problem	1 	2 	3 	4 	5 	6 
7010702	b. Have students generate new strategies	1 	2 	3 	4 	5 	6 
7010703	c. Have students work on an investigation, problem or project over an extended period of time	1 	2 	3 	4 	5 	6 
7010704	d. Have students solve problems using multiple methods	1 	2 	3 	4 	5 	6 
7010705	e. Begin instructional units with worked examples (explaining how work is completed, step by step, and what you think as you complete each step)	1 	2 	3 	4 	5 	6 
7010706	f. Teach the most efficient solution strategy using simple, direct language	1 	2 	3 	4 	5 	6 
7010707	g. Have students explain solutions in their own words	1 	2 	3 	4 	5 	6 
7010708	h. Have students practice solution strategies that you taught	1 	2 	3 	4 	5 	6 
7010709	i. Have students explain how taught strategies are efficient	1 	2 	3 	4 	5 	6 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF A01 IS 1 or 2}

A07C. When teaching transition and life skills, how often do you use the following instructional strategies:

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Never	Once a month or less	Two or three times a month	Once or twice a week	Three or four times a week	Every day
7010721	a. Time delay (e.g., constant, progressive)	1 	2 	3 	4 	5 	6 
7010722	b. Computer-assisted instruction	1 	2 	3 	4 	5 	6 
7010723	c. Community-based instruction	1 	2 	3 	4 	5 	6 
7010724	d. Video modeling	1 	2 	3 	4 	5 	6 
7010725	e. Prompting strategies	1 	2 	3 	4 	5 	6 
7010726	f. Mnemonic strategies	1 	2 	3 	4 	5 	6 
7010727	g. One-more-than (next dollar strategy)	1 	2 	3 	4 	5 	6 
7010728	h. Peer-mediated instruction	1 	2 	3 	4 	5 	6 
7010729	i. Visual displays	1 	2 	3 	4 	5 	6 
7010730	j. Self-management (self-monitoring, self-instruction)	1 	2 	3 	4 	5 	6 

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

A08. Please indicate the extent to which you agree or disagree with each of the following statements on teaching.

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
7010801	a. I really enjoy my present job.	1 	2 	3 	4 	5 
7010802	b. I am certain I am making a difference in the lives of the students I work with.	1 	2 	3 	4 	5 
7010803	c. If I could start over, I would choose this career again.	1 	2 	3 	4 	5 
7010804	d. I am satisfied with my class size/caseload.	1 	2 	3 	4 	5 
7010805	e. I worry about the security of my job because of the performance of the students in my class(es) on state or local tests.	1 	2 	3 	4 	5 
7010806	f. I get frustrated working with general education teachers.	1 	2 	3 	4 	5 
7010807	g. I plan to continue to teach special education for at least the next five years.	1 	2 	3 	4 	5 
7010808	h. The amount of paperwork that I need to complete for my students takes away from my ability to deliver high quality instruction.	1 	2 	3 	4 	5 
SOFT CHECK: IF Q#=NO RESPONSE; see previous programmer note

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

A08A. Please indicate the extent to which you agree or disagree with each of the following statements:

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
7010821	a. I have a team of professionals who support my work with students	1 	2 	3 	4 	5 
7010822	b. I have regular meetings with consultants	1 	2 	3 	4 	5 
7010823	c. I often feel isolated in my school	1 	2 	3 	4 	5 

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

A08B. Please indicate the extent to which you agree or disagree with each of the following statements:

PROGRAMMER: CODE ONE PER ROW

Select one per row.

		Strongly disagree	Disagree	Neither disagree nor agree	Agree	Strongly agree
7010831	a. I have adequate planning time.	1 	2 	3 	4 	5 
7010832	b. I meet regularly with other special education professionals about how to meet the needs of the students that I serve.	1 	2 	3 	4 	5 
7010833	c. I have adequate support from my colleagues.	1 	2 	3 	4 	5 
7010834	d. It is difficult to motivate general education teachers to invest in the strategies that will help my students.	1 	2 	3 	4 	5 
7010835	e. I check in every week with the general education teachers who are teaching my students.	1 	2 	3 	4 	5 
7010836	f. The school supports inclusion in general education classrooms by accommodating the needs of special education students.	1 	2 	3 	4 	5 

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7010900

A09. During this school year, how many students with IEPs have you worked with or provided services for, on average, each week?

Include students you work with directly, as well as students for whom you consult with the general education teacher and/or another special education teacher/service provider.

 1-10 1

 11-20 2

 21-40 3

 More than 40 4

 Don’t know D

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see previous programmer note

B. BACKGROUND AND EDUCATION

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

B01. The next several questions ask about your background and education.

7020100

What is your sex?

 Male 1

 Female 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see previous programmer note

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7020200

B02. In what year were you born?

YEAR BORN

PROGRAMMER: CHANGE THIS TO A DROP DOWN BOX WITH 1925 – 1997 ONLY YEARS LISTED

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see previous programmer note

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7020300

B03. Are you of Hispanic or Latino/Latina origin?

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER BOX B03

HYPERLINK THE WORDS “Hispanic or Latino/Latina” FOR B03 QUESTION TEXT:

Hispanic or Latino/Latina: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultures or origin (or descent), regardless of race.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

B04. Which of the following best describes your race?

Select all that apply.

7020402

7020401

 a. White 1

 b. Black or African American 2

7020403

 c. Asian 3

7020405

7020404

 d. Native Hawaiian or other Pacific Islander 4

 e. American Indian or Alaska Native 5

NO RESPONSE M

PROGRAMMER BOX BO4

HYPERLINK EACH OF THE RESPONSE OPTIONS OF B04 WITH EACH HYPERLINK CONTAINING ONLY ITS CORRESPONDING DEFINITION:

White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American: a person having origins in any of the black racial groups of Africa.

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.

Native Hawaiian or other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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.

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7020500

B05. What is the highest level of education you have completed?

 Did not complete high school 1

 High school diploma or equivalent/GED 2

 Some college or technical or vocational school 3

 Associate's degree 4

 Bachelor's degree 5

 Master's degree 6

 Advanced professional degree beyond a master's degree (for example, Ph.D., Ed.D.) 7

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

B06. Which of the following credentials, licenses, or certificates do you have for working with students with disabilities?

7020601

Select all that apply.

 a. Emergency credential 1

7020609

7020603

7020602

7020613

7020606

7020611

 b. Provisional or temporary credential 2

 c. Disability-specific credential or endorsement 3

7020604

 d. Special education credential or endorsement (for more than one disability category) 4

7020605

 e. General education credential 5

 f. Speech/language therapy state license or certification 6

7020607

 g. Physical therapy state license or certification 7

7020608

 h. Occupational therapy state license or certification 8

 i. Social work license or certification 9

7020610

 j. School psychology license or certification 10

 k. Clinical psychology license or certification 11

7020612

 l. Certificate of Clinical Competence 12

 m. Other professional license, credential, or endorsement (please specify) 13

Please specify (STRING 255 default)

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “Please specify.”

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7020700

B07. Which of the following describes the teaching certificate you currently hold?

 Regular or standard state certificate or advanced professional certificate 1

 Certificate issued after satisfying all requirements except the completion of a probationary teaching period 2

 Certificate that requires some additional coursework or passing a test 3

 Certificate issued to persons who must complete a certification program in order to continue teaching 4

 I do not hold any of these certifications 5

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

{B07=1, 2, 3, 4}

B08. In what subject(s) are you certified?

7020810

7020802

7020801

7020803

7020804

Select all that apply.

 a. Early childhood or Pre-K, general 1

 b. Elementary grades, general 2

 c. Middle grades, general 3

 d. Secondary grades, general 4

7020805

 e. Special education, general 5

7020806

 f. Specific area of disability (for example, autism, learning disabilities, etc.) 6

Please Specify (STRING (255 default))

7020807

 g. Instruction for English Language Learners (e.g., English for Speakers of Other Languages or bilingual education: general) 7

7020808

 h. Instruction for English Language Learners (e.g., English for Speakers of Other Languages or bilingual education: Spanish) 8

7020809

 i. Instruction for English Language Learners (e.g., English for Speakers of Other Languages or bilingual education: other) 9

 j. English/Language arts 10

7020811

 k. Reading 11

7020813

7020812

 l. Speech 12

 m. Mathematics 13

7020814

 n. Science (including general science, biology or life sciences, earth science, and other natural sciences) 14

7020815

 o. Social studies (including history, government or civics, geography) 15

7020816

 p. Social or behavioral science (including psychology, sociology, anthropology, and other social sciences) 16

7020817

 q. Other (please specify) 99

Please Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “Please specify.”

[{IF A01 IS NOT 4} and {A02 IS NOT 8}

B09. Have you received any training related to Response to Intervention (RTI) from any of the following sources?

7020902

7020901

Select all that apply.

 a. College courses 1

7020903

 b. Professional development 2

 c. Personal reading and study 3

7020905

7020904

 d. I have not received any training on issues related to Response to Intervention 4

 e. Other training (please specify) 99

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “Please specify.”

PROGRAMMER BOX B09

Please program so respondent can either select “I HAVE NOT RECEIVED ANY TRAINING ON ISSUES RELATED TO RESPONSE TO INTERVENTION” OR ANY OTHER RESPONSE CATEGORY BUT NOT BOTH

C. PROFESSIONAL EXPERIENCE

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7030300

C03. Next, we would like to ask about your years of experience. Counting this school year, how many total years (including part-time) have you been working with any students in any school? This would include both providing special education services as well as teaching in a regular classroom.

Enter the number of years.

If you have been working for less than one year, enter 1.

YEARS WORKED WITH STUDENTS

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF C03 <1 or C03 > 45; Just to confirm, you answered [C03] YEARS WORKED WITH STUDENTS. Press “Edit” to return to this screen or press “Next” to continue.

SOFT CHECK: IF Q#=NO RESPONSE: see earlier programmer note.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7030200

C02. Counting this school year, how many total years (including part-time) have you been working with students receiving special education or related services in any school?

Enter the number of years.

If you have been working for less than one year, enter 1.

YEARS WORKED WITH SPECIAL EDUCATION STUDENTS

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF C02 <1 or C02 > 45; Just to confirm, you answered [C02] YEARS WORKED WITH SPECIAL EDUCATION STUDENTS. Press “Edit” to return to this screen or press “Next” to continue.

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

HARD CHECK: If C03 < C02; Your total years working with any students ([C03]) is inconsistent with the number of years you have worked with special education students ([C02]). Please change your response to this question or go back and change your response for years worked with any students.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7030400

C04. Counting this school year, how many years of experience do you have teaching general education math classes to students (in any grades 6-12)?

Enter the number of years.

If you have been working for less than one year, enter 1.

YEARS WORKED TEACHING MATH 6-12

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF C04 <1 or C04 > 45; Just to confirm, you answered [C04] YEARS WORKED TEACHING MATH 6-12. Press “Edit” to return to this screen or press “Next” to continue.

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

HARD CHECK: If C03 < C04; Your total years working with any students ([C03]) is inconsistent with the number of years you have taught math ([C04]). Please change your response to this question or go back and change your response for years worked with any students.

[{IF A01 IS NOT 4} and {A02 IS NOT 8}]

7030100

C01.

Counting this school year, how many years have you worked in your current school, including part time?

Enter the number of years.

If you have been working for less than one year, enter 1.

YEARS WORKED IN CURRENT SCHOOL

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF C01 <1 or C01 > 45 Just to confirm, you answered [C01] YEARS WORKED IN CURRENT SCHOOL. Press “Edit” to return to this screen or press “Next” to continue.

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

HARD CHECK: If C03 < C01; Your total years working with any students ([C03]) is inconsistent with the number of years you have worked in your current school ([C01]). Please change your response to this question or go back and change your response for years worked with any students.

ALL

INCENTADDR. To show our appreciation for completing the survey today, we would like to send you a [FILL CHECK AMOUNT] check. Please provide the address to which you would like the check mailed.

(Allow 4 weeks for delivery.)

Name:

Street Address:

ZIP Code:

City:

State:

END1. Thank you for taking the time to answer our questions! Since we had some inaccurate information, we will send you a new user name and password with the updated information you provided.

That is all we have for you today. Click “End” to finish.

PROGRAMMER: SURVEY SHOULD CLOSE DOWN AND NOT PROCEED TO THANK YOU/SUBMIT PAGE. PROGRAM AN “END” BUTTON ON THE SCREEN: The button will finalize answers and close down the interface in which the survey was displayed.

PROGRAMMER: END1 should NOT have a header.

LOOP SCREEN: CONFIRM

CONFIRM. You have completed the questions for [STUDENT]. Thank you very much!

Please click the “Next” button to confirm you have finished rating [STUDENT]. If you want to make changes or review your responses, click the “Previous” button.

END:

You have completed the survey for all of your students that are in the study.

These are all the questions we have for you. We appreciate you taking the time to complete the survey.
Thank you very much for participating in MGLS:2017!
Press "Finish" to complete and close the survey.

Appendix OFT1-U5. School Administrator Survey Specifications

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 40 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

A. INTRO

All

A01a. You have received an invitation to complete this questionnaire because you are an administrator in one of the schools participating in the MGLS:2017 field test.

To enhance the information we obtain from your students, their parents, and teachers we need your input. We are asking you to report on the characteristics and population of students in your school, courses offered, security measures, teachers, and your own personal background.

Taking part in the study is voluntary and you can skip questions you do not want to answer. We realize you are very busy, but urge you to complete this questionnaire as completely and accurately as possible.

Your answers are very important to the study’s success.

Please select an option below and then click Next.

Let's get started.

 Continue 1 A01b

 Come back later 2

HARD CHECK: IF A01a= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOX A01a

if A01a = 2 “COME BACK LATER”, Please logout the respondent. the RESPONDENT should be able to log back in.

A01a = 1

A01b. Thank you very much for participating! Gathering the following information in advance will help you complete the questionnaire more quickly:

1. For the current school year:

• Average daily attendance

• Math curriculum information

• Matriculation information

• Student body demographic information, including the number of students in sixth grade who are:

• Receiving free or reduced price lunch

• English language learners

• Alternative program attendees

• Students with disabilities/Individualized Education Program (IEP)

• Students in each racial/ethnic category

• School personnel counts such as the:

• Number of teachers by subject taught

• Number of security personnel

2. For the 2015-16 school year:

• Average state assessment scores by subject for sixth-graders

• Programs, services, and supports available for students with IEPs and the percentage of students who use them

Press Next to continue.

PROGRAMMER BOx A01b

Please add AN INFORMATION ICON to the bullet “English language learners” that links to the help text below:

English language learners (ELL): Students whose native language is one other than English and whose skills in listening, speaking, reading, or writing English are such that he or she has difficulty understanding school instruction in English.

Please add AN INFORMATION ICON to the bullet text “individualized education program (iep)” that links to the help text below:

Individualized Education Program (IEP): A written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

All

A01c. How to Complete the Survey:

• Please record your answers by checking the box next to the appropriate answer or entering information as directed. Answer each question as accurately as possible; if you need to estimate an answer that is okay.

• Press the “Next” button to move forward.

• Press the "Previous" button to go back.

• To jump to another section, click on the desired section in the progress bar at the top of the screen. You will be taken to the first question in the section.

• The progress bar is color coded to indicate if a section has not been viewed (white), is in progress (gray), partially completed (teal), or completed (green).

• Some questions have help text available. If you see an information icon [insert image

of icon] there is help text available. Click the icon to see the help text.

• The “Log out” button can be used to save your responses and finish later.

• In order to save your responses, you must press the "Next" button. To protect your answers, you will be logged off if you are idle for more than 20 minutes.

Press Next to begin.

ALL

A01d. Please select the box next to the grade level(s) offered at your school.

Select all that apply.

8010101

8010102

 a. Pre-K 1

8010103

 b. Kindergarten 2

8010104

 c. Grade 1 3

8010105

 d. Grade 2 4

8010106

 e. Grade 3 5

8010107

 f. Grade 4 6

8010108

 g. Grade 5 7

8010109

 h. Grade 6 8

8010110

 i. Grade 7 9

8010111

 j. Grade 8 10

8010112

 k. Grade 9 11

 l. Grade 10 12

8010113

 m. Grade 11 13

8010115

8010114

 n. Grade 12 14

 o. Ungraded 15

A01d = 8

8010201

A02a. Please confirm that you are a person at this school who is knowledgeable about sixth-grade students, teachers, programs, and services.

 Yes 1 A03

 No 2 A02c

HARD CHECK: IF A02a= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOx A02a

Only respondents indicating at least grade 6 (A01d = 8) are eligible for this item, regardless of what other middle grade may be available at the school

A01d NE 8

A02b. Please confirm that your school does not offer a sixth grade.

8010202

 My school does not offer a sixth grade 1 END1

 My school does offer a sixth grade. 0 A01d

HARD CHECK: IF A01a= NO RESPONSE; Please provide an answer to this question and then click Next.

A02A = 2

A02c. Please provide the name and contact information for a person at your school who is knowledgeable about sixth-grade students, teachers, programs, and services. They will be notified to complete the survey.

First Name: (STRING 50)

Last Name: (STRING 50)

Title: (STRING 50)

Phone: (STRING 10)

Email: (STRING 50)

SOFT CHECK: IF A02c= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOx A02c

PLEASE VALIDATE PHONE NUMBER BY AREA CODE AND EXCHANGE NUMBER.

PLEASE VALIDATE EMAIL ADDRESS.

A02a=2

If text entered at A02c, fill TITLE, FIRST NAME, and LAST NAME

A02d. Thank you! The MGLS:2017 team will be in touch with [TITLE] [FIRST NAME] [LAST NAME] very soon.

Press Next to close this survey.

PROGRAMMER BOX a02d

PROGRAM A “next” BUTTON ON THE SCREEN. The button will close down the interface in which the survey was displayed. EXIT SURVEY.

A02a = 1

A03. What is your title or position at this school?

8010300

Select the one that best describes you.

 Principal/Administrator 1 B01

 Vice Principal 2 B01

 Counselor 3 B01

 School administrative personnel 4 B01

 Other (Please specify) 99 B01

Specify (STRING 250)

SOFT CHECK: IF A03= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOX a03

If “other” is selected and no response is entered in the text box, please use a Soft check with the following text:

Please specify your title or position at this school.

B. SCHOOL CHARACTERISTICS

all

The following questions ask about characteristics of your school.

B01. Which of the following best describes your school?

8020100

 Regular public school 1 B02

 Public school that has a magnet program for some of the students 2 B02

 Public school that is exclusively a magnet school 3 B02

 Charter school 4 B02

 Private school 5 B02

 Other (Please specify) 99 B02

Specify (STRING 250)

PROGRAMMER BOX B01

If “other” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please describe your school.

All

8020300

B02. What is the Average Daily Attendance (ADA) for your school this year? Please report as a number or a percent.

(NUMBER OF STUDENTS RANGE 0-9999) (PERCENT OF STUDENTS RANGE 0-100)

 Number of students 1 B03

 Percent of students 2 B03

SOFT CHECK: IF A NUMERICAL RESPONSE IS ENTERED AND NO UNIT IS SELECTED; Please indicate if your answer is a number or percent, then click Next to move on. To skip the question, click the Next button.

B01=5 OR 99

8020400

B03. What is the maximum yearly tuition to attend your school? Enter "0" if school does not charge tuition.

(RANGE 0-50000)

B03 > 0

B04. What percentage of your students pay the maximum yearly tuition?

8020500

 0 – 25 percent 1 B05

 26 - 50 percent 2 B05

 51 - 75 percent 3 B05

 76 - 100 percent 4 B05

B01=5 OR 99

The next set of questions is about your student population.

B05. Please indicate the percentages of students at your school that are male and female.

PROGRAMMER: RANGE FOR GRID IS 0-100

8020602

8020601

	Percent male students
	Percent female students

SOFT CHECK: IF PERCENT MALE + PERCENT FEMALE NE 99,100, or 101; Please make sure your answers add to 100 percent.

All

B06. What percentage of the total student body in your school…

8020703

8020702

8020701

PROGRAMMER: RANGE FOR GRID IS 0-100

	Percentage
Receives free or reduced-price lunch?	percent
Are English language learners (ELL)?	percent
Are enrolled in an alternative program either at your school or off-site?	percent

PROGRAMMER box b06

Do not allow nonnumeric response for this item (i.e., alphabetic or symbol responses).

Range of percentages can be 0-100.

PLEASE ADD AN INFORMATION ICON TO THE ROW HEADER“English language learners (ell)” that links TO THE HELP TEXT BELOW:

English language learners (ELL): Students whose native language is one other than English and whose skills in listening, speaking, reading, or writing English are such that he or she has difficulty understanding school instruction in English.

All

These next questions only ask about sixth grade at your school.

B07. What type of daily schedule is typically used for the sixth-grade level at your school?

8020201100

 Self-contained classrooms 1 B08

 Daily periods uniform in length 2 B08

 Daily periods of varying length 3 B08

 Flexible schedule for teams 4 B08

 Other (Please specify) 99 B08

Specify (STRING 250)

PROGRAMMER BOX B07

If “other” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please describe the daily schedule for the sixth grade.

Other (Please specify)

(STRING 8000)

All

The next set of questions asks about additional supports your school provides for struggling students.

B08. Which of the following steps does this school take for sixth-grade students who need extra assistance?

8020801

Select all that apply.

 a. The school provides tutoring during the regular school day 1 B09

8020802

 b. The school provides extra assistance to classroom teachers by school staff 2 B09

8020803

 c. The school provides pull-out instruction during the regular school day 3 B09

8020804

 d. The school provides a homework assistance program to students 4 B09

8020805

 e. The school provides additional support outside the regular school day 5 B09

8020806

 f. The school takes other steps to assist struggling students 6 B09

(Please specify) (STRING 8000)

8020807

 g. The school does not have any programs for students who need extra assistance 7 B09

PROGRAMMER box B08

Please add an information icon next to “additional support outside the regular school day” that LINKs TO THE HELP TEXT BELOW:

By additional support outside the regular school day we mean, for example, before school or afterschool tutoring or special programs, weekend programs, or summer school programs.

IF “School does not have any programs for students who need extra assistance” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

Please program so respondent can NOt select the response option “your school does not have any programs for students who need extra Assistance” if other Responses are selected. if “your school does not have any programs for students who need extra Assistance” is selected, then do not allow other response options to be checked and Deselect all previously selected responses.

If “School takes other steps to assist struggling students” is selected and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other steps taken to assist struggling students.

All

B09. Does your school offer any of the following programs to assist sixth-grade students who are struggling academically?

Select all that apply.

8020901

 a. Summer program prior to entry into the next grade that provides supplemental instruction in reading and math 1 B10

8020902

 b. Small learning communities for over‐aged students who have not met promotion criteria 2 B10

8020903

 c. Small sixth-grade learning communities separate from the rest of the school 3 B10

8020904

 d. Block scheduling, also called double‐block or extended‐block scheduling, for struggling sixth-graders 4 B10

8020905

 e. Catch‐up courses or “double‐dosing” of classes 5 B10

8020907

8020906

 f. Specific professional development, coaches, or technical assistance for teachers working with struggling sixth-graders 6 B10

 g. Tutoring 7 B10

8020908

 h. Another program (Please specify) 8 B10

(STRING 8000)

8020909

 i. There are no programs to assist sixth graders who are struggling academically. 9 B10

PROGRAMMER box B09

IF “There are no programs to assist sixth-grade students who are struggling academically” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

Please program so respondent can NOt select the response option “There are no programs to assist sixth-grade students who are struggling academically” if other Responses are selected. if “There are no programs to assist [sixth-]grade students who are struggling academically” is selected, then do not allow other response options to be checked and Deselect all previously selected responses.

If “Another Program” is selected and no response is entered in the text box, please Use a Soft check with the following text:

:

Please specify another program offered to assist students who are struggling academically.

B01 NE 5

The next set of items is about state assessment scores.

B10-B12.Based on 2015-16 state assessments, please indicate the percentage(s) of sixth-grade students in your school who scored at or above "proficient" in the following subjects.

8021001

 Check this box if your school was not required to take the state assessment because it does not accept Title I funds 1 B13

	Percentage of students at or above “proficient”
Grade 6 students
a. Reading or verbal skills	8021002 percent
b. Mathematics	8021004 percent
PROGRAMMER BOX B10-B12 Range of percent can be 0-100. Please program so that no other responses can be selected if “Check this box if your school was not required to take the state assessment because it does not accept Title I funds” is checked. If it is checked please deselect all previous responses.

All

The next set of questions is about instructional programs at your school.

B13-B15.Approximately what percentage(s) of your sixth-grade students are in each of the following instructional programs?

If the program is available but no students currently receive it, enter 0 for that program.

	Percentage of students	Check here if program is not available
Grade 6 students
a. Programs that focus on developing students’ literacy solely in English	8021301 percent	8021302 
b. Programs that focus on developing students’ literacy in two languages	8021303 percent	8021304 
c. Special education	8021305 percent	8021306 

PROGRAMMER BOX B13–B15

grade level should be 6.

Range of percent can be 0-100.

PLEASE add AN INFORMATION ICON to the row header “Special education” that links TO THE HELP TEXT BELOW:

By special education we mean programs in which the student receives services with an Individualized Education Program (IEP). An Individualized Education Program (IEP) is a written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

Please program so respondent can either enter a percentage or check the “Service not available” box, but not both answers. if the respondent enters a response and checks the box, the following CONSISTENcy check should pop up:

You selected “Service not available” and entered in a percentage greater than 0. This creates conflicting information. Please change your response(s) to be consistent.

C. SUPPORTS FOR STUDENTS

All

The next set of questions asks about Individualized Education Program (IEP) placement options.

C01. What percentage of students with IEPs at your school are served by each of the following placement options?

If the service is available but no students currently receive it, enter 0 for that service.

If the service is not available at your school, check the column labeled "Service not available."

PROGRAMMER: RANGE FOR GRID IS 0 -100

	Percentage of students with IEPs	Service not available
a. General education with services or supports	8030101 percent	8030102 
b. Classes co-taught by general and special education teachers	8030103 percent	8030104 
c. Part-time resource room for special education students	8030105 percent	8030106 
d. Self-contained special education classrooms	8030107 percent	8030108 
e. Individual instruction such as home school or a residential, off site, incarceration or hospital program	8030109 percent	8030110 
f. Other (Please specify)	8030111 percent	8030112 

Specify (STRING 8000)

PROGRAMMER BOX C01

Range of percent can be 0-100.

PLEASE add AN INFORMATION ICON the question texT “individualized education program (iep)” that links TO THE HELP TEXT BELOW:

Individualized Education Program (IEP): A written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

PLEASE add AN INFORMATION ICON to the row header “Special education” that links TO THE HELP TEXT BELOW:

By special education we mean programs in which the student receives services with an Individualized Education Program (IEP). An Individualized Education Program (IEP) is a written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

By co-taught we mean, for example, when both the teacher and special education teacher (or related services provider) are in the classroom together, but trade off instruction.

Please program so respondent can either enter a percentage or check the “Service not available” box, but not both answers. If the “Service not available” box is selected, please gray out percentage box and remove any percentage entered.

If “other (Please specify)” is selected and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other placement options for students with IEPs.

All

The next questions are about services and supports schools can offer to teachers of students with IEPs.

C02. Are the following available to general education teachers in this school when students with IEPs are included in their classes?

8030201

 Check this box if students with IEPs are not included in general education classrooms at your school 1 C03

Select one answer for each row.	Yes	No
8030202 a. Consultation with or technical assistance from special education or other staff with general special education training, not specific to child's disability	1 	2 
8030203 b. Special equipment or materials	1 	2 
8030204 c. Professional development	1 	2 
8030205 d. Teacher aides, instructional assistants, paraprofessionals, or aides for individual students	1 	2 
8030206 e. Smaller student load or class size	1 	2 
8030207 f. Co-teaching with a special education teacher or related services provider	1 	2 
8030208 g. Team teaching with a special education teacher or related services provider	1 	2 
8030209 h. Team planning	1 	2 
8030210 i. Other (Please specify)	1 	2 

Specify (STRING 8000)

PROGRAMMER BOX C02

C02a-c02i should not be able to be answered if the box for “Check this box if students with IEPs are not included in general education classrooms at your school” is checked. please skip to c03.

IF “Check this box if students with IEPs are not included in general education classrooms at your school” is checked, then deselect any previously selected responses.

PLEASE add AN INFORMATION ICON NEXT to the text in the row header “special education or other staff” that links TO THE HELP TEXT BELOW:

By special education or other staff we mean, for example, a school psychologist or teacher trained in a related disability area.

PLEASE ADD AND INFORMATION ICON TO the row header “Co-teaching” THAT LINKS TO THE HELP TEXT BELOW:

By co-teaching we mean, for example, when both the teacher and special education teacher (or related services provider) are in the classroom together, but tradeoff instruction.

PLEASE ADD AN INFORMATION ICON TO THE ROW HEADER“team teaching” that links TO THE HELP TEXT BELOW:

By team teaching we mean, for example, when both teachers are NOT in classroom together, but alternate instruction and are responsible for teaching the same set of students.

PLEASE add a information icon to the question text “Iep” that links TO THE HELP TEXT BELOW:

Individualized Education Program (IEP): A written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

If “other (Please specify)” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other services and supports your school offers to teachers of students with IEPs.

All

The next questions are about programs and supports schools can offer to students with IEPs.

C03. For each of the following programs and supports, please indicate what percentage of students with IEPs in your school receive this program or support during the current school year. Please include programs provided by alternate service providers.

If a program or support is available but no students currently receive it, enter 0 in the “Percentage of students with IEPs” column.

If a program and supports are not available at your school, check the box in the "Program and supports not available" column.

PROGRAMMER: RANGE FOR GRID IS 0-100

	Percentage of students with IEPs	Program and supports not available
a. Referrals to vocational rehabilitation services	8030301 percent	8030302 
b. Help developing capability to dress, clean, care for self	8030303 percent	8030304 
c. Learning self-determination and self-advocacy skills	8030305 percent	8030306 
d. Peer buddy program	8030307 percent	8030308 
e. Alternative placements for students who are expelled and/or suspended	8030309 percent	8030310 
f. Helping students connect to outside transition services, supports, and activities	8030311 percent	8030312 
g. Helping students connect to adult residential providers and day services	8030313 percent	8030314 
h. Information bank for parents or guardians with materials and resources relating to independent living	8030315 percent	8030316 
i. Instruction for parents or guardians on youth’s rights and responsibilities under disability-related laws	8030317 percent	8030318 
j. Other (Please specify)	8030319 percent	8030320 

(STRING 8000)

PROGRAMMER BOX C03

RANGE OF PERCENT CAN BE 0-100.

PLEASE add an information icon to the row header “Helping students connect to outside transition services, supports, and activities” that links TO THE HELP TEXT BELOW:

By helping students connect to outside transition services, supports, and activities we mean, for example, tutoring, mentoring, transportation, assistive technology, and networking.

PLEASE add an information icon to the question text “Iep” THAT LINKS TO THE HELP TEXT BELOW:

Individualized Education Program (IEP): A written statement of the educational program designed to meet the individual needs of a school-aged child with a disability that is judged to affect the child’s educational performance. Children who receive special education services under the Individuals with Disabilities Education Act (IDEA) are expected to have an IEP.

Please program so respondent can either enter a percentage or check the “Program or Service not available” box, but not both answers. If the “program or Service not available” box is selected, please gray out percentage box and remove any percentage entered.

You selected “Program or service not available” and entered in a percentage greater than 0. This creates conflicting information. Please change your response(s) to be consistent.

If “other (Please specify)” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other programs and supports your school offers to students with IEPs.

D. SCHOOL PROGRAMS

all

The following questions ask about programs and practices aimed at serving all students at your school.

D01. Does your school use interdisciplinary team teaching in sixth grade?

8040101

 Yes 1 D02

 No 2 D08

NO RESPONSE M D08

PROGRAMMER BOX D01

PLEASE add an information icon to the question text “interdisciplinary team teaching” THAT LINKS to the help text below:

By interdisciplinary team teaching we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

if D01 = 2 (no) or m (no response) (i.e., interdisciplinary team teaching is not used in grade 6, skip respondent to D08.

D01 = 1

8040102

D02. When did your school begin using interdisciplinary team teaching in sixth grade?

 Before 2008-09 01 D03

 2009-10 02 D03

 2010-11 03 D03

 2011-12 04 D03

 2012-13 05 D03

 2013-14 06 D03

 2014-15 07 D03

 2015-16 08 D03

 Current school year 09 D03

 Don’t know 10 D03

PROGRAMMER BOX D02

PLEASE add an information icon to the question text “interdisciplinary team teaching” that linksto the help text below:

By interdisciplinary team teaching or interdisciplinary teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

D01 = 1

D03. For sixth grade , please indicate the number of interdisciplinary teams, average number of teachers per team, and average number of students per team. Your best estimate is fine.

	a. Number of interdisciplinary teams		b. Average number of teachers per team			c. Average number of students per team
8040301	Teams…	8040302		Teachers…	8040303		Students…

PROGRAMMER BOX D03

PLEASE add an information icon to the question text “interdisciplinary teams” that links to the help text below:

By interdisciplinary team teaching or interdisciplinary teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

Please add an information icon to the question text “teacher” that links to the help text below:

Please include full-time and part-time teachers in your counts of average number of teachers per interdisciplinary team. If a teacher teaches across teams, please count that person as one teacher for each team.

Please program dropdown box for number of interdisciplinary teams to have the default as “teams…” with the following options (note, do not include “1.” these are just for classification purposes):

1. 1

2. 2

3. 3

4. 4

5. 5 or more

Please program dropdown box for number of teacher to have the default as “teachers…” with the following options (note, do not include “1.” these are just for classification purposes):

1. 2

2. 3

3. 4

4. 5

5. 6

6. 7 or more

Please program dropdown box for number of students to have the default as “students…” with the following options (note, do not include “1.” these are just for classification purposes):

1. Less than 60

2. 61-90

3. 91-120

4. 121-150

5. 151-180

6. 181-210

7. 211 or more

D01 = 1

D04. Please indicate whether the following subject areas are part of your typical interdisciplinary teaching team for sixth grade by checking the box.

		Select all that apply on each row.
8040413		English/Language arts
8040414		Mathematics
8040415		Science
8040416		Social studies/civics
8040417		Health
8040418		Art
8040419		Music
8040420		Technology/computer science
8040421		Foreign language
8040422		Physical education (P.E.)
8040423		Special education
8040424		Other (Please specify)

Specify (STRING 250)

PROGRAMMER BOX d04

PLEASE add an information icon to the question text “interdisciplinary teaching teams” that links to the help text below:

By interdisciplinary team teaching or interdisciplinary teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

Please add an information icon to the row text “Other (Please specify)” that links to the help text below:

If there are other subject areas typically part of your interdisciplinary teaching team, please describe the other subject areas in the text box provided.

If “other” is selected and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other subject areas that are part of your typical interdisciplinary teaching team.

D01 = 1

D05. For sixth grade, on average, how much common planning time is regularly scheduled each week for interdisciplinary teaching teams? Your best estimate is fine.

Select one answer.	Average common planning time per week	Don’t know
8040501	Please select…	8040502 

PROGRAMMER BOX D05

PLEASE add an information icon to the question text “interdisciplinary teaching teams” that linksto the help text below:

By interdisciplinary team teaching or interdisciplinary teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

Please program dropdown box to have the default as “please select…” with the following options (note, do not include “1.” these are just for classification purposes):

1. None

2. Less than 30 minutes

3. 30-60 minutes

4. 61-120 minutes

5. 121-180 minutes

6. More than 180 minutes

Please program so respondent can either select from dropdown or check the “don’t know” box, but not both answers. if the respondent selects and answer and checks the box, the following SOFT check should pop up:

You selected an amount of time and checked “Don’t know”. Please only choose one or the other. If you are unsure of the exact amount of time, your best estimate if fine.

D05a>= 2

D06. In a typical common planning time period for an interdisciplinary teaching team, how often do you estimate teachers engage in the following activities? Your best estimate is fine.

Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
8040601 Teachers collaboratively develop or revise curriculum.	1 	2 	3 	4 	5 
8040602 Teachers work collaboratively to coordinate and/or develop assignments.	1 	2 	3 	4 	5 
8040603 Teachers work collaboratively to coordinate and/or develop assessments.	1 	2 	3 	4 	5 
8040604 Teachers discuss individual students (e.g., issues accomplishments, problems).	1 	2 	3 	4 	5 
8040605 Teachers discuss activities related to parent involvement or communicate with parents.	1 	2 	3 	4 	5 
8040606 Teachers decide common themes and related topics for instruction.	1 	2 	3 	4 	5 
8040607 Teachers arrange assemblies, trips, or other team activities.	1 	2 	3 	4 	5 
8040608 Teachers work on their own lessons, tests, grades, etc.	1 	2 	3 	4 	5 
8040609 Other (Please specify)	1 	2 	3 	4 	5 

Specify (STRING 8000)

PROGRAMMER BOX D06

PLEASE add an information icon to the question text “interdisciplinary teaching team” that links to the help text below:

By interdisciplinary team teaching or interdisciplinary teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

Please add an information icon to the row text “Other (Please specify)” that links to the help text below:

If there are other activities that your interdisciplinary teaching team typically engages in, please indicate how often they engage in it, and describe the other activities in the text box provided.

If “other” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other activities teachers engage in during a typical common planning time period for an interdisciplinary teaching team.

D01a = 1

D07. Please indicate the extent to which you agree or disagree with each of the following statements regarding the interdisciplinary teaching teams at your school.

Select one answer for each row.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
8040701 Teachers are sufficiently trained in the team approach	1 	2 	3 	4 	5 
8040702 Teachers identify with the team	1 	2 	3 	4 	5 
8040703 Teachers collaborate and provide professional support	1 	2 	3 	4 	5 
8040704 Teachers use integrated curriculum across subjects	1 	2 	3 	4 	5 
8040705 The school schedule has flexibility to regroup students or vary time for different subjects	1 	2 	3 	4 	5 
8040706 Students identify with the team	1 	2 	3 	4 	5 
8040707 Individual student problems are recognized quickly	1 	2 	3 	4 	5 

PROGRAMMER BOX D07

PLEASE ADD AN INFORMATION ICON TO the question text “interdisciplinary teaching team teaching” THAT LINKS TO THE help text below:

By interdisciplinary teaching teams we mean a group of two or more teachers from different subject areas who have a common group of students and who work together to coordinate and integrate curriculum and instruction on a regular basis.

all

D08. Please indicate whether the following programs or practices have never been used, are currently used, are not currently used but have been in the past, or are not currently being used but will likely be implemented in the future at your school.

Select one answer for each row.	Never been used	Currently used	Used in the past, no longer in use	Not currently used, plan to use in future
8040801 Minimum competency tests for promotion to next grade	1 	2 	3 	4 
8040802 Common academic curriculum for all students in the same grade	1 	2 	3 	4 
8040803 Classes organized for cooperative learning	1 	2 	3 	4 
8040804 Exploratory mini courses for all students in all grades	1 	2 	3 	4 
8040805 Students from more than one grade level assigned together to the same academic classes	1 	2 	3 	4 
8040806 Information on how to help children with homework and skills provided to parents	1 	2 	3 	4 
8040807 Extracurricular activities for all students	1 	2 	3 	
8040808 Schools-within-a-school with their own administrative staffs	1 	2 	3 	4 

all

D09. The following questions are about math courses at your school.

Which of the following math courses are offered to sixth graders by your school?

Select one answer for each row.	Yes, offered in a traditional classroom setting	Yes, offered at a neighboring school	Yes, offered virtually	No, the course is not offered
8040902 a. Remedial math	1 	2 	3 	4 
8040903 b. General math	1 	2 	3 	4 
8040904 c. Honors math	1 	2 	3 	4 
Other math
8040914 d. Introduction to Algebra/Prealgebra	1 	2 	3 	4 
8040915 e. Algebra 1, part 1	1 	2 	3 	4 
8040916 f. Algebra 1, part 2	1 	2 	3 	4 
8040917 g. Algebra I	1 	2 	3 	4 
8040918 h. Algebra II	1 	2 	3 	4 
8040919 i. Geometry	1 	2 	3 	4 
8040920 j. Trigonometry	1 	2 	3 	4 
8040921 k. Precalculus	1 	2 	3 	4 
8040922 l. Calculus	1 	2 	3 	4 
8040923 m. Other (Please specify)	1 	2 	3 	4 

Specify (STRING 250)

SOFT CHECK: IF D09a-m = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

PROGRAMMER box d09

IF d09 = no response skip to d11

if all rows =4 skip to d11

please gray out other specify box is do9m = 4

If D09m= 1, 2, or 3 and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other math courses offered by your school.

If any row in d09 = 1, 2, or 3

[D09mOS] INSERT TEXT FROM D090S

D10. Are there enough slots available for the following course or courses so that sixth-grade students who have the necessary prerequisites and interest can enroll?

Select one answer for each row.	Yes	No
8041001 a. Remedial math	1 	2 
8041002 b. General math	1 	2 
8041003 c. Honors math	1 	2 
Other math
8041010 d. Introduction to Algebra/Prealgebra	1 	2 
8041011 e. Algebra 1, part 1	1 	2 
8041012 f. Algebra 1, part 2	1 	2 
8041013 g. Algebra I	1 	2 
8041014 h. Algebra II	1 	2 
8041015 i. Geometry	1 	2 
8041016 j. Trigonometry	1 	2 
8041017 k. Precalculus	1 	2 
8041018 l. Calculus	1 	2 
8041019 m. [D09OS]	1 	2 

PROGRAMMER Box D10

PLEASE note: table should be populated based on responses to D09. if D09a-m = 1, 2 or, 3, then the corresponding row should appear in this table, otherwise row should be removed.

please note: despite subselection of rows from D09 table, all lettering should remain the same, rather than being adjusted to reflect the subset of math courses that may have been selected.

Please populate M with text from D09os.

A01d = 8

D11. Please estimate the percentage of sixth-grade students repeating the level of mathematics they took in fifth grade.

8041100

If your school uses a semester or block course system, please indicate the percentage of sixth-grade students repeating the last course section they took in fifth grade.

 Less than 1 percent 1

 1 - 5 percent 2

 6 - 10 percent 3

 11 - 25 percent 4

 More than 25 percent 5

 Students are not grouped by ability 6

 Do not know 7

A01d = 8

8041300

D13. Please estimate the percentage of students demoted to a previous level in mathematics between sixth and seventh grade.

 Less than 1 percent 1

 1 - 5 percent 2

 6 - 10 percent 3

 11 - 25 percent 4

 More than 25 percent 5

 Students are not grouped by ability 6

 Do not know 7

ALL

D15a. Thinking about students who are performing below grade level in math, what is the sequence of courses they would take starting in sixth grade?

8041504

8041503

8041502

8041501

Grade 6	Grade 7	Grade 8	Grade 9
Select course…	Select course…	Select course…	Select course…

PROGRAMMER BOX D15A

“SelEct course…” is a dropdown menu that will list all mathematics courses offered by the school and all courses under “other math” category including respondent specified courses. in addition the option “not sure” should be added at the end of the list

if all rows in D09=4 OR D09 = No Response, then skip D15a.

if all rows D09 = No Response, please program the following soft check to appear at the beginning of the question:

Please go back and complete item D09 before answering this item. To skip the question, click the Next button.

If no response if provided after soft check is triggered at d15a, then skip to d17.

ALL

D15b. Thinking about students who are performing at grade level in math, what is the sequence of courses they would take starting in sixth grade?

8041508

8041507

8041506

8041505

8041508

8041507

8041506

8041505

Grade 6	Grade 7	Grade 8	Grade 9
Select course…	Select course…	Select course…	Select course…

PROGRAMMER BOX D15b

“SelEct course…” is a dropdown menu that will list all mathematics courses offered by the school and all courses under “other math” category including respondent specified courses. in addition the option “not sure” should be added at the end of the list

if all rows in D09=4 D09 = No Response, then skip D15B.

ALL

D15c. Thinking about students who are performing above grade level in math, what is the sequence of courses they would take starting in sixth grade?

8041512

8041511

8041510

8041509

Grade 6		Grade 7	Grade 8		Grade 9
Select course…		Select course…	Select course…		Select course…
	PROGRAMMER BOX D15c “SelEct course…” is a dropdown menu that will list all mathematics courses offered by the school and all courses under “other math” category including respondent specified courses. in addition the option “not sure” should be added at the end of the list if all rows in D09=4 D09 = No Response, then skip D15c.

A01d = 8

D17. The next questions are about courses other than math at your school.

Approximately what percentage of your sixth-grade students are in each of the following instructional programs?

	Percentage of sixth-grade students	Instructional program not available at this grade
a. Reading instruction for students performing below grade level in reading	8041701 percent	8041702 
b. Additional instruction for students performing below grade level in other areas of English language arts	8041703 percent	8041704 
c. Instruction for students performing below grade level in mathematics	8041705 percent	8041706 
d. Gifted and talented or International Baccalaureate® (IB)	8041707 percent	8041708 

PROGRAMMER BOX D17

RANGE OF PERCENT CAN BE 0 – 100.

Please program so respondent can either enter a percentage or check the “Instructional program not available” box, but not both answers. IF “Instructional program not available at this grade” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

All

The next questions are about assisting students in the transition from one grade to the next.

D20. Does your school organize the transition from fifth grade to sixth grade in any of the following ways?

Select all that apply

8042001  a. Sixth-grade students share information with the fifth-grade students 1 D21

8042002  b. Fifth-grade students visit an assembly of sixth-grade students 2 D21

8042003  c. Fifth-grade students attend regular sixth grade courses 3 D21

8042004  d. Buddy programs that pair new students with an older student in the fall 4 D21

8042005  e. Parents visit the school or sixth-grade section while students are still in fifth-grade 5 D21

8042006  f. Parents can attend an orientation in the fall after students start sixth grade 6 D21

8042007  g. Meetings for fifth-grade students during the summer prior to beginning the sixth grade 7 D21

8042008  h. Sixth-grade and fifth-grade teachers meet together on courses and requirements 8 D21

8042009  i. sixth-grade and fifth-grade administrators meet together on articulation and programs 9 D21

8042010  j. Fifth-grade counselors meet with sixth-grade counselors or staff 10 D21

8042011  k. Sixth-grade counselors meet with students while they are still in fifth-grade 11 D21

8042012  l. Sixth-grade counselors meet with individual fifth-grade students and assist them with selecting sixth-gradecourses while they are still in fifth grade 12 D21

8042013  m. Fifth-grade counselors present information to fifth-grade students’ parents or guardians about sixth-grade courses and registration 13 D21

8042014  n. Fifth-grade counselors place fifth-grade students into sixth-grade courses based on school or district placement policies 14 D21

8042015  o. Fifth-grade counselors present information to fifth-grade students about sixth-grade courses and registration 15 D21

8042016  p. No special activities until students enter sixth grade 16 D21

8042017  q. Other (Please specify.) 99 D21

Specify (STRING 8000)

8042018  r. No transition – sixth grade seamlessly continues directly from fifth grade 17 D21

PROGRAMMER BOX D20

PLEASE note: first autofill [AF1] in the question stem is determined by the lowest grade level offered by school provided at a01d . Second autofill [AF2] in the question stem is determined by the lowest grade level offered by school of the three grade levels provided in the fill plus one (E.G. if lowest grade offered is sixth grade, then second autofill is seventh grade)

Please note: once AF1 and AF2 are determined for the question stem, those values should be used for each subsequent occurrence of [af1] and [af2] appear in the text of the item.

Please note: for the oft, af1=fifth grade and af2=sixth grade

Please add an information icon next to “counselor” that LINKs TO THE HELP TEXT BELOW:

A counselor is an educator who works in schools to provide academic, career, college readiness, and personal/social competencies to all students through a school counseling program.

If “other” is selected and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other ways your school organizes the transition from [AF1] grade to [AF2] grade.

IF “No transition – [AF2] grade seamlessly continues directly from [AF1] grade” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

D21. Does your school provide additional assistance with the transition from fifth grade to sixth grade for students with disabilities?

8042100

 Yes 1 D22

(STRING 8000)

 No. 2 D22

PROGRAMMER BOX D21

PLEASE note: first autofill (AF1) and Second autofill (AF2) are same as D20.

If “Yes” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other ways your school organizes the transition from [AF1] grade to [AF2] grade.

all

D22. Does your school organize the transition from sixth grade to seventh grade in any of the following ways?

Select all that apply.

8042203

 a. Seventh-grade students share information with the sixth-grade students 3 D23

8042204

 b. Sixth -grade students visit an assembly of seventh- grade students 4 D23

8042205

 c. Sixth -grade students attend regular seventh-grade courses 5 D23

8042206

 d. Buddy programs that pair new students with an older student in the fall 6 D23

8042207

 e. Parents visit the school or seventh-grade section while students are still in sixth grade 7 D23

8042208

 f. Parents can attend an orientation in the fall after students start seventh grade 8 D23

8042209

 g. Meetings for sixth -grade students during the summer prior to beginning the seventh grade 9 D23

8042210

 h. Seventh-grade and sixth-grade teachers meet together on courses and requirements 10 D23

8042211

 i. Seventh-grade and sixth-grade administrators meet together on articulation and programs 11 D23

8042212

 j. Sixth -grade counselors meet with seventh-grade counselors or staff 12 D23

8042214

8042213

 k. Seventh -grade counselors meet with students while they are still in sixth grade 13 D23

 l. Seventh-grade counselors meet with individual sixth -grade students and assist them with selecting seventh-grade courses while they are still in sixth grade 14 D23

8042215

 m. Sixth-grade counselors present information to sixth -grade students’ parents or guardians about seventh-grade courses and registration 15 D23

8042216

 n. Sixth-grade counselors place sixth-grade students into seventh-grade courses based on school or district placement policies 16 D23

8042217

o. Sixth-grade counselors present information to sixth -grade students about seventh-grade courses and registration 17 D23

8042202

 p. No special activities until students enter seventh grade 2 D23

8042218

 q. Other (Please specify.) 99 D23

Specify (STRING 8000)

8042201

 r. No transition— seventh grade seamlessly continues directly from sixth grade 1 D23

PROGRAMMER Box d22

PLEASE note: first autofill [AF3] in the question stem is selected by HIGHEST grade level offered by school of at A01d. Second autofill [AF4] in the question stem is determined as the value from first autofill plus 1 (e.g., if highest grade offered by school is eighth grade, then the [AF3] autofill is “Eighth” and the second autofill [af4] autofill is “ninth”).

Please note: once AF3 and AF4 are determined for the question stem, those values should be used for each subsequent occurrence of [AF3] and [AF4] appear in the text of the item.

please note: for the oft, af3=sixth grade, af4=seventh grade

Please add an information icon next to “counselor” That LINKs TO THE HELP TEXT BELOW:

A counselor is an educator who works in schools to provide academic, career, college readiness, and personal/social competencies to all students through a school counseling program.

If “other” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other ways your school organizes the transition from [AF3] grade to [AF4] grade.

IF “No transition—[AF4] grade seamlessly continues directly from [AF3]] grade ” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

All

8042300

D23. Does your school provide additional assistance with the transition from sixth -grade to seventh-grade for students with disabilities?

 Yes 1 D24

OTHER ASSISTANCE

(STRING 8000)

 No. 2 D24

PROGRAMMER BOX D23

PLEASE note: first autofill (AF3) and Second autofill (AF4) are same as D22.

If “Yes” is selected and no response is entered in the text box, please Use a Soft check with the following text:

Please specify other ways your school organizes the transition from [AF3] grade to [AF4] grade.

all

D24. Does your school have an advisory program in the sixth grade?

8042401	Yes	 1
	No	 2

PROGRAMMER BOX d24

PLEASE ADD AN INFORMATION ICON TO the question text “advisory program” THAT LINKS TO THE HELP TEXT BELOW:

By advisory program we mean a guidance effort that provides every student with one adult advisor who serves as an advocate and small group leader. The group meets on a regular basis and typically focuses on educational advisement, study skills, personal and social development, schoolwide communication, or homeschool community relations.

if d24 = 2 (i.e., advisory program is not used in any of the middle grades offered by the school), skip respondent to D28.

D24 = 1

8042501

D25. Which of the following best describes the way your school schedules time for the advisory program in sixth grade?

 We have a separate class period for advising 1 D26

 Advising is part of our homeroom period 2 D26

 We integrate advisory activities within our teams and/or classrooms 3 D26

 Other (Please specify) 99 D26

Specify (STRING 8000)

PROGRAMMER BOX D25

PLEASE ADD AN INFORMATION ICON TO the question text “advisory program” THAT LINKS TO THE HELP TEXT BELOW:

By advisory program we mean a guidance effort that provides every student with one adult advisor who serves as an advocate and small group leader. The group meets on a regular basis and typically focuses on educational advisement, study skills, personal and social development, schoolwide communication, or homeschool community relations.

If “other” is selected and no response is entered in the text box, please Use a SOFT check with the following text:

Please specify other ways your school schedules time for the [D24] grade advisory program.

D24 = 1

D26. When did your school begin using an advisory program in the sixth grade?

Select one answer.	School year started using advisory program	Don’t know
8042601	Select school year…	8042602 

PROGRAMMER BOX D26

PLEASE ADD AN INFORMATION ICON TO the question text “advisory program” THAT LINKS TO THE HELP TEXT BELOW:

By advisory program we mean a guidance effort that provides every student with one adult advisor who serves as an advocate and small group leader. The group meets on a regular basis and typically focuses on educational advisement, study skills, personal and social development, schoolwide communication, or homeschool community relations.

Please program dropdown box to have the default as “select school year…” with the following options (note, do not include “1.” these are just for classification purposes):

1. Before 2008-09

2. 2009-10

3. 2010-11

4. 2011-12

5. 2012-13

6. 2013-14

7. 2014-15

8. 2015-16

9. Current school year

Please program so respondent can either select from dropdown or check the “don’t know” box, but not both answers. if the respondent selects an answer and checks the box, the following SOFT check should pop up:

You selected a school year and checked “Don’t know”. Please only choose one. If you are unsure of the exact school year, your best estimate is fine.

D24 = 1

D27. On average, how much time do teachers regularly meet with sixth-grade students for advising? Your best estimate is fine.

Select one answer.	Average advising time per week	Don’t know
8042701	Please select…	8042702 

PROGRAMMER BOX D27

PLEASE ADD AN INFORMATION ICON TO the question text “advisory program” THAT LINKS TO THE HELP TEXT BELOW:

By advisory program we mean a guidance effort that provides every student with one adult advisor who serves as an advocate and small group leader. The group meets on a regular basis and typically focuses on educational advisement, study skills, personal and social development, schoolwide communication, or homeschool community relations.

Please program dropdown box to have the default as “please select…” with the following options (note, do not include “1.” these are just for classification purposes):

1. None

2. Less than 30 minutes

3. 30-60 minutes

4. 61-120 minutes

5. 121-180 minutes

6. More than 180 minutes

Please program so respondent can either select from dropdown or check the “don’t know” box, but not both answers. if the respondent selects an answer and checks the box, the following soft check should pop up:

You selected an amount of time and checked “Don’t know”. Please only choose one. If you are unsure of the exact amount of time, your best estimate is fine.

ALL

The next questions are about health instruction at your school.

D28. Are sixth-grade students offered instruction on…

Select all that apply.

8042801		a. Nutrition and dietary behavior?
8042802		b. Physical activity and fitness that is classroom instruction, not a physical education period?
8042803		c. Alcohol or other drug use prevention?
8042804		d. Tobacco use prevention?
8042805		e. HIV (human immunodeficiency virus) prevention?
8042806		f. STD (sexually transmitted disease) prevention?
8042807		g. Sexual health education?
8042808		h. Instruction was not offered for any of the topics listed.

PROGRAMMER box D28

IF “Instruction was not offered for any of the topics listed.” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

E. SCHOOL ENVIRONMENT

all

The following questions are about problems you may experience at your school.

E01. To what degree is each of the following a problem at your school?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.	Not a problem	Minor problem	Moderate problem	Serious problem
8050101 a. School tardiness	1 	2 	3 	4 
8050102 b. School absenteeism	1 	2 	3 	4 
8050103 c. Student class cutting	1 	2 	3 	4 
8050104 d. Teacher absenteeism	1 	2 	3 	4 
8050105 e. Students dropping out	1 	2 	3 	4 
8050106 f. Student apathy	1 	2 	3 	4 
8050107 g. Lack of parental involvement	1 	2 	3 	4 
8050108 h. Students coming to school unprepared to learn	1 	2 	3 	4 
8050109 i. Poor student health	1 	2 	3 	4 
8050110 j. Lack of resources and materials	1 	2 	3 	4 
8050111 k. Student mobility	1 	2 	3 	4 

all

E02. To the best of your knowledge, how often did the following types of problems occur in your school in the last month?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
8050201 a. Conflicts resulting from student racial/ethnic tensions	1 	2 	3 	4 	5 
8050202 b. Student bullying	1 	2 	3 	4 	5 
8050203 c. Student sexual harassment of other students	1 	2 	3 	4 	5 
8050204 d. Student harassment of other students based on sexual orientation or gender identity	1 	2 	3 	4 	5 
8050205 e. Widespread disorder in classrooms	1 	2 	3 	4 	5 
8050206 f. Students yelling and screaming at teachers	1 	2 	3 	4 	5 
8050207 g. Student acts of disrespect for teachers other than verbal abuse	1 	2 	3 	4 	5 
8050208 h. Gang activities	1 	2 	3 	4 	5 
8050209 i. Cult or extremist group activities	1 	2 	3 	4 	5 

PROGRAMMER BOX E02

PLEASE MAKe the response option text “Sexual orientation or gender identity” THAT LINKS TO THE HELP TEXT BELOW:

By sexual orientation or gender identity we mean, for example, harassment toward students who might be lesbian, gay, bisexual, transgender, and/or questioning.

all

The next questions are about school-level security at your school.

E03. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your most recent practice.

PROGRAMMER: CODE ONE PER ROW

	Select all that apply.
8050301		a. Require visitors to sign or check in
8050302		b. Control access to school buildings during school hours
8050303		c. Control access to school grounds during school hours
8050304		d. Require students to pass through metal detectors each day
8050305		e. Require students to wear uniforms
8050306		f. Enforce a strict dress code
8050307		g. Perform one or more random sweeps for contraband, including dog sniffs
8050308		h. Provide school lockers to students
8050309		i. Require clear book bags or ban book bags on school grounds
8050310		j. Require students to wear badges or picture IDs
8050311		k. Require faculty and staff to wear badges or picture IDs
8050312		l. Use one or more security cameras to monitor the school
8050313		m. Limit access to social networking websites from school computers
8050314		n. Prohibit use of cell phones, smart phones, and text messaging devices during school hours

PROGRAMMER BOX E03

PLEASE MAKe the response option text “Control access to school buildings” THAT LINKS TO THE HELP TEXT BELOW:

By control access to school buildings we mean, for example, having locked or monitored doors.

PLEASE MAKe the response option text “Control access to school grounds” THAT LINKS TO THE HELP TEXT BELOW:

By control access to school grounds we mean, for example, having locked or monitored gates.

PLEASE MAKe the response option text “contraband” THAT LINKS TO THE HELP TEXT BELOW:

By contraband we mean, for example, drugs or weapons.

PLEASE MAKe the response option text “social networking websites” THAT LINKS TO THE HELP TEXT BELOW:

By social networking websites we mean web-based services that allow people to create a personal profile and to connect with other people who share similar interests, activities, backgrounds or real-life connections. For example, Facebook and Twitter.

All

8050400

E04. During this school year, have you had any security guards, security personnel, school resource officers or sworn law enforcement officers present at your school at least once a week?

 Yes 1 E05

 No 2

PROGRAMMER BOX E04

PLEASE ADD AN INFORMATION ICON TO the question text “security guard, security personnel” THAT LINKS TO THE HELP TEXT BELOW:

Security guard or security personnel are not official law enforcement.

PLEASE MAKe the row text “school resource officer” THAT LINKS TO THE HELP TEXT BELOW:

For school resource officer please include all career law enforcement officers with arrest authority, who have specialized training and are assigned to work in collaboration with school organizations.

PLEASE ADD AN INFORMATION ICON TO the question text “sworn law enforcement officer” THAT LINKS TO THE HELP TEXT BELOW:

For sworn law enforcement officer please include sworn law enforcement officers who are not school resource officers.

E04=1

E05. Are these security guards, security personnel, school resource officers, or sworn law enforcement officers used at least once a week in or around your school at the following times?

Select all that apply.

8050501

 At any time during school hours 1 E06

8050502

 While students are arriving or leaving 2 E06

8050503

 At selected school activities 3 E06

8050504

 When school activities are not occurring 4 E06

PROGRAMMER BOX E05

PLEASE ADD AN INFORMATION ICON TO the question text “security guard, security personnel” THAT LINKS TO THE HELP TEXT BELOW:

Security guard or security personnel are not official law enforcement.

PLEASE MAKe the row text “school resource officer” THAT LINKS TO THE HELP TEXT BELOW:

For school resource officer please include all career law enforcement officers with arrest authority, who have specialized training and are assigned to work in collaboration with school organizations.

PLEASE ADD AN INFORMATION ICON TO the question text “sworn law enforcement officer” THAT LINKS TO THE HELP TEXT BELOW:

For sworn law enforcement officer please include sworn law enforcement officers who are not school resource officers.

Please add an information icon next to “school activities” that LINKs TO THE HELP TEXT BELOW:

By school activities we mean, for example, athletic and social events, open houses, or science fairs.

E04=1

E06-E08.How many full-time equivalent (FTE) of the following personnel are present in your school during a typical week?

PROGRAMMER: RANGE FOR GRID IS 0-50

	Number of full-time equivalent (FTE)
8050601 a. Security guard or security personnel		FTE
8050701 b. School resource officer		FTE
8050801 c. Sworn law enforcement officer		FTE

PROGRAMMER BOX E06-E08

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

PLEASE MAKe the Column Header text “number of full-time equivalent” THAT LINKS TO THE HELP TEXT BELOW:

One full-time personnel at your school should be counted as 1.0 full-time equivalent (FTE) and one part-time personnel should be counted as 0.5 full-time equivalent (FTE).

If a personnel works full-time across multiple schools in the district, please count this person as “part-time” for your school (i.e., 0.5 FTE).

PLEASE MAKe the row text “security guard or security personnel” THAT LINKS TO THE HELP TEXT BELOW:

Security guard or security personnel are not official law enforcement.

PLEASE MAKe the row text “school resource officer” THAT LINKS TO THE HELP TEXT BELOW:

For school resource officer please include all career law enforcement officers with arrest authority, who have specialized training and are assigned to work in collaboration with school organizations.

PLEASE MAKe the row text “sworn law enforcement officer” THAT LINKS TO THE HELP TEXT BELOW:

For sworn law enforcement officer please include sworn law enforcement officers who are not school resource officers.

The following question is about the community around your school.

All

E09b. How would you describe the crime level in the area where your school is located?

8050902

 High level of crime 1 F01

 Moderate level of crime 2 F01

 Low level of crime 3 F01

F. SCHOOL’S TEACHERS

all

The following questions are about teachers at your school.

F01. Please indicate the number of full-time equivalent (FTE) sixth-grade teachers by subject area. Please give your best estimate.

PROGRAMMER: RANGE FOR GRID IS 0-100

	Number of full-time equivalent (FTE)
8060102 a. Mathematics		FTE
8060103 b. English/Language arts		FTE
8060104 c. Science		FTE

PROGRAMMER BOX F01

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

PLEASE ADD AN INFORMATION ICON TO the question text “full-time equivalent (FTE)” THAT LINKS TO THE HELP TEXT BELOW:

A full-time teacher at your school should be counted as 1.0 full-time equivalent (FTE) and a part-time teacher should be counted as 0.5 FTE.

If a teacher works full-time in your school, but divides his or her time between subject areas or across grades, consider that teacher as part-time in each subject area or grade.

All

F02. Thinking of all the subjects offered in your school, how many classroom teachers are currently working at your school? Your best estimate is fine.

8060200

Please include full-time and part-time teachers, and only include onsite teachers.

Please exclude staff who work at the school but are not classroom teachers, or classroom teachers that do not teach onsite (e.g., online course instructors).

Classrooms teachers F03

(RANGE 0-1000)

NO RESPONSE M F03

SOFT CHECK: IF ENTRY IS NON-NUMERIC; Please enter only numbers in your response.

SOFT CHECK: IF ENTRY CONTAINS VALUES OUTSIDE OF THE RANGE OF 0-1000; Please enter a number between 0 and 1000.

PROGRAMMER BOX f02

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

all

F03. How many classroom teachers in your school have the following certifications? Your best estimate is fine.

Please include provisionally certified teachers in your counts.

PROGRAMMER: RANGE FOR GRID IS 0-1000

	Number of classroom teachers
8060301 a. Elementary certification
8060302 b. Secondary subject matter certification
8060303 c. Middle grades endorsement
8060304 d. Specific middle grades certification
8060305 e. Special education certification
SOFT CHECK: IF ENTRY IS NON-NUMERIC; Please enter only numbers in your response.
SOFT CHECK: IF ENTRY CONTAINS VALUES OUTSIDE OF THE RANGE OF 0-1000; Please enter a number between 0 and 1000.

PROGRAMMER BOX F03 Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”). PLEASE MAKe the ROW text “middle grades endorsement” THAT LINKS TO THE HELP TEXT BELOW: By middle grades endorsement we mean an add-on to elementary or secondary certification. PLEASE MAKe the ROW text “Specific middle grades certification” THAT LINKS TO THE HELP TEXT BELOW: By specific middle grades certification we mean a certification separate from elementary or secondary.
	All

The following questions ask about teacher preparedness to teach specific subjects.

F04. To what extent do you disagree or agree with the following statements?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Subject not taught at this school
8060401 a. English/Language Arts teachers at your school are adequately prepared to teach English/Language Arts.	1 	2 	3 	4 	5	6 
8060402 b. General mathematics teachers at your school are adequately prepared to teach general mathematics.	1 	2 	3 	4 	5	6 
8060403 c. Algebra teachers at your school are adequately prepared to teach Algebra.	1 	2 	3 	4 	5	6 
8060404 d. Algebra II teachers at your school are adequately prepared to teach Algebra II.	1 	2 	3 	4 	5	6 

ALL

F05. How often do you do the following?

Select one answer for each row.	Not at all	Once or twice a year	Once per reporting period	Monthly	Weekly	More than weekly
8060601 a. Participate in meetings about challenges that students are having	1 	2 	3 	4 	5	6 
8060602 b. Discuss instructional strategies with teachers	1 	2 	3 	4 	5	6 
8060603 c. Summarize and share data with teachers	1 	2 	3 	4 	5	6 
8060604 d. Interpret data for or with teachers	1 	2 	3 	4 	5	6 
8060605 e. Press teachers to raise learning standards	1 	2 	3 	4 	5	6 

All

The next questions ask about teacher preparedness to assist students who are experiencing difficulties in specific subjects.

F06. To what extent do you disagree or agree with the following statements?

PROGRAMMER: CODE ONE PER ROW

Select one answer for each row.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Subject not taught at this school
8060501 a. General mathematics teachers at your school are adequately prepared to assist students who are experiencing difficulties in general mathematics.	1 	2 	3 	4 	5	6 
8060502 b. Algebra I teachers at your school are adequately prepared to assist students who are experiencing difficulties in Algebra I.	1 	2 	3 	4 	5	6 
8060503 c. Algebra II teachers at your school are adequately prepared to assist students who are experiencing difficulties in Algebra II.	1 	2 	3 	4 	5	6 

G. ADMINISTRATOR’S BACKGROUND

All

The next set of questions are about your background and experience.

8070100

G01. What is your sex?

Select the one that best describes you.

 Male 1 G02

 Female 2 G02

NO RESPONSE M G02

All

8070200

G02. Are you Hispanic or Latino/Latina?

Select the one that best describes you.

 Yes 1 G03

 No 2 G03

NO RESPONSE M G03

SOFT CHECK: IF G02 = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

PROGRAMMER BOX G02

HYPER LINK THE WORDS “Hispanic or Latino/Latina” FOR G02 QUESTION TEXT:

Hispanic or Latino/Latina: a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish cultures or origin (or descent), regardless of race.

all

G03. Which of the following best describes your race? You may choose more than one.

Select all that apply.

8070301

 a. White 1 G04

8070302

 b. Black or African American 2 G04

8070303

 c. Asian 3 G04

8070304

 d. Native Hawaiian or other Pacific Islander 4 G04

8070305

 e. American Indian or Alaska Native 5 G04

NO RESPONSE M G04

SOFT CHECK: IF G03 = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

PROGRAMMER BOX G03

Please add an information icon next to each of these response categories which would be the link to the help text but not activate the check box. If they clicked the information icon , it would take them to the help text but will not automatically check the response:

White: a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American: a person having origins in any of the black racial groups of Africa.

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.

Native Hawaiian or other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

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.

all

8070400

G04. What is the highest degree you have earned?

 Associate's degree 1 G05

 Bachelor’s degree 2 G05

 Master’s degree 3 G05

 Educational Specialist degree 4 G05

 Ph.D.,Ed.D., M.D., law degree, or other high level professional degree 5 G05

 You do not have a degree 6 G06

SOFT CHECK: IF G04 = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

G04 NE 6 or g04 is missing

FILL RESPONSE FROM G04

G05. What was your major(s) or field(s) of study for your [G04]?

8070500

(STRING 250)

PROGRAMMER BOX G05

AUTOFILL FOR g05 BASED ON RESPONSE TO G04>=1 AND G04<=5. IF G04 = MISSING AUTOFILL SHOULD READ “HIGHEST DEGREE EARNED”

all

G06. What teaching certification(s) have you ever held?

Select all that apply.

8070601

 a. Middle grades certification 1 G07

8070602

 b. Elementary certification 2 G07

8070603

 c. Secondary subject matter certification 3 G07

8070604

 d. Special education certification 4 G07

8070605

 e. Other (Please specify) 99 G07

Specify (STRING 250)

PROGRAMMER BOX G06

Please add an information icon next to “Middle grades” That links to the following text:

By middle grades we mean a certification that is separate from elementary or secondary certification.

If “other” is selected and no response is entered in the text box, please Use a hard check with the following text:

Please specify the other teaching certification(s) you have ever held.

all

G07. Have you received any specialized training in the instructional and organizational needs of a middle school?

Select all that apply.

8070701

 a. Preservice coursework 1 G08

8070702

 b. Certification coursework 2 G08

8070703

 c. Professional development 3 G08

8070704

 d. Master’s degree 4 G08

8070705

 e. Doctoral degree 5 G08

8070706

 f. Other (Please specify) 99 G08

Specify (STRING 250)

8070707

 g. Never received any specialized training 6 G08

PROGRAMMER BOX G07

If “other” is selected and no response is entered in the text box, please Use a hard check with the following text:

Please specify any other specialized training in the instructional and organizational needs of a middle school you have received.

IF “Never received any specialized training.” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

all

G08. What other experiences in education have you had in the past?

Select all that apply.

8070801

 a. Principal/school administrator of another elementary school 1 G09

8070802

 b. Principal/school administrator of another middle school or junior high school 2 G09

8070803

 c. Principal/school administrator of another high school 3 G09

8070804

 d. Assistant principal 4 G09

8070806

8070805

 e. Elementary school teacher 5 G09

8070807

 f. Middle school or junior high school teacher 6 G09

8070808

 g. High school teacher 7 G09

8070809

 h. Coach/Group sponsor 8 G09

 i. Other (Please specify) 99 G09

Specify (STRING 250)

PROGRAMMER BOX G08

If “other” is selected and no response is entered in the text box, please Use a hard check with the following text:

Please specify other experiences in education you have had in the past.

All

Finally, we would like to ask you about your years of experience.

G09.Including this school year…

PROGRAMMER: RANGE FOR GRID IS 0-99

	Number of years
8070901 a. How many years have you served [as the [A03]] at any school?		Year(s)
8070902 b. How many years have you served [as the [A03]] at your current school?		Year(s)
8070903 c. How many years have you taught sixth, seventh, or eighth grade?		Year(s)

SOFT CHECK: IF ENTRY IS NON-NUMERIC; Please enter only numbers in your response.

SOFT CHECK: IF ENTRY CONTAINS VALUES OUTSIDE OF THE RANGE OF 0-99; Please enter a value between 0 and 99.

CONSISTENCY CHECK: If number of years entered at G9b is > G09a; You entered a number greater than the number of years you have served at any school. This creates conflicting information. Please change your response(s) to be consistent.

PROGRAMMER BOX G09

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

AUTOFILL FOR G09A/G09B BASED ON RESPONSE TO A03>0 AND A03<=4. IF A03 = 99, AUTOFILL FOR G09A/G09B BASED ON RESPONSE TO A03OS. IF A03 = MISSING, MODIFY G09A/G09B TEXT TO replace “as the [A03]” with “at the current position you have”

HYPER LINK THE QUESTION TEXT “SCHOOL YEAR” TO HAVE THE FOLLOWING HELP TEXT:

If this is your first year in your current position, please count it as “1” even if you have not finished an entire year.

ALl

Section Review.These are all the questions we have for you. We appreciate you taking the time to complete the survey.

Your responses are very important to this study!

The following sections of your survey have not yet been fully completed:

IntroSchool CharacteristicsSchool ProgramsSchool EnvironmentSchool's TeachersAdministrator Background

Please use the navigation bar at the top of this page or follow the link(s) above
to return to the incomplete sections to provide any missing responses.

PROGRAMMER BOX Section Review

Please populate hyperlinked section list Based on the sections that are incomplete when the respondent reaches this question. Clicking on the hyperlink will take the user back to the corresponding section that is not completed.

For Section A: INTRO to be complete

Questions: A01a, A01b, A01c, A01d, A02a, A03 must all have responses for every item on the screen.

If A02a = 2, THEN A02b, A02c, and A02d must have a response, but otherwise A02b, A02c, and A02d can be blank.

For Section B: SCHOOL CHARACTERISTICS to be complete

Questions: B01, B02, B03, B06, B07, B08, B09, B13-15 must all have responses for every item on the screen.

If B01 = 2 or 99 THEN B03 must have a response, but otherwise B03 can be blank.

If B01 = 5 or 99 THEN B05 must have a response, but otherwise B04 can be blank.

If B03 > 0, THEN B04 must have a response, but otherwise B05 can be blank.

If B01 = 5 or 99 AND B03 > 0 THEN B05 must have a response, but otherwise B05 can be blank.

If B01 NE 5, THEN B10, B11, and B12 must have a response, but otherwise B10, B11, and B12 can be blank.

For Section C: SUPPORTS FOR STUDENTS to be complete

Questions: C01, C02, C03 must all have responses for every item on the screen.

For Section D: SCHOOL PROGRAMS to be complete

Questions: D01, D08, D09, D10, D20, D21, D22, D23, D24, D28 must all have responses for every item on the screen.

If D01 =1, THEN D02, D03, D04, D05, D06, and D07 must have a response, but otherwise D02, D03, D04, D05, D06, and D07 can be left blank.

If A01d = 8, THEN D17 must have a response, but otherwise D17 can be left blank.

If A01d = 9, THEN D11, D13, D15a, D15b, D15c must have a response, but otherwise D11, D13, D15a, D15b, D15ccan be left blank.

If D24 = 1, THEN D25, D26, and D27 must have a response, but otherwise, D25, D26, and D27 can be left blank.

For Section E: SCHOOL ENVIRONMENT to be complete

Questions: E01, E02, E03, E04, E09b must all have responses for every item on the screen.

If E04 = 1, THEN E05, E06, E07, and E08 must have a response, but otherwise E05, E06, E07, and E08 can be blank.

For Section F: SCHOOL’S TEACHERS to be complete

Questions: F01, F02, F03, F04, F05, F06 must all have responses for every item on the screen.

For Section G; ADMINISTRATOR’S BACKGROUND to be complete

Questions: G01, G02, G03, G04, G06. G07, G08 G09, must all have responses for every item on the screen.

If G04 NE 6, THEN G05 must have a response, but otherwise G05 can be blank.

ALl

END. These are all the questions we have for you. We appreciate you taking the time to complete the survey.

Thank you very much for participating in MGLS:2017!

Press "Submit" to complete and close the survey.

PROGRAMMER BOX END

PROGRAM A “Submit” BUTTON ON THE SCREEN. The button will finalize answers, and close down the interface in which the survey was displayed. EXIT SURVEY.

a02b = 1

END1. Thank you for your time.

Press “Submit” to finish.

PROGRAMMER BOX END1

PROGRAM A “Submit” BUTTON ON THE SCREEN. The button will finalize answers, and close down the interface in which the survey was displayed. EXIT SURVEY.

Appendix OFT1-V. Facilities Checklist Specifications

The Facilities Checklist will be completed by data collection contractor study team member staff.

Facilities Checklist

AA. School structure

The following question is about the features at the school.

AA1. Please indicate all features you observed at this school

	Select one answer for each row	Observed	Not observed
9000102	Auditorium/Performing Arts	1 	2 
9000103	Art Facilities	1 	2 
9000104	Cafeteria (separate from auditorium and gym)	1 	2 
9000106	Common areas/courtyards	1 	2 
9000107	Computer lab	1 	2 
9000108	Gymnasium	1 	2 
9000109	Health Services room	1 	2 
9000110	Library or media center	1 	2 
9000113	Music Education room	1 	2 
9000115	Science room, set-up as a lab space	1 	2 
9000117	Building(s) with more than one floor (multiple stories)	1 	2 
9000118	Campus with more than one building	1 	2 
9000119	Each grade housed in different areas of the school	1 	2 
9000120	Elevators	1 	2 
9000121	Trailers (for classrooms or offices)	1 	2 

9010100

A0. Please note the time of day that you observed the items below:

A. General Condition of Neighborhood/Area Around School

The following questions are about the condition of the immediate neighborhood/area around the school.

A1. While you are standing outside of the school (near the entrance where most visitors arrive), look at the neighborhood/area surrounding the school. Please indicate the extent to which you notice the following factors in the neighborhood/area surrounding this school.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
9010101	Litter or trash	1 	2 	3 	4 	5 
9010102	Graffiti	1 	2 	3 	4 	5 
9010103	Boarded up buildings	1 	2 	3 	4 	5 
9010104	People congregating on streets	1 	2 	3 	4 	5 
9010105	Student(s) loitering	1 	2 	3 	4 	5 

B. General Upkeep-Main Entrance and Hallways and Displays at the School

9020100

B0. Please note the time of day that you observed the items below:

The next questions are about the general upkeep of the entrance and the hallways and displays at the school.

B1. Observe the school's main entrance (near the entrance where most visitors arrive) and the hallway(s) and displays during a time when most students are in class (i.e., a class period). Take as much time as necessary to observe the hallway(s). Please indicate to what degree you notice the following factors about the general upkeep and displays at the school.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
	General Upkeep
9020101	a. Trash on the floors	1 	2 	3 	4 	5 
9020102	b. Trash overflowing from trash cans	1 	2 	3 	4 	5 
9020103	c. Broken lights	1 	2 	3 	4 	5 
9020104	d. Graffiti on the walls, doors, or ceilings	1 	2 	3 	4 	5 
9020105	e. Graffiti on the lockers	1 	2 	3 	4 	5 
9020106	f. Visible fire alarms or emergency alarms	1 	2 	3 	4 	5 
9020107	g. Chipped paint on the walls, doors, or ceilings	1 	2 	3 	4 	5 
9020108	h. Ceiling in disrepair (e.g., falling in, water damage, missing tiles, or plaster)	1 	2 	3 	4 	5 
9020109	i. Visible exit signs	1 	2 	3 	4 	5 
	Displays
9030104	j. School identity is visible (e.g., mascot, logo, colors, slogan)	1 	2 	3 	4 	5 
9030105	k. Accomplishments of the school are noted	1 	2 	3 	4 	5 
9030101	l. Displays of the works or accomplishments of students on walls or lockers	1 	2 	3 	4 	5 
9030106	m. Student academic work displayed	1 	2 	3 	4 	5 
9030107	n. Expectations for student behavior displayed	1 	2 	3 	4 	5 
9030103	o. Displays of posters encouraging positive behavior choices and well being, such as conflict resolution guidance or healthy food choices	1 	2 	3 	4 	5 
9030102	p. Displays of student activities and opportunities for involvement, such as student government, yearbook, or school event committees	1 	2 	3 	4 	5 
9030108	q. Learning resources for students are displayed, for example, formulas, abbreviations, steps for reviewing.	1 	2 	3 	4 	5 

K. School accomplishments include award display cases that highlight both sports and/or academic accomplishments, individual student success may be highlighted such as student of the month, caught being good, banners announcing exemplary programming and school awards and designations.

L. Individual accomplishments might be displayed on walls or on lockers. For example, behavioral and academic recognition, such as perfect attendance, most cooperative, strong effort, most improved, high achievement.

Q. Learning resources include displays of information such as how to find circumference, how to edit an essay, abbreviations for measurements such as ounce, pound, inch, foot, and their equivalents [ex: 16 oz = 1 lb]

B2. For each item listed, please indicate the extent to which you notice the following factors in school displays.

In the questions below, by “team” we mean for example in some schools students are put into separate groups with common teaching teams, and these students share homeroom with their groups.

	Select one answer for each row	Not at all	A little	Some	A lot		No opportunity to observe
9030109	Team identification is visible (e.g., team name, team mascots, team slogans)	1 	2 	3 	4 		5 
9030110	Team expectations and team rules are posted	1 	2 	3 	4 		5 
9030111	Team calendars are displayed	1 	2 	3 	4 		5 
9030112	Student recognition is noted with the team (e.g., student or team-centered celebrations, random acts of kindness, team most improved or student of the week)	1 	2 	3 	4 		5 

B3. For each item listed, indicate the extent to which you notice the following.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
9030118	Student social spaces (e.g., open space, outside of the classroom, teaching team pod areas)	1 	2 	3 	4 	5 
9030119	Teachers are at classroom doors during passing periods	1 	2 	3 	4 	5 
9030115	Data walls are visible	1 	2 	3 	4 	5 

Data walls are displays of student performance and/or progress in different areas related to behavior (for example, attendance) or academics (for example, graphs of scores on tests of different objectives). May show performance and/or progress for a single month or compare current performance and/or progress to that of prior months.

D. Classrooms

The next questions are about the general upkeep of classrooms.

D.1 During a change in classes or other time when classes are not in session, enter at least one classroom in which students in grade 6 are taught. For each item listed, indicate the extent to which you notice the following factors in the classroom.

Note: If no windows available, mark as No opportunity to observe.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
9040101	Locks controlled from inside of door	1 	2 	3 	4 	5 
9040102	Ceiling in disrepair (e.g., falling in, water damage, missing tiles or plaster)	1 	2 	3 	4 	5 
9040103	Broken lights	1 	2 	3 	4 	5 
9040104	Graffiti on the walls, doors, or ceilings	1 	2 	3 	4 	5 
9040105	Graffiti on desks	1 	2 	3 	4 	5 
9040106	Trash on the floors	1 	2 	3 	4 	5 
9040107	Trash overflowing from trash cans	1 	2 	3 	4 	5 
9040108	Floors and walls appear clean	1 	2 	3 	4 	5 
9040109	Posters or other materials on glass windows	1 	2 	3 	4 	5 
9040110	Bars on windows	1 	2 	3 	4 	5 
9040111	Broken windows	1 	2 	3 	4 	5 

The next questions are about the classroom set up.

D2. For each item listed, indicate the extent to which you notice the following factors in the classroom set up.

			Select one answer for each row
			Not at all	A little	Some	A lot	No opportunity to observe
9040112	Desks are clustered or small tables available in classrooms so that they allow for small group work		1 	2 	3 	4 	5 
9040114	Desks are set up in rows in classrooms		1 	2 	3 	4 	5 
9040115	Class rules and responsibilities are displayed		1 	2 	3 	4 	5 
9040116	Colorful and engaging materials that support learning and/or character development are displayed		1 	2 	3 	4 	5 
9040117	Standards and learning guides are posted		1 	2 	3 	4 	5 
9040118	Multimedia is visible, e.g., smartboards, computers or tablets, calculators		1 	2 	3 	4 	5 
9040119	Weekly or daily assignments are posted		1 	2 	3 	4 	5 
9040120	Student work is displayed		1 	2 	3 	4 	5 

E. General Upkeep - Restrooms

The following questions are about the general upkeep of the school restrooms.

E.1 During a time when most students are in class (i.e., a class period), enter any student restroom appropriate for your sex. For each item listed, please indicate to what degree you notice the following factors in the general upkeep of the school restrooms.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
9050101	Graffiti on walls and ceilings	1 	2 	3 	4 	5 
9050102	Graffiti on restroom stall doors or walls	1 	2 	3 	4 	5 
9050103	Trash on the floors	1 	2 	3 	4 	5 
9050104	Trash overflowing from trash cans	1 	2 	3 	4 	5 
9050105	Doors on all stalls	1 	2 	3 	4 	5 
9050106	Student(s) loitering	1 	2 	3 	4 	5 
9050107	Student(s) smoking	1 	2 	3 	4 	5 

F. Security

The next questions are about security measures at the school.

F.1 Indicate the extent to which you observed the presence of the following security measures today.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
9060101	Security guard	1	2 	3 	4 	5 
9060102	Metal detectors	1	2 	3 	4 	5 
9060103	Security cameras	1	2 	3 	4 	5 
9060104	Fencing around the entire school	1	2 	3 	4 	5 
9060105	Sign-in policies being followed	1	2 	3 	4 	5 
9060106	Visitors greeted and directed by an adult to sign in at office	1	2 	3 	4 	5 
9060107	Fire alarms	1	2 	3 	4 	5 
9060108	Fire extinguishers	1	2 	3 	4 	5 
9060109	Fire sprinklers	1	2 	3 	4 	5 
9060110	Exterior lights	1	2 	3 	4 	5 
9060111	Student uniforms	1	2 	3 	4 	5 
9060112	Signs at exterior doors stating alarm will go off if door is opened	1	2 	3 	4 	5 

F.2 The next questions are about signs that may be posted at or near the main entrance of the school (near the entrance where most visitors arrive) and can be inside and/or outside the building.

		Not at all	A little	Some	A lot	No opportunity to observe
	Select one answer for each row
9060201	Signs providing directions to the front office or stating that visitors must proceed to the front office	1 	2 	3 	4 	5 
9060202	Signs conveying the message "no drugs"	1 	2 	3 	4 	5 
9060203	Signs conveying the message "no trespassing"	1 	2 	3 	4 	5 
9060204	Signs conveying the message "no weapons"	1 	2 	3 	4 	5 
9060205	Where to get assistance (e.g., school support services such as Counselor, Social Worker, Media Specialist, Nurse, or Health Care Assistant)	1 	2 	3 	4 	5 
9060206	Conflict resolution and peer mediation	1 	2 	3 	4 	5 
9060207	Healthy choices	1 	2 	3 	4 	5 
9060208	Cell phone use	1 	2 	3 	4 	5 
9060209	Anti-bullying messages	1 	2 	3 	4 	5 
9060210	Anti-drug messages	1 	2 	3 	4 	5 
9060211	Anti-smoking messages	1 	2 	3 	4 	5 

F.3 Do a majority of the following individuals wear identification cards/badges?

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe	Not required
9060301	Students	1 	2 	3 	4 	5 	6 
9060302	Teachers	1 	2 	3 	4 	5 	6 
9060303	Other personnel	1 	2 	3 	4 	5 	6 
9060304	Visitors	1 	2 	3 	4 	5 	6 

G. Facilities for Students with Disabilities

The next set of questions is about accessibility inside the building.

G.1 For each of the following, please indicate if it is observed in the building.

	Select one answer for each row	Yes	No
9070101	Are all areas of the school accessible to students with disabilities? (For example, are there routes that do not have stairs? If the building is multi-level, are there ramps, elevators, or lifts available?)	1 	2 
9070102	Inside the building, are signs posted to help people with disabilities navigate the building? (For example, directional and informational signs containing Braille with raised characters, pictograms, arrows, etc.)	1 	2 
9070103	Would students with mobility problems be able to sit with other students in the cafeteria? (For example, a cafeteria with all bench seats means they may not.)	1 	2 
9070104	Would students with mobility problems be able to work with other students in the library? (For example, are group work areas accessible to students with disabilities?)	1 	2 
9070105	In general, do students with mobility problems have access to social spaces within the school?	1 	2 
9070200	If there is a resource room, is the resource room in a location accessible to all students?	1 	2 	Not applicable 

Accessibility might include an elevator, ramp, or lift to access that level to a social space or resource room.

Mobility problems include difficulty moving around, such as a need for use of walkers or wheelchairs.

H. Observer Access

9080101

H1. What percentage of the campus did you observe?

 Less than or equal to 25% 1

 More than 25% but less than or equal to 50% 2

 More than 50% but less than or equal to 75% 3

 More than 75% but less than 100% 4

 100% 5

Appendix MS1-T. Student Rostering Form

Appendix T includes the student rostering form referenced in Appendix S.

Appendix T - Rostering Form

Main Study

Instructions: For each student currently enrolled in grade 6 in your school, please provide the below information.

Please be certain to include all children in each grade.

General Student information

Race/Ethnicity (Y/N all that apply)

IEP

ELL

Disability Code

Parent Contact information

Student's Math Teacher

Student's Special Education Teacher, if applicable

StudentID

FirstName

Does student have IEP? (Y/N)

LastName

Suffix

Grade

Date of birth MM/DD/YY

Sex(M/F)

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Hispanic (Y/N)

IEP status (disability codes)

Student ELL Status?

If student has an IEP, please enter the disability code. Disability Code(s): (1) Specific Learning Disability (2) Autism (3) Emotional Disturbance (4) Other

Parent's First Name

Parent's Last Name

Parent's Address

Parent City

Parent State

Parent Zip

Parent's Email

Parent's Home Phone

Parent's Cell Phone

MathTeacherFirstName

MathTeacherLastName

MathTeacherEmail

Math Course Name

Math Course Period/Section

SpecialEDTeacherFirstName

SpecialEDTeacherLastName

SpecialEDTeacherEmail

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C., § 9543). The data are being collected for NCES by RTI International, a nonprofit research organization based in North Carolina. The collected data 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 (ESRA 2002, 20 U.S.C., § 9573). The collected information will be combined across respondents to produce statistical reports.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 1850-0911. Approval expires 09/30/2018. The time required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this information collection, please write directly to:  Middle Grades Longitudinal Study (MGLS), National Center for Education Statistics (NCES), 550 12th St. SW, Room 4002, Washington, DC 20202

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