International Early Learning Study (IELS) 2018 Field Test Data Collection and Main Study Recruitment

International Early Learning Study (IELS)

Field Test Data Collection

OMB# 1850-0936 v.3

National Center for Education Statistics (NCES)

U.S. Department of Education

Institute of Education Sciences

Washington, DC

These draft field test instruments include the final international field test versions and proposed additional U.S. adaptation items (revised July 2017). The final field test instruments, including all internationally approved U.S. adaptations will be submitted to OMB as a change request upon approval of this request in August 2017.

April 2017

revised July 2017

Appendix C: Draft Field Test Instruments

Instructions for School Coordinators to E-file student lists – Field Test 1

Instructions for School Coordinators to E-file student lists – Main Study 3

Draft IELS Parent Questionnaire 5

Draft IELS Teacher Questionnaire 19

Additional National Questions 26

Instructions for School Coordinators
to E-file Student Lists – Field Test

1. Prepare Electronic Student File (E-File)

Steps for preparing an Electronic Student File (E-File)

Step 1: Identify ALL students at your school who meet the eligibility criteria

Criteria for the IELS student eligibility are:

^{ Born between Date and Date.}

NCES needs accurate information about all students at your school who meet the above criteria for IELS student eligibility. Include all students, even those students who typically may be excluded from other testing programs, such as students with IEPs or 504 plans (SD), English language learners (ELL), or students with limited English proficiency (LEP). A small number of these students may be unable to complete the IELS assessment. Do not include on your list students who are known to be withdrawn. All other eligible students must be added to your list of students.

Step 2: List each of the eligible students along with their grade and demographic information (see Figure 1 below for an example)

Using the electronic listing form template provided on the MyIELSUSA.com website (www.MyIELSUSA.com), list students in your school who are eligible for the IELS along with their demographic information.

 Student first name

^{ Student middle name (not required)}

^{ Student last name}

^{ Month of birth (M or MM; must be submitted in numeric format, not text)}

^{ Year of birth (YYYY: 2012)}

^{ Grade}

^{ Sex (1 = Female; 2 = Male)}

^{ Primary Teacher’s first name}

^{ Primary Teacher’s last name}

^{ Primary Teacher’s email address}

Figure 1: Example of Electronic Student File

Student First Name	Student Middle Name	Student Last Name	Month of Birth	Year of Birth	Grade	Sex	Primary Teacher First Name	Primary Teacher Last Name	Primary Teacher Email Address
Ted	Brian	Brooks	5	2012	K	2	Ann	Le	[email protected]
Jeffrey		Jenkins	3	2012	K	2	Ann	Le	[email protected]
Rose	Ann	Matthews	9	2012	K	1	Gert	Otter	[email protected]
Jennifer	Lynn	Trader	4	2012	K	1	Ann	Le	[email protected]
José		Rodriguez	5	2012	K	2	Gert	Otter	Otter@bates
Roy	John	Zastrow	8	2012	K	2	Gert	Otter	Otter@bates
Sam		Walker	3	2012	K	2	Gert	Otter	Otter@bates
Julie		Walters	6	2012	K	1	Ann	Le	[email protected]

Submitting Your Electronic Student File

After you have created and saved your E-File, proceed to MYIELSUSA. Once you have logged in, click the “Submit Student List” link on the left side of the page. Then click the START E-FILE button at the bottom of the page.

IMPORTANT! If at any point you have any difficulties with this process, please do not hesitate to contact the IELS Help Desk for assistance at 1-888-xxxx.

Please Note: You must submit both your student lists before your school's sample is processed.

Instructions for School Coordinators
to E-file student lists – Main Study

1. Prepare Electronic Student File (E-File)

Steps for preparing an Electronic Student File (E-File)

Step 1: Identify ALL students at your school who meet the eligibility criteria

Criteria for the IELS student eligibility are:

^{ Born between Date and Date.}

NCES needs accurate information about all students at your school who meet the above criteria for IELS student eligibility. Include all students, even those students who typically may be excluded from other testing programs, such as students with IEPs or 504 plans (SD), English language learners (ELL), or students with limited English proficiency (LEP). A small number of these students may be unable to complete the IELS assessment. Do not include on your list students who are known to be withdrawn. All other eligible students must be added to your list of students.

Step 2: List each of the eligible students along with their grade and demographic information (see Figure 1 below for an example)

Using the electronic listing form template provided on the MyIELSUSA.com website (www.MyIELSUSA.com), list students in your school who are eligible for the IELS along with their demographic information.

 Student first name

^{ Student middle name (not required)}

^{ Student last name}

^{ Month of birth (M or MM; must be submitted in numeric format, not text)}

^{ Year of birth (YYYY: 2012)}

^{ Grade}

^{ Sex (1 = Female; 2 = Male)}

^{ Primary Teacher’s first name}

^{ Primary Teacher’s last name}

^{ Primary Teacher’s email address}

Figure 1: Example of Electronic Student File

Student First Name	Student Middle Name	Student Last Name	Month of Birth	Year of Birth	Grade	Sex	Primary Teacher First Name	Primary Teacher Last Name	Primary Teacher Email Address
Ted	Brian	Brooks	5	2012	K	2	Ann	Le	[email protected]
Jeffrey		Jenkins	3	2012	K	2	Ann	Le	[email protected]
Rose	Ann	Matthews	9	2012	K	1	Gert	Otter	[email protected]
Jennifer	Lynn	Trader	4	2012	K	1	Ann	Le	[email protected]
José		Rodriguez	5	2012	K	2	Gert	Otter	Otter@bates
Roy	John	Zastrow	8	2012	K	2	Gert	Otter	Otter@bates
Sam		Walker	3	2012	K	2	Gert	Otter	Otter@bates
Julie		Walters	6	2012	K	1	Ann	Le	[email protected]

Submitting Your Electronic Student File

After you have created and saved your E-File, proceed to MYIELSUSA. Once you have logged in, click the “Submit Student List” link on the left side of the page. Then click the START E-FILE button at the bottom of the page.

IMPORTANT! If at any point you have any difficulties with this process, please do not hesitate to contact the IELS Help Desk for assistance at 1-888-xxxx.

Please Note: You must submit both your student lists before your school's sample is processed.

IELS

International Early Learning Study

PARENT QUESTIONNAIRE

FIELD TEST DRAFT: PAPER VERSION

The National Center for Education Statistics (NCES) is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543). All of the information you provide may only be used for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). Individuals are never identified in any reports. All reported statistics refer to the U.S. as a whole or to national subgroups.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0936. The time required to complete this survey is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: International Early Learning Study (IELS), National Center for Education Statistics, Potomac Center Plaza, 550 12^th Street, SW, Washington, DC 20202.

OMB No. 1850-0936, Approval Expires 04/30/2020.

The International Early Learning Study

PARENT QUESTIONNAIRE

Your child’s school has agreed to participate in the International Early Learning Study (IELS), an educational research project sponsored by the Organization for Economic Cooperation and Development (OECD) and conducted in the United States by the National Center for Education Statistics (NCES) of the U.S. Department of Education. IELS measures a range of early learning skills and competencies in children who are 5 years old. IELS is working across several countries in order to help improve the educational outcomes of children at this critical developmental stage of life.

Your child has been randomly selected along with several other children in the school. The children will directly participate by completing fun activities on a tablet.

We are asking parents or legal guardians of participating students to also complete a questionnaire. This is the person who lives with the child and knows about his/her behavior, personality, and daily care arrangements. If two people equally consider themselves the main caregiver, please jointly complete this questionnaire.

The information being collected will provide valuable insight into the factors that influence the development of cognitive skills and competencies. We ask that you respond to all of the questions you feel comfortable answering.

Your responses will be combined with responses from other parents to calculate totals and averages. All of the information you provide may only be used for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151).

This questionnaire should be completed by the child’s parent or current legal guardian or jointly by both parents, or legal guardians.

PLEASE READ THESE INSTRUCTIONS

Use black pen when completing this form.

If a mistake is made, correct it this way:  Yes  No

Leave answer circles blank where you have no response.

There are no ”right” or ”wrong” answers. Please answer each question as best as you can.

Please return your form to your child’s teacher or return in the pre-paid envelope.

Please fill out this form with regard to yourself and the
child named on the front page of this questionnaire.

Section A:
About your child

1

Is your child female or male? Please check one circle.

Female

1

Male

2

P01

2
	On what day was your child born? (DD/MM/YY)

P02

3	Does your child engage in any of these activities?
P03	Please check one circle for each line, in response to the child’s capacity in English.	Yes		No
a)	Shows interest in books or e-books	1		2
b)	Respond to questions about the story they have listened to	1		2
c)	Speaks using simple, complete sentences	1		2
d)	Recognize the sounds of words that rhyme	1		2
e)	Classify objects (e.g. blocks) by shape or color or both	1	2
f)	Group objects by size or length or both	1	2
g)	Count to 10 out loud correctly	1	2
h)	Count to 20 out loud correctly	1	2
i)	Recognize simple written numbers (e.g. 3, 10)	1	2
j)	Able to do simple addition using objects	1	2

4	How often does your child use a desktop or laptop computer, tablet device, or a smartphone?
P04	Please check one circle only.
a)	Never or hardly ever	1
b)	At least once a month, but not every week	2
c)	At least once a week, but not every day	3
d)	Every day	4

5	How is your child developing in these areas?	Much less than average	Somewhat less than average	Average	Somewhat more than average	Much more than average
P05	Please check one circle for each line.
a)	Social skills (e.g. adapts, cooperates, is responsible)	1	2	3	4	5
b)	Emotional skills (e.g. controls emotions)	1	2	3	4	5
c)	Trust (e.g. trusts others, asks for help)	1	2	3	4	5
d)	Empathy (e.g. considerate, helpful, caring)	1	2	3	4	5
e)	Self-regulation (e.g. attentive, organized)	1	2	3	4	5
f)	Gross motor skills (e.g. runs, catches and throws balls, has good strength and balance)	1	2	3	4	5
g)	Fine motor skills (e.g. manual dexterity, uses writing and drawing tools)	1	2	3	4	5
h)	Expressive language skills (e.g. uses language effectively, can communicate ideas)	1	2	3	4	5
i)	Receptive language skills (e.g. understands, interprets, listens)	1	2	3	4	5
j)	Numeracy skills (e.g. sort shapes, recognize numbers, count, add objects)	1	2	3	4	5

6	What has your child experienced?
P06	Please check one circle for each line.	Yes	No
a)	Low birth weight	1	2
b)	Hearing difficulties (that can’t be corrected by a hearing aid)	1	2
c)	Vision difficulties (that can’t be corrected by glasses)	1	2
d)	Mobility difficulties	1	2
e)	Intellectual difficulties	1	2
f)	Social, emotional and/or behavioral difficulties	1	2

7	For each statement, select the response that best describes your child.
P07	Please check one circle for each line.	Never	Rarely	Sometimes	Often	Always
1)	Understands others’ feelings, like when they are happy, sad or angry	1	2	3	4	5
2)	Is helpful to other children (e.g. if someone is hurt or upset)	1	2	3	4	5
3)	Obeys instructions or requests	1	2	3	4	5
4)	Dislikes it when asked to play in a different way (frowns, stamps foot)	1	2	3	4	5
5)	Follows rules in games	1	2	3	4	5
6)	Gets upset when you don’t give him/her enough attention	1	2	3	4	5
7)	Tries to comfort others when they are upset	1	2	3	4	5
8)	Waits his/her turn in games or other activities	1	2	3	4	5
9)	Is confident around adults	1	2	3	4	5
10)	Is curious, likes to explore or try new things	1	2	3	4	5
11)	Considers other people’s feelings	1	2	3	4	5
12)	Says nice or friendly things to other children	1	2	3	4	5
13)	Joins in with other children playing	1	2	3	4	5
14)	Prefers watching others instead of joining activities	1	2	3	4	5
15)	Is friendly towards others	1	2	3	4	5
16)	Is calm and relaxed	1	2	3	4	5
17)	Plays games and talks with other children	1	2	3	4	5
18)	Shares toys or possessions with other children	1	2	3	4	5
19)	Teases other children, calls them names	1	2	3	4	5
20)	Is confident with other children	1	2	3	4	5
21)	Prevents other children from doing their own activities	1	2	3	4	5
22)	Is proud of things she/he does	1	2	3	4	5
23)	Has trouble adjusting to change (e.g. becomes upset)	1	2	3	4	5
24)	Bullies or fights with other children	1	2	3	4	5
25)	Is interested in many different things	1	2	3	4	5
26)	Is worried about missing-out (e.g. on attention, access to toys, food/drink)	1	2	3	4	5
27)	Is controlling, needs to have his/her way	1	2	3	4	5
28)	Enjoys talking or being with you	1	2	3	4	5
29)	Likes to visit new places and learn new things	1	2	3	4	5

Section B:
Activities outside of the home

8	Which of the following are available in your local community (e.g. in your neighborhood area)?
P08	Please check one circle for each line.	Yes	No, not available
a)	Public library	1	2
b)	Theater, movie theater, or music hall	1	2
c)	Museum or cultural center	1	2
d)	Local playground or sports center	1	2

9	In the last six months, how often has your child participated in the following family activities that are in addition to school activities?
P09	Please check one circle for each line.	Never	Once	2 to 4 times	5 times or more
a)	Visited a public library	1	2	3	4
b)	Participated in an organized sports or dance lesson	1	2	3	4
c)	Attended the theater or a musical performance	1	2	3	4
d)	Visited a museum or cultural center	1	2	3	4
e)	Went to the local playground	1	2	3	4
f)	Attended a community cultural event	1	2	3	4
h)	Visited a zoo, aquarium, or petting farm	1	2	3	4

10	Is your child attending a language school or receiving tuition to learn a second language?
P10	Please check one circle only.
	Yes	1
	No	2

11	In the past, did your child regularly attend any of the following early education and care programs at each of the following age ranges?
P11	Please check at least one box in each row. Select as many as apply.	Did not attend	Birth to 1 year old	1 year old	2 years old	3 years old	4 years old	5 years or older
a)	Child care or day care in someone’s home	1	2	3	4	5	6	7
b)	Child care or day care in a center	1	2	3	4	5	6	7
c)	Pre-primary education in a public, private, or religious institution (e.g. preschool, preK or TK in a public school, private preschool or place of worship, etc.)	1	2	3	4	5	6	7
d)	Kindergarten	1	2	3	4	5	6	7
e)	1st grade	1	2	3	4	5	6	7

We are interested in your child’s normal routine in most weeks (e.g. not school holidays). We call this a ‘typical week’. Please do not count things that happen sometimes or that are not part of your child’s regular routine. If your child attends services, programs or activities on a schedule where each week is different, please use a weekly average.

12	In a typical week during the last six months, how often is your child cared for by the following people, inside or outside of the home?
P12	Please check one circle for each line.	Not at all	1 day	2 days	3 days	4 days	5 days or more
a)	Nanny, babysitter, or au pair	1	2	3	4	5	6
b)	Grandparent or other relative	1	2	3	4	5	6
c)	Family friend	1	2	3	4	5	6
d)	Before- or after- care provider in a paid program	1	2	3	4	5	6
e)	Playgroup	1	2	3	4	5	6

Section C:
Activities in the home

13	In a typical week during the last six months, how often do you or another person in your home do the following activities with your child?
P13	Please check one circle for each line.	Never	No-longer do this	Less than once a week	1-4 days in a week	5-7 days in a week
a)	Read to this child from a book	1	2	3	4	5
b)	Tell this child a story, not from a book	1	2	3	4	5
c)	Draw pictures or color	1	2	3	4	5
d)	Play music or dance with this child	1	2	3	4	5
e)	Sing songs or nursery rhymes with this child	1	2	3	4	5
f)	Play with toys or games inside like board or card games with this child	1	2	3	4	5
g)	Involve this child in everyday activities like cooking or caring for a pet	1	2	3	4	5
h)	Do things outside together like walking, ball games, swimming or biking	1	2	3	4	5
i)	Do activities with this child that help them to learn letters of the alphabet	1	2	3	4	5
j)	Do activities with this child that help them to learn numbers, measurement and shapes	1	2	3	4	5
k)	Do educational activities on a computer, tablet or smartphone (e.g. use an educational app)	1	2	3	4	5
l)	Play games on a computer, tablet or smartphone	1	2	3	4	5
m)	Do craft activities (e.g. painting, sculpting, building models)	1	2	3	4	5
n)	Take this child to a special or extra-cost activity outside of the home like sports activity, ballet, scouts, swimming lessons, language lessons, etc.	1	2	3	4	5

14	About how many children’s books are there in your home, including from a public library or a school library?
P14	Please check one circle only.
	None	1
	Fewer than 5 books	2
	5-10 books	3
	11-20 books	4
	More than 20 books	5

15	Which of the following are in your home?
P15	Please check one circle for each line.	Yes	No
a)	Computer, laptop, tablet device or smartphone	1	2
b)	Internet access	1	2
c)	Educational software or apps	1	2
d)	Reading material for older children or adults	1	2
e)	Children’s books to help this child with their learning	1	2
f)	Reference books about parenting or child development	1	2

Section D:
About you and your family

For the purposes of this questionnaire, ‘Parent 1’ is the main person who lives with the study child and is most knowledgeable about their behavior, personality and daily care arrangements. We also use the term ‘Parent 2’, who may not necessarily live with the child.

Please only choose one person for Parent 1 and one person for Parent 2 and apply these consistently throughout this section.

16	Please indicate Parent 1 and Parent 2.
P16	Please check one circle in each column.	a) Parent 1	b) Parent 2
	Mother	1	1
	Father	2	2
	Stepmother	3	3
	Stepfather	4	4
	Grandmother	5	5
	Grandfather	6	6
	Aunt	7	7
	Uncle	8	8
	Female guardian	9	9
	Male guardian	10	10
	Other	11	11

16a	Are you Parent1, Parent2, or someone else?
P16a	Please check one circle in each column.
	Parent1	1
	Parent2	2
	Someone else	3

17	How many of the following people usually live at home with your child?
P17	This is the home where the child mainly lives but could include living in more than one home if it is an equal share arrangement. Please check one circle for each line.	None	One	Two	Three	Four or more
a)	Mother(s) (including stepmother or foster mother)	1	2	3	4	5
b)	Father(s) (including stepfather or foster father)	1	2	3	4	5
c)	Brothers (including stepbrothers)	1	2	3	4	5
d)	Sisters (including stepsisters)	1	2	3	4	5
e)	Grandparents	1	2	3	4	5
f)	Aunts or uncles	1	2	3	4	5
g)	Others (e.g. cousin, friend)	1	2	3	4	5

18	How many younger or older siblings does your child have?
P18	This could include other children permanently living in the home (e.g. cousins). Please check one circle for each line.	None	One	Two	Three	Four	Five	More than five
a)	Younger	1	2	3	4	5	6	7
b)	Older	1	2	3	4	5	6	7

19	How old are the child’s parents?
P18	Please check one circle for each line, where applicable.	24 years or younger		25–29 years	30–34 years	35–39 years	40–44 years	45–49 years	50 or older
a)	Parent 1		1	2	3	4	5	6	7
b)	Parent 2		1	2	3	4	5	6	7

20	Were the following family members born in the United States?
P20	Please check one circle for each line.	Yes	No
a)	Your child	1	2
b)	Parent 1	1	2
c)	Parent 2	1	2

21	If your child was not born in the United States, how old was your child when he/she arrived?
P21	Please check one circle.	Age 0-1	Age 1	Age 2	Age 3	Age 4	Age 5
	Your child	1	2	3	4	5	6

22	What is the language most often spoken at home by the following family members?
P22	Please check one circle for each line.	English	Spanish	Chinese	Another language
a)	Your child	1	2	3	6
b)	Parent 1	1	2	3	6
c)	Parent 2	1	2	3	6

23	What is the highest level of formal education completed by the child’s parents?
P23	Please check one circle for each line.	Primary education (any of grades 1-6)	Lower secondary education (any of grades 7-9)	Upper secondary education (any of grades 10-12) general education programs	Associate’s degree (2-year college program)	Bachelor’s degree (4-year college program)	Master’s degree, professional degree, or doctorate
a)	Parent 1	1	2	3	5	6	7
b)	Parent 2	1	2	3	5	6	7

24	What is your annual household income?
P24	Add together the total income, before tax, from all members of your household. Please check one circle only.
	Less than $20,000	1
	$20,000 or more but less than $35,000	2
	$35,000 or more but less than $55,000	3
	$55,000 or more but less than $85,000	4
	$85,000 or more but less than $150,000	5
	$150,000 or more	6

25	Which best describes the current employment situation of this child’s parents?
P25	Please check one circle for each line.	Not working for pay	Part-time (less than 50% of full-time hours)	Part-time (50-70% of full-time hours)	Part-time (71-90% of full-time hours)	Full-time (more than 90% of full-time hours)
a)	Parent 1	1	2	3	4	5
b)	Parent 2	1	2	4	4	5

26	What are the main jobs of the child’s parents?
P26	Please write in the job title (e.g. school teacher, kitchen-hand, sales manager). If he/she is not currently working, please tell us the last main job.
a)	Parent 1
b)	Parent 2

27	What do the child’s parents do in their main jobs?
P27	Please write a sentence to describe the kind of work he/she does or did in that job (e.g. teaches high school students, helps the cook prepare meals in a restaurant, manages a sales team).
a)	Parent 1
b)	Parent 2

Thank you for taking the time to fill in this form

Please return this form to your child’s teacher or in the pre-paid envelope provided.

Site Identification Label

IELS

International Early Learning Study

TEACHER
QUESTIONNAIRE

FIELD TEST DRAFT: PAPER VERSION

The National Center for Education Statistics is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543). All of the information you provide may only be used for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). Individuals are never identified in any reports. All reported statistics refer to the U.S. as a whole or to national subgroups.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0936. The time required to complete this information collection is estimated to average approximately 3 minutes for the teacher-level information and 5 minutes per study student, including the time to review instructions, gather the data needed, and complete and review the information collection.If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: International Early Learning Study (IELS), National Center for Education Statistics, Potomac Center Plaza, 550 12^th Street, SW, Washington, DC 20202.

OMB No. 1850-0936, Approval Expires 04/30/2020.

© ACER, V4 Mar 2017

The International Early Learning Study

TEACHER QUESTIONNAIRE

Your school has agreed to participate in the International Early Learning Study (IELS), an educational research project sponsored by the Organization for Economic Cooperation and Development (OECD) and conducted in the United States by the National Center for Education Statistics (NCES) of the U.S. Department of Education (NCES). IELS measures a range of early learning skills and competencies in 5 year old children. IELS is working within schools, preschool, and child care settings across several countries in order to help improve the educational outcomes of children at this critical developmental stage of life.

This study focuses on a small number of randomly selected children in your school. The children will directly participate by completing fun activities on a tablet, and we are asking their parents or legal guardians to complete a questionnaire. We are also asking the classroom teacher of each sampled child similar questions. These perspectives provide valuable information for the study.

Ideally, you should have known each participating child for at least one month and be able to provide responses about their behaviour and learning, whilst in your care.

This questionnaire should be completed by the staff member who best knows the child.

PLEASE READ THESE INSTRUCTIONS

Please complete SECTION A (about you) only once, and then as many of the SECTION B forms (about a child) assigned to you.

• Use black pen when completing this form.

• If a mistake is made, correct it this way:  Yes  No

• Leave answer boxes blank where you have no response.

• There are no ”right” or ”wrong” answers. Please answer each question as best as you can.

• When you have finished, please staple your Section A form and your Section B forms together.

• Please return all forms to your IELS school coordinator or return in the pre-paid envelope.

Section A:
About you

1

Are you female or male? Please check one circle.

Female

1

Male

2

SA01

2	How old are you?
SA02	Please check one circle only.
	19 years or younger	1
	20-24	2
	25–29	3
	30–39	4
	40–49	5
	50–59	6
	60 years or older	7

3	What is the highest level of formal education you have completed?
SA03	Please check one circle only.
	Master’s degree, professional degree (MD, DDS, lawyer, minister), or doctorate (Ph.D., or Ed.D.)	1
	Bachelor’s degree (4-year college program)	2
	Associate’s degree (2-year college program)	3
	High school	5
	I did not complete high school	6

4	What is the major field of study in your educational qualification?
SA04	If you have more than one area of specialization, please indicate the most recent. Please check one circle only.
	Pre-primary education (pre-kindergarten, preschool)	1
	Kindergarten	2
	Primary education (any of grades 1-6)	3
	Other education-related major (such as secondary education, Educational psychology, education administration, music education, etc.) ………………………	4
	Child development or psychology	5
	Social work	6
	Special Education	8
	None of the above	7

5	How many years of work experience do you have?	Fewer than 2 years	2 to 5 years	6 to 10 years	11 to 20 years	More than 20 years
SA05	Please check one circle only in each row.
a)	Years working as a teacher at this school	1	2	3	4	5
b)	Years working as a teacher, in total	1	2	3	4	5

6	What is your current employment status as a teacher?
SA06	Please consider your employment status at this school and for all your teaching employments together. Please check one circle only in each row.	Part-time (less than 50% of full-time hours)	Part-time (50-70% of full-time hours)	Part-time (71-90% of full-time hours)	Full-time (more than 90% of full-time hours)
a)	My employment at this school	1	2	3	4
b)	All my work as teacher in total	1	2	3	4

Identification Label

Childs name

<First name> <Last name>

<Site-Student ID number>

Section B:
About this child

Please fill out this form with regard to the named child. It is important that you are the staff person who best knows this child. If this is not you, then please let the IELS School Coordinator know.

1	How long have you known this child?
SB01	Please check one circle only.
	1 month or less	1
	2 to 6 months	2
	More than 6 months up to 1 year	3
	More than 1 year	4

2	In your opinion, how involved are this child’s parents/legal guardians in his/her learning?
SB02	Please check one circle only.
	Strongly involved	1
	Moderately involved	2
	Slightly involved	3
	Not involved at all	4
	I do not know the parents/legal guardians of this child well enough to make a judgement	5

3	To your knowledge, which of the following extra services has this child received?
SB03	Please check one circle for each line.	Yes	No
a)	Speech therapy	1	2
b)	Physical therapy	1	2
c)	Individual Family Service Plan (IFSP)	1	2
d)	Occupational therapy	1	2
e)	Psychological assessment	1	2
f)	Learning support (private tutoring)	1	2
g)	English as a second language or bilingual program	1	2
h)	Behavioral management program	1	2

4	Does this child engage in any of these activities?
SB04	Please check one circle for each line, in response to the child’s capacity in English.	Yes	No	Not sure
a)	Shows interest in books or e-books	1	2	3
b)	Respond to questions about a story they have listened to	1	2	3
c)	Speaks using simple, complete sentences	1	2	3
d)	Recognize the sounds of words that rhyme	1	2	3
e)	Classify objects (e.g. blocks) by shape or color or both	1	2	3
f)	Group objects by size or length or both	1	2	3
g)	Count to 10 out loud correctly	1	2	3
h)	Count to 20 out loud correctly	1	2	3
i)	Recognize simple written numbers (e.g. 3, 10)	1	2	3
j)	Do simple addition using objects	1	2	3

5	How is this child developing for their age?	Much less than average	Somewhat less than average	Average	Somewhat more than average	Much more than average
SB05	Please check one circle for each line.
a)	Social skills (e.g. adapts, cooperates, is responsible)	1	2	3	4	5
b)	Emotional skills (e.g. controls emotions)	1	2	3	4	5
c)	Trust (e.g. trusts others, asks for help)	1	2	3	4	5
d)	Empathy (e.g. considerate, helpful, caring)	1	2	3	4	5
e)	Self-regulation (e.g. attentive, organized)	1	2	3	4	5
f)	Gross motor skills (e.g. runs, catches and throws balls, has good strength and balance)	1	2	3	4	5
g)	Fine motor skills (e.g. manual dexterity, uses writing and drawing tools)	1	2	3	4	5
h)	Expressive language skills (e.g. uses language effectively, can communicate ideas)	1	2	3	4	5
i)	Receptive language skills (e.g. understands, interprets, listens)	1	2	3	4	5
j)	Numeracy skills (e.g. sort shapes, recognize numbers, count, add objects)	1	2	3	4	5

6	For each statement, select the response that best describes this child.
SB06	Please check one circle for each line.	Never	Rarely	Sometimes	Often	Always
1)	Understands others’ feelings, like when they are happy, sad or angry	1	2	3	4	5
2)	Is helpful to other children (e.g. if someone is hurt or upset)	1	2	3	4	5
3)	Obeys instructions or requests	1	2	3	4	5
4)	Dislikes it when asked to play in a different way (frowns, stamps foot)	1	2	3	4	5
5)	Follows rules in games	1	2	3	4	5
6)	Gets upset when you don’t give him/her enough attention	1	2	3	4	5
7)	Tries to comfort others when they are upset	1	2	3	4	5
8)	Waits his/her turn in games or other activities	1	2	3	4	5
9)	Is confident around adults	1	2	3	4	5
10)	Is curious, likes to explore or try new things	1	2	3	4	5
11)	Considers other people’s feelings	1	2	3	4	5
12)	Says nice or friendly things to other children	1	2	3	4	5
13)	Joins in with other children playing	1	2	3	4	5
14)	Prefers watching others instead of joining activities	1	2	3	4	5
15)	Is friendly towards others	1	2	3	4	5
16)	Is calm and relaxed	1	2	3	4	5
17)	Plays games and talks with other children	1	2	3	4	5
18)	Shares toys or possessions with other children	1	2	3	4	5
19)	Teases other children, calls them names	1	2	3	4	5
20)	Is confident with other children	1	2	3	4	5
21)	Prevents other children from doing their own activities	1	2	3	4	5
22)	Is proud of things she/he does	1	2	3	4	5
23)	Has trouble adjusting to change (e.g. becomes upset)	1	2	3	4	5
24)	Bullies or fights with other children	1	2	3	4	5
25)	Is interested in many different things	1	2	3	4	5
26)	Is worried about missing out (e.g. on attention, access to toys, food/drink)	1	2	3	4	5
27)	Is controlling, needs to have his/her way	1	2	3	4	5
28)	Enjoys talking or being with you	1	2	3	4	5
29)	Likes to visit new places and learn new things	1	2	3	4	5

Thank you for taking the time to fill in this form

Please return this form to the IELS school coordinator or in the pre-paid envelope provided.

Additional Questions for Parents (U.S. Only)

Category	Which best describes you?
	(Please select one response.)
1	I am Hispanic or Latino
2	I am not Hispanic or Latino
	Which of these categories best describes your race?
	(Please select one or more responses.)
	White
	Black or African American
	Asian
	American Indian or Alaska Native
	Native Hawaiian or Other Pacific Islander
1	Selected
2	Not Selected
Category	Which best describes your child?
	(Please select one response.)
1	I am Hispanic or Latino
2	I am not Hispanic or Latino
	Which of these categories best describes your child's race?
	(Please select one or more responses.)
	White
	Black or African American
	Asian
	American Indian or Alaska Native
	Native Hawaiian or Other Pacific Islander
1	Selected
2	Not Selected

Additional Questions for Teachers (U.S. Only)

Category	Which best describes you?
	(Please select one response.)
1	I am Hispanic or Latino
2	I am not Hispanic or Latino
	Which of these categories best describes your race?
	(Please select one or more responses.)
	White
	Black or African American
	Asian
	American Indian or Alaska Native
	Native Hawaiian or Other Pacific Islander
1	Selected
2	Not Selected

B-2