Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) Main Study Base Year (MS1), Operational Field Test First Follow-up (OFT2), and Tracking and Recruitment for Main Study First Follow-up (MS2)

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

Main Study Base Year (MS1), Operational Field Test First Follow-up (OFT2), and Tracking and Recruitment for Main Study First Follow-up (MS2)

OMB# 1850-0911 v.16

Appendices MS1-T-V: Student Roster Template and Data Collection Instruments

Appendices OFT2-U1 and OFT2-U2: Data Collection Instruments

National Center for Education Statistics

U.S. Department of Education

Institute of Education Sciences

Washington, DC

July 2017

revised September 2017

Table of Contents

Appendix MS1-T. Student Rostering Form 1

Appendix MS1-U1. Student Survey Specifications 2

Appendix MS1-U2. Parent Interview Survey Specifications 30

Appendix MS1-U3. Mathematics Teacher Survey Specifications 99

Appendix MS1-U4. Special Education Teacher Survey Specifications 154

Appendix MS1-U5. School Administrator Survey Specifications 221

Appendix MS1-V. Facilities Checklist Specifications 273

Appendix OFT2-U1. Student Survey Specifications 284

Appendix OFT2-U2. School Administrator Survey Specifications 288

Appendix MS1-T. Student Rostering Form

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

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

Please be certain to include all students currently enrolled in sixth grade at your school.

Please include ungraded students at ages 11-13 currently enrolled at your school whose primary IEP
designation is one of the three focal IEP categories: Autism, Emotional Disturbance, or Specific Learning Disability.

Please include in your enrollment list students with an IEP classification of Autism, Emotional Disturbance, or Specific Learning Disability (whether in sixth grade or in an ungraded setting) who are enrolled at your school, even if they may spend time at another school. These students may take academic or non-academic classes; or they may be in a “school within a school,” or a school co-located with your school.

General Student information

Race (Y/N all that apply)

Ethnicity (Y/N)

ELL

IEP

Disability Code

Parent Contact information

Student's Math Teacher

Student's Special Education Teacher, if applicable

StudentID

FirstName

LastName

Suffix

Grade 6 or U=ungraded

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

Student ELL Status?

Does student have IEP? (Y/N)

IEP status (disability codes)

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) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 5 minutes per row, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

Appendix MS1-U1. Student Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 20 minutes per response, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

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

MS1 Student Questionnaire

Note: Survey specifications are presented in order of administration. Item numbering is retained between rounds so may not reflect that order.

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.

ALL

Intro to Part 1.

The first questions are about you.

Please click START to begin.

ALL

A.005 (Q1.00A) Is English your first language?

4110810

 Yes 1 Q1.00B

 No 0 Q1.00B

NO RESPONSE M Q1.00B

ALL

A.010 (Q1.00B) How well do you read English?

4110820

 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

ALL

A.015 (Q1.01) How old are you?

Q1.02

▼

4110104

(9 or younger, 10, 11, 12, 13, 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, “Your responses are very important. Please answer as many questions as possible. Use the PREVIOUS button at the bottom of each page to back up and answer questions that were left blank or press “Next” to continue.”, should appear when three consecutive questions that are select all/select one questions are left blank.

ALL

A.020 (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

A.025 (Q1.03) What is your sex?

4110200

Select the one that best describes you.

 Male 1 Q1.04

 Female 2 Q1.04

NO RESPONSE M Q1.04

ALL

A.030 (Q1.04) This question is 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

	Select one answer for each row.	Did not participate	Participated	Participated as an officer, leader, or captain
4020101	a. School sports	1 	2 	3 
4020102	b. Math or science clubs	1 	2 	3 
4020104	c. Performing arts, such as music, dance, and/or theater	1 	2 	3 
4020105	d. Student government	1 	2 	3 
4020106	e. School yearbook, newspaper, or literary magazine	1 	2 	3 
4020110	f. Media arts, such as animation, computer graphics, or video games	1 	2 	3 
4020111	g. Visual arts, such as painting, sculpture, or pottery	1 	2 	3 
4020103	h. Other school clubs	1 	2 	3 
4020107	i. Other school-sponsored activities	1 	2 	3 

If Q1.04H>1 or q1.04I>1

A.030OTHER (Q1.04OTHER)

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

4020109

(STRING 255)

4020108

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

(STRING 255)

ALL

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

A.035A (Q1.05A) How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
4050601	a. You have a certain amount of intelligence and you can’t really do much to change it.	1 	2 	3 	4 	5 	6 
4050602	b. Your intelligence is something about you that you can’t change very much.	1 	2 	3 	4 	5 	6 
4050603	c. No matter who you are, you can change your intelligence.	1 	2 	3 	4 	5 	6 

ALL

A.035B (Q1.05B) How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
4050604	d. You can learn new things, but you can’t really change your basic intelligence.	1 	2 	3 	4 	5 	6 
4050605	e. You can always change your intelligence.	1 	2 	3 	4 	5 	6 
4050606	f. No matter how much intelligence you have, you can always change it quite a bit.	1 	2 	3 	4 	5 	6 

ALL

A.040 (Q1.06) How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all true	A little bit true	Somewhat true	True	Very true
4050301	a. I am certain I can learn everything taught in math.	1 	2 	3 	4 	5 
4050302	b. I am sure I can do even the most difficult homework problems in math.	1 	2 	3 	4 	5 
4050303	c. I am confident I can do all the work in math class if I don’t give up.	1 	2 	3 	4 	5 
4050304	d. I am confident I can do even the hardest work in my math class.	1 	2 	3 	4 	5 

ALL

A.045 (Q1.07) How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all true	A little bit true	Somewhat true	True	Very true
4050401	a. Math will be useful for me later in life.	1 	2 	3 	4 	5 
4050402	b. Math helps me in my daily life outside of school.	1 	2 	3 	4 	5 
4050403	c. Being someone who is good at math is important to me.	1 	2 	3 	4 	5 
4050404	d. I enjoy doing math.	1 	2 	3 	4 	5 

all

A.050 (Q1.08) What time do you usually wake up on school days?

PROGRAMMER: INSERT THREE DOWN FIELDS

HOUR MINUTE AM/PM

4080111

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

A.055 (Q1.09) What time do you usually go to sleep on school nights?

PROGRAMMER: INSERT THREE DOWN FIELDS

HOUR MINUTE AM/PM

4080112

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

End1 Thank you. Next are some math problems.

Please click START to begin.

PROGRAMMER BOX

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

ALL

Next are some more questions about you.

Press "Next" to continue.

all

B.005 (Q2.01) These questions ask about activities you might do outside of school.

How often do you spend time…

PROGRAMMER: CODE ONE PER ROW

	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
4020210	a. Working on arts and/or crafts?	1 	2 	3 	4 	5 
4020230	b. Playing organized non-school sports?	1 	2 	3 	4 	5 
4020250	c. Participating in a non-school organized group activity, like 4-H, Scouts, or youth group?	1 	2 	3 	4 	5 
4020280	d. Singing, playing a musical instrument, creating or performing music, dancing, or acting?	1 	2 	3 	4 	5 
4020290	e. Journaling or your own creative writing?	1 	2 	3 	4 	5 
	f. Doing other activities or hobbies?	1 	2 	3 	4 	5 

If Q2.01F>1

B.005OTHER (Q2.01OTHER)

4020270

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

(STRING 255)

ALL

4024120

B.010 (Q2.02) Do you receive an allowance?

 Yes 1 Q2.03

 No 0 Q2.03

All

B.015 (Q2.03) Some people your age get paid for work they do.

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.)

4024110

 Yes 1 Q2.04

 No 0 Q2.04

PROGRAMMER BOX Q2.03

PROGRAMMERS: IN QUESTION Q2.03, PLEASE Display help text when THE PHRASE “WORK outside of the home” is hovered over

Help text for Q2.03 QUESTION TEXT:

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

ALL

B.020 (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

B.025 (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

B.030 (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 Q2.07A

 Never 1 Q2.07A

 Rarely 2 Q2.07A

 Sometimes 3 Q2.07A

 Often 4 Q2.07A

 Very often 5 Q2.07A

 Always 6 Q2.07A

NO RESPONSE M Q2.07A

ALL

B.035A (Q2.07A) How often do you...

	Select one answer for each row.	Never	Less than once a week	A few times a week	About once a day	Many times a day
4021101	a. Watch video clips for fun on YouTube, Instagram, Snapchat, or other sites?	1 	2 	3 	4 	5 
4021102	b. Look up information online for your own interests (for example, using Google, Reddit, Tumblr, or other sites)?	1 	2 	3 	4 	5 
4021103	c. Play video games, computer games, or mobile games?	1 	2 	3 	4 	5 
4021104	d. Video chat through programs like Facetime, OoVoo, or Skype?	1 	2 	3 	4 	5 
4021105	e. Message with friends using texting, KIK, iMessage, Snapchat, WhatsApp, or some other app?	1 	2 	3 	4 	5 

ALL

B.035B (Q2.07B) How often do you...

	Select one answer for each row.	Never	Less than once a week	A few times a week	About once a day	Many times a day
4021106	f. Post photos, videos, or updates on social media sites (such as Twitter, Instagram, Facebook, Snapchat, or Ask.fm)?	1 	2 	3 	4 	5 
4021107	g. Send emails to friends, family members, teachers, or others?	1 	2 	3 	4 	5 
4021108	h. Make your own digital art or music (such as painting, graphics, videos, music)?	1 	2 	3 	4 	5 
4021109	i. Write computer programs (code) or develop apps?	1 	2 	3 	4 	5 
4021110	j. Do some other activity using a computer, tablet, phone, or similar device?	1 	2 	3 	4 	5 

If Q2.07J>1

B.035OTHER (Q2.07OTHER)

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

4021111

(STRING 255)

ALL

B.040 (Q2.08) On a typical weekday, how much time each day do you spend using electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.):

4021201

1. For school-related activities:

Minutes

▼

Hours

▼

(Hours: 0-24)

(Minutes: 00, 15, 30, 45)

4021202

2. For all other activities that are not school-related:

Minutes

▼

Hours

▼

(Hours: 0-24)

(Minutes: 00, 15, 30, 45)

ALL

B.045 (Q2.10) On a typical weekend day, how much time each day do you spend using electronic devices (including phone, tablet, computer, video game systems, television, iPod, etc.):

4021203

1. For school-related activities:

Minutes

▼

Hours

▼

(Hours: 0-24)

(Minutes: 00, 15, 30, 45)

4021204

2. For all other activities that are not school-related:

Minutes

▼

Hours

▼

(Hours: 0-24)

(Minutes: 00, 15, 30, 45)

ALL

B.050 (Q2.11A) How much time do you spend reading, not counting school work or any school-assigned reading:

4021205

Hours

Minutes

▼

▼

1. On the average weekday:

(Minutes: 00, 15, 30, 45)

(Hours: 0-24)

▼

4021206

Hours

Minutes

▼

2. On the average weekend day:

(Hours: 0-24)

(Minutes: 00, 15, 30, 45)

PROGRAMMER BOX Q2.11A

display help text when hovering over THE WORDS “SPEND ReadING” for Q2.11A (first time that Reading is mentioned)

help text:

Reading includes anything you read from a paper or electronic source, such as a book, magazine, or tablet.

ALL

C.005 (Q2.12) Next is a question about things that may happen at your school.

How often does the following happen at your school?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
4010201	a. I feel like a real part of my school.	1 	2 	3 	4 	5 
4010202	b. People notice when I’m good at something.	1 	2 	3 	4 	5 
4010203	c. Other students take my opinions seriously.	1 	2 	3 	4 	5 
4010204	d. People are friendly to me.	1 	2 	3 	4 	5 
4010205	e. I’m included in lots of activities.	1 	2 	3 	4 	5 
4010303	f. I feel safe at this school.	1 	2 	3 	4 	5 

all

C.010 (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

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
4010601	a. Physical conflicts (fights) among students.	1 	2 	3 	4 	5 
4010602	b. Students bullied other students.	1 	2 	3 	4 	5 
4010603	c. Students yelled and screamed at the teachers.	1 	2 	3 	4 	5 

all

C.015 (Q2.13A) The next questions are about the students at your school.

During this school year, how often have other students…

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4010604	a. Teased you, made fun of you, or called you names?	1 	2 	3 	4 	5 	6 
4010605	b. Told lies or untrue stories about you?	1 	2 	3 	4 	5 	6 
4010606	c. Pushed, shoved, slapped, hit, or kicked you?	1 	2 	3 	4 	5 	6 

all

C.020 (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

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4010501	a. I get along well with my teachers.	1 	2 	3 	4 	5 	6 
4010502	b. My teachers listen to what I have to say.	1 	2 	3 	4 	5 	6 
4010503	c. If I need extra help, I receive it from my teachers.	1 	2 	3 	4 	5 	6 
4010504	d. My teachers treat me fairly.	1 	2 	3 	4 	5 	6 
4010505	e. My teachers care about my feelings.	1 	2 	3 	4 	5 	6 

All

C.025 (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

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4030101	a. My classmates think it is important to be my friend.	1 	2 	3 	4 	5 	6 
4030102	b. My classmates like me the way I am.	1 	2 	3 	4 	5 	6 
4030103	c. My classmates care about my feelings.	1 	2 	3 	4 	5 	6 
4030104	d. My classmates like me as much as they like other classmates.	1 	2 	3 	4 	5 	6 
4030105	e. My classmates really care about me.	1 	2 	3 	4 	5 	6 

all

C.030 (Q2.16) Next are a few questions about people who you hang out with, including people you know from school or from somewhere else.

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

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all important	A little bit important	Somewhat important	Important	Very important
4030201	a. Attend classes regularly?	1 	2 	3 	4 	5 
4030202	b. Get good grades?	1 	2 	3 	4 	5 
4030203	c. Work hard in school?	1 	2 	3 	4 	5 

ALL

The next questions are about sleeping and how you feel physically.

D.005 (Q2.17) In the last month, how often…

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
4080101	a. Did you wake up feeling tired?	1 	2 	3 	4 	5 
4080102	b. Did you have trouble falling asleep?	1 	2 	3 	4 	5 
4080103	c. Did you have trouble staying asleep?	1 	2 	3 	4 	5 
4080104	d. Did you move a lot when you slept / had restless sleep?	1 	2 	3 	4 	5 
4080105	e. Did you have trouble staying awake while sitting in class or watching TV?	1 	2 	3 	4 	5 

all

D.010 (Q2.18) In the last month, how often…

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often
4040101	a. Did you have a headache?	1 	2 	3 	4 	5 
4040102	b. Did you have aches, pains, or soreness in your muscles or joints?	1 	2 	3 	4 	5 
4040103	c. Did you have a stomachache?	1 	2 	3 	4 	5 

all

D.015 (Q2.19) Do you…

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Yes	No
4040200	a. Have a hard time seeing things in the distance?	1 	2 
4040201	b. Have a hard time seeing the board in your classroom?	1 	2 
4040202	c. Have a hard time seeing things close-up (like letters on paper)?	1 	2 

ALL

D.020 (Q2.20A) How often do you wear eyeglasses or contact lenses to help you see better?

4040204

 Always/Most of the time 1 Q2.21

 Often 2 Q2.21

 Sometimes 3 Q2.21

 Rarely 4 Q2.21

 Never 5 Q2.21

 I do not have glasses/contact lenses 6 Q2.20B

IF Q2.20A = 6

D.025 (Q2.20B) Have you been told by a professional like an eye doctor that you need glasses or contact lenses to help you see better?

4040203

 Yes 1

 No 2

ALL

D.030 (Q2.21) The next questions are about you and your family.

Are you Hispanic or Latino/Latina?

4110300

 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

D.035 (Q2.22) Which of the following best describes you?

Select all that apply.

4110410

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

4110470

 Other Hispanic or Latino/Latina 99 Q2.23

4110471

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

D.040 (Q2.23) Which of the following best describes your race?

Select all that apply.

4110510

 White 1 Q2.25

4110540

4110520

4110530

 Black or African American 2 Q2.25

 Asian 3 Q2.24

 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

D.045 (Q2.24) Which of the following best describes you?

Select all that apply.

4110650

4110620

4110610

 Asian Indian 1 Q2.25

 Chinese 2 Q2.25

4110630

 Filipino 3 Q2.25

4110640

 Japanese 4 Q2.25

4110660

 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

D.050 (Q2.25) How much do you agree or disagree with the following statements?

PROGRAMMER: CODE ONE PER ROW

	Please select one response per row.	Strongly agree	Agree	Slightly agree	Slightly disagree	Disagree	Strongly disagree
4051101	a. I feel close to others who share my race/ethnicity.	1 	2 	3 	4 	5 	6 
4051102	b. Other people judge me based on my race/ethnicity.	1 	2 	3 	4 	5 	6 
4051103	c. I get in fights with other people because of my race/ethnicity.	1 	2 	3 	4 	5 	6 
4051104	d. People do not want to hang out with me because of my race/ethnicity.	1 	2 	3 	4 	5 	6 

all

D.055 (Q2.26) Now imagine a ladder that represents how your school is set up.

• 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 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.

4051020

 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

D.060 (Q2.27) How often do your parents/guardians...

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4060302	a. Respect your privacy?	1 	2 	3 	4 	5 	6 
4060303	b. Give you a lot of freedom?	1 	2 	3 	4 	5 	6 
4060304	c. Make most of the decisions about what you can do?	1 	2 	3 	4 	5 	6 
4060305	d. Believe you have a right to your own point of view?	1 	2 	3 	4 	5 	6 

all

D.065 (Q2.28) How often do your parents/guardians...

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4060401	a. Know what you do during your free time?	1 	2 	3 	4 	5 	6 
4060402	b. Know how much homework you have?	1 	2 	3 	4 	5 	6 
4060403	c. Know what you spend your money on?	1 	2 	3 	4 	5 	6 
4060404	d. Know when you have an exam or paper due at school?	1 	2 	3 	4 	5 	6 
4060405	e. Know what your school grades are?	1 	2 	3 	4 	5 	6 

PROGRAMMER BOX Q2.28

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

Help text for Q2.28 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

E.005 (Q2.29) Next are statements about you and where you live.

How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all true	A little bit true	Somewhat true	True	Very true
4060601	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 
4060602	b. I want to get away from my neighborhood as soon as I can.	1 	2 	3 	4 	5 
4060603	c. I can count on people in my neighborhood to help me if I need it.	1 	2 	3 	4 	5 
4060604	d. I feel very safe walking and playing in my neighborhood.	1 	2 	3 	4 	5 
4060605	e. I feel very safe participating in after school activities in my community.	1 	2 	3 	4 	5 

all

E.010A (Q2.30A) How often are the following statements true for you?

I see myself as someone who...

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4050101	a. Does things carefully and completely.	1 	2 	3 	4 	5 	6 
4050102	b. Can be somewhat careless.	1 	2 	3 	4 	5 	6 
4050103	c. Is a reliable worker.	1 	2 	3 	4 	5 	6 
4050104	d. Tends to be disorganized.	1 	2 	3 	4 	5 	6 
4050105	e. Tends to be lazy.	1 	2 	3 	4 	5 	6 

all

E.010B (Q2.30B) How often are the following statements true for you?

I see myself as someone who...

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4050106	f. Keeps working until things are done.	1 	2 	3 	4 	5 	6 
4050107	g. Does things efficiently (quickly and correctly).	1 	2 	3 	4 	5 	6 
4050108	h. Makes plans and sticks to them.	1 	2 	3 	4 	5 	6 
4050109	i. Is easily distracted.	1 	2 	3 	4 	5 	6 
4050110	j. Has trouble paying attention.	1 	2 	3 	4 	5 	6 

all

E.015 (Q2.31) How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all true	A little bit true	Somewhat true	True	Very true
4050901	a. I like to explore strange places.	1 	2 	3 	4 	5 
4050902	b. I like to do frightening things.	1 	2 	3 	4 	5 
4050903	c. I like new and exciting experiences.	1 	2 	3 	4 	5 
4050904	d. I prefer friends who are exciting and unpredictable.	1 	2 	3 	4 	5 

all

E.020 (Q2.32) How true are the following statements for you?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Not at all true	A little bit true	Somewhat true	True	Very true
4050701	a. When I become confused about something I’m learning at school, I try to figure it out.	1 	2 	3 	4 	5 
4050702	b. I work my hardest to learn at school, even if I do not like the subject.	1 	2 	3 	4 	5 
4050703	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 
4050704	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

E.025A (Q2.33A) How often are the following statements true for you?

PROGRAMMER: CODE ONE PER ROW

	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
4050201	a. I think I am doing pretty well.	1 	2 	3 	4 	5 	6 
4050202	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 
4050203	c. I am doing at least as well as other people my age.	1 	2 	3 	4 	5 	6 

all

E.25B (Q2.33B) How often are the following statements true for you?

PROGRAMMER: CODE ONE PER ROW

	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
4050204	d. When I have a problem, I can come up with lots of ways to solve it.	1 	2 	3 	4 	5 	6 
4050204	e. I think the things I have done in the past will help me in the future.	1 	2 	3 	4 	5 	6 
4050206	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

E.30 (Q2.34) As things stand now, how far in school do you think you will go?

Select one only.

4070200

 I won’t finish high school. 1 END1

 I will graduate from high school, but won’t go any further. 2 END1

 I will go to a technical or trade school after high school. 3 END1

 I will attend college. 4 END1

 I will graduate from college. 5 END1

 I will attend a higher level of school after graduating from college. 6 END1

 Don’t know. 7 END1

NO RESPONSE M END1

PROGRAMMER BOX Q2.34

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

help text for response option 3:

Examples of things a person might study in a 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:

A person attending a higher level of school after graduating from college may be studying for a master’s degree, a PhD degree, or a professional degree, for example to become a lawyer or a doctor..

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.”

PROGRAMMER BOX Q2.35

IF SCHOOL OPTS OUT OF SENSITIVE ITEMS, THE STUDENT DOES NOT ANSWER ANY MORE QUESTIONS,

gO TO final screen:

End of Part 2. Next you will be completing some reading activities.

Press “Next” to continue to the next section.

all

F.005 (Q2.35) How often does the following happen with your parents/guardians?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Rarely	Sometimes	Often	Very often	Always
4060503	a. I keep a lot of secrets from my parents/guardians about what I do during my free time.	1 	2 	3 	4 	5 	6 
4060501	b. 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 
4060502	c. 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 

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 reading module of the in-school session.

Appendix MS1-U2. Parent Interview Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 40 minutes per response, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

ALL

A. WEB INTRO

INTRO1 (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 {CFNAME}’s 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 ($20-40) check for completing this survey.]

Please click the “Next” button below.

ALL

INTRO2 (A01c). Before you get started, here are a few helpful hints.

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

• 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 20 minutes.

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

HH2FNAME=Respondent’s first name HH2LNAME= Respondent’s last name

A001 (A02.) Are you {HH2FNAME HH2LNAME TAKEN FROM CONSENT FORM}?

5010200

 Yes 1 A005

 No 2 A005

PROGRAMMER BOX A001

Hard check if a001=missing:

Please respond to this question so you may continue.

ALL

CFNAME=Child’s first name

5010301

A005 (A03a.) Does {CFNAME} {CLNAME} live with you?

 Yes 1 A010

 No 2 A040

PROGRAMMER BOX A005

Hard check if a005=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.

ALL

CFNAME=Child’s first name

5010302

A006 How much of the time does {CFNAME} live with you?

 All of the time 1 A010

 More than half of the time 2 A007

 Half of the time 3 A007

 Less than half of the time 4 A007

 None of the time 5 A007

ASK IF A006>1

CFNAME=Child’s first name

5010303

A007 With whom does {CFNAME} live most of the time when not living with you?

 With another parent 1

 With another adult relative 2

 With a friend 3

 At a boarding school 4

 By himself or herself 5

 Other 6

Specify

ASK IF A005=1

CFNAME=Child’s first name

A010 (A03.) Are you the parent, guardian, or person in this household who knows the most about {CFNAME}'s development, schooling, and home life?

5010300

 Yes 1 A015

 No 2 A025

NO RESPONSE M A025

ASK IF A001=1 and A005=1

HH2FNAME= Respondent’s first name; HH2MNAME = Respondent’s middle name; HH2LNAME = Respondent’s last name; HH2SUFFIX = Respondent’s suffix to name

A015 (A04a.) Please check the spelling of your full name.

First name: [HH2FNAME]

Middle name: [HH2MNAME]

Last name: [HH2LNAME]}

Suffix: [HH2SUFFIX]

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 A001=2 OR MISSING and A010=1

HH2FNAME= Respondent’s first name; HH2MNAME = Respondent’s middle name; HH2LNAME = Respondent’s last name

A020 (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 A020

If A001=2 AND A010=1, GOTO A020. Do not display "Current info" information.

ASK IF A010 NE 1

CFNAME= Child’s first name

A025 (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 2018 to complete this questionnaire?

5010501

 Yes 1 A030

 No 2 A040

NO RESPONSE M A040

ASK IF A025=1

A030 (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)

5010507

e Phone Number: [___________________](STRING 10)

5010508

f Email: [___________________](STRING 50)

ASK IF A025=1

A035 (FPPREINTRO.) If {NAME FROM A030B} 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 INTRO1

 Log out 2

ASK IF A025 NE 1 OR IF A005=2

CFNAME= Child’s first name

A040 (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 A040

If A025=2 and new respondent information is entered at A040, GOTO “Exit Screen".

PROGRAMMER NOTE: When re-entering this case, GOTO to INTRO1 for the new respondent.

HARD CHECK if A040a or A040b=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.

HARD CHECK if A040e and A040f= MISSING. Please provide a phone number or email address so you may continue.

ASK IF A040=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 (A040).

PROGRAMMER BOX “ALL”

FROM THIS POINT FORWARD, ENTRANCE REQUIREMENTS FOR “ALL” REFERS TO ELIGIBLE RESPONDENTS (I.E., A010=1)

ALL

CFNAME= Child’s first name

A045 (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)

ALL

CFNAME= Child’s first name

A050 (A08.) What is {CFNAME}'s sex?

5010800

 Male 1

 Female 0

ALL

CFNAME= Child’s first name

A055 (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) (2000-2011)

NO RESPONSE M

PROGRAMMER BOX A055

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 A055_DAY = MISSING AND {CFNAME}’S A055_MONTH = MONTH(INTERVIEW_DATE), THEN ROUND {CFNAME’S} B005A (AGE) UP

ASK IF A055 IS NOT MISSING

A060 (A09CONFIRM.) Just to confirm, is {CFNAME} {AGE IN YEARS} years old?

5010905

 Yes 1 A070

 No 0 A065

PROGRAMMER BOX A060

{AGE IN YEARS} TO BE CALCULATED USING THE DATE OF BIRTH PROVIDED IN A055.

ASK IF A055_MONTH = MISSING OR IF A055_YEAR = MISSING

CFNAME= Child’s first name

A065 (A09a.) How old is {CFNAME}?

5010904

▼

PROGRAMMER: INSERT DROP DOWN FIELDS

0 YEARS OLD

(7-18)

NO RESPONSE M

PROGRAMMER BOX A065

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

ALL

CFNAME= Child’s first name

A070 (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 to continue.

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 A070

NOTE TO PROGRAMMER:

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

ALL

IF A010=1 and A070 NE Missing; A075e-i should not display

A075 (A11.) Please provide up-to-date contact information for yourself

5010011

a. Primary phone:

5010012

b. Alternate phone (if available):

5010014

5010013

c. Primary email:

5010015

d. Alternate email (if available):

e. Street address 1:

5010017

5010016

f. Street address 2:

5010018

g. Zip code:

5010019

h. City:

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

B001 (B01.) In addition to you and {CFNAME}, does anyone else live in the household?

5021000

 Yes 1 B005A

 No 2 B010

ASK IF B001=1

CFNAME= Child’s first name

B005A (B01b.) In addition to you and {CFNAME}, who else lives in your household? To add someone, fill in that person’s first name, last name, and suffix (if applicable), then click “Add.” When all the people living in your household are listed, press “Next.”

First name	Last name	Suffix
{HH2FNAME} 5021001	{HH2LNAME} 5021002	{HH2SUFFIX} 5021003
{CFNAME} 5021101	{CLNAME} 5021102	{CSUFFIX} 5021103
{HH3FNAME} 5020203	{HH3LNAME} 5020303	{HH3SUFFIX} 5020403

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 B005A 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.”

B005B (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 B005A

 No 2 B010

PROGRAMMER BOX B005A and b005b

In addition to child and respondent, Respondent permitted to add up to 23 household members (for 25 total). if limit is met, and respondent indicates b005b=1, a pop-up should appear:

Thanks for listing your additional household members up to this point. We will now move on to the next section.

AFTER COMPLETING THE PROCESS OF ADDING HOUSEHOLD MEMBERS, When a respondent clicks “No” (B005b=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 “yes” and “no” button should be on the pop-up with “yes” advancing the respondent through the survey, and “no” returning TO the family roster data.

ALL

FILL from A015 or A020: HH2FNAME= Respondent’s first name; HH2LNAME= Respondent’s last name

FILL from A045: CFNAME= Child’s first name; CLNAME= Child’s last name.

B010 (B02.) Please tell us a little bit about the members of your household. For each household member, tell the age, relationship to {CFNAME} and sex. If you are not sure of something, your best guess is fine.

	{HH2FNAME} {HH2LNAME}	{CFNAME}	{HH3FNAME} {HH3LNAME}
B010a (B02a.) What is [your/{HHNAME}’s] age?	5022001 Select age…	5022001 {Age from A060}	5022201 Select age…
B010b (B02f.) What is [your/{HHNAME}’s] relationship to {CFNAME}?	5022006 Select relationship…		5022206 Select relationship…
B010c (B02g.) Which of the following best describes this relationship with {CFNAME}?	5022007 Select specific relationship…		Select specific relationship… 5022207
B010d (B02b.) What is [your/{CFNAME}’s/{HHNAME}’s] sex?	5022002 Select sex…		Select sex… 5022202
B010e (b02d.) Which of the following choices describes [your/IDP1’s/{CFNAME}’s/IDP2’s] race? You may choose more than one.	5022004 Select race…	5022104 Select race…	5022204 Select race…
B010f (b02c.) [Are you/Is IDP1/Is {CFNAME}/Is IDP2] Hispanic or Latino/Latina?	5022003 Select…	5022103 Select…	5022203 Select…

SOFT CHECK: IF B010A THROUGH B010E IS MISSING FOR EITHER THE RESPONDENT {HH2FNAME}, 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 B010 THE B010 LOOP SHOULD ASK SEX, AGE, RACE, ETHNICITY, AND RELATIONSHIP QUESTIONS ACCORDING TO THE B001 MEMBER TYPE ORDERING. RESPONDENT (HH MEMBER #2) CHILD (HH MEMBER #1) HH MEMBER #3 HH MEMBER #4, ETC. row a should already be filled out for the child based on responses to a055. 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 be asked of every member in the household, with the response for child prefilled. Other response options for row B include: Mother/Female guardian # Father/Male guardian # Sister Brother Girlfriend or partner of {CFNAME}’s parent/guardian Boyfriend or partner of {CFNAME}’s parent/guardian Grandmother Grandfather Aunt Uncle Cousin Other relative (please specify) Other non-relative Focus child programmer note: row B - When asking B010 question SERIES for {CFNAME} [CLNAME] , automatically code B010B as 14(focus child). Do not display the B010B question. row C will be populated based on responses to row B. if row B=1, row C will be: Biological or birth mother Adoptive mother Step mother Foster mother or female guardian 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 B=2, row C will be: Biological or birth father Adoptive father Step father Foster father or male guardian 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 B=3, row C will be: Full sister Half sister Step sister Adoptive sister 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 B=4, row C will be: Full brother Half brother Step brother Adoptive brother 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 B=13, row C will be: Girlfriend or partner of {CFNAME}’s parent/guardian Boyfriend or partner of {CFNAME}’s parent/guardian Female guardian Male guardian Daughter/son of {CFNAME}’s parent’s partner Other relative of {CFNAME}’s parent’s partner (please specify) 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 D will have the following response options: Male Female FOR ROW D: Don’t ask B010D when A050=1 or 0 and B010D is asked in regards to THE focus child. Fill in gender fills based on responses to row B. if row B = 1, 3, 7, 9, then automatically fill row D = 2 (female). If row B=2, 4, 8, or 10, then automatically fill row D = 1 (male). For all other options in row B, responses will be recorded using the drop down boxes. For {CFNAME}, fill in row D based on response in a050. In other words, if row B= Mother/Female guardian #: FILL ROW D = 2 (Female) Father/Male guardian #: FILL ROW D = 1 (Male) Sister: FILL ROW D = 2 (Female) Brother: FILL ROW D = 1 (Male) Girlfriend or partner of {CFNAME}’s parent/guardian: NO FILL. Allow respondents to select 1 or 2 for Row D Boyfriend or partner of {CFNAME}’s parent/guardian: NO FILL. Allow respondents to select 1 or 2 for Row D Grandmother: FILL ROW D = 2 (Female) Grandfather: FILL ROW D = 1 (Male) Aunt: FILL ROW D = 2 (Female) Uncle: FILL ROW D = 1 (Male) Cousin: NO FILL. Allow respondents to select 1 or 2 for Row D Other relative (please specify): NO FILL. Allow respondents to select 1 or 2 for Row D Other non-relative: NO FILL. Allow respondents to select 1 or 2 for Row D For Focus child: FILL ROW D = 1 IF A050=1; FILL ROW B=2 IF A050=0. row E will have the following response options: White Black or African American Asian Native Hawaiian or other Pacific Islander American Indian or Alaska Native PROGRAMMER NOTE (for Row E): “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 F will have the following response options: Yes, this person is Hispanic or Latino/Latina No, this person is not Hispanic or Latino/Latina

PROGRAMMER BOX B010 – Identification of parent 1 and parent 2

1) If there was only one mother (of any type) and only one father (of any type) in the household, the mother was identified as parent 1 (IDP1) and the father was identified as parent 2 (IDP2);

2) IF THERE IS ONLY ONE MOTHER (OF ANY TYPE) IN THE HOUSEHOLD, THE MOTHER IS IDENTIFIED AS PARENT 1. IF THERE IS A MOTHER AND SHE HAD A MALE SPOUSE/PARTNER IN THE HOUSEHOLD, THE SPOUSE/PARTNER IS IDENTIFIED AS PARENT 2 (IDP2). IF THERE IS NO SPOUSE/PARTNER IN THE HOUSEHOLD, PARENT 2 IS CODED AS NOT APPLICABLE;

3) IF THERE IS ONLY ONE FATHER (OF ANY TYPE) IN THE HOUSEHOLD AND NO MOTHER, THE FATHER IS IDENTIFIED AS PARENT 1 (IDP1). IF THERE IS A FATHER AND HE HAD A FEMALE SPOUSE/PARTNER IN THE HOUSEHOLD, THE SPOUSE/PARTNER IS IDENTIFIED AS PARENT 1 (IDP1) AND THE FATHER IS IDENTIFIED AS PARENT 2 (IDP2). IF THERE IS NO SPOUSE/PARTNER IN THE HOUSEHOLD, PARENT 2 IS CODED AS NOT APPLICABLE;

4) IF THERE ARE TWO MOTHERS IN THE HOUSEHOLD, AN ORDER OF PREFERENCE WILL BE USED TO IDENTIFY ONE MOTHER TO BE PARENT 1 (IDP1), WITH THE ORDER SPECIFIED AS BIOLOGICAL, ADOPTIVE, STEP-, FOSTER MOTHER OR FEMALE GUARDIAN, THEN OTHER FEMALE PARENT OR GUARDIAN. THE OTHER MOTHER IS IDENTIFIED AS PARENT 2 (IDP2). IF THERE ARE TWO MOTHERS OF THE SAME TYPE (E.G., TWO ADOPTIVE MOTHERS), THE MOTHER WITH THE LOWEST PERSON NUMBER IN THE HOUSEHOLD ROSTER IS IDENTIFIED AS PARENT 1 (IDP1) AND THE OTHER MOTHER IS IDENTIFIED AS PARENT 2 (IDP2).

5) IF THERE ARE TWO FATHERS IN THE HOUSEHOLD, AN ORDER OF PREFERENCE WILL BE USED TO IDENTIFY ONE FATHER TO BE PARENT 1 (IDP1), WITH THE ORDER SPECIFIED AS BIOLOGICAL, ADOPTIVE, STEP-, FOSTER FATHER OR MALE GUARDIAN, THEN OTHER MALE PARENT OR GUARDIAN. THE OTHER FATHER IS IDENTIFIED AS PARENT 2 (IDP2). IF THERE ARE TWO FATHERS OF THE SAME TYPE (E.G., TWO ADOPTIVE FATHERS), THE FATHER WITH THE LOWEST PERSON NUMBER IN THE HOUSEHOLD ROSTER IS IDENTIFIED AS PARENT 1 (IDP1) AND THE OTHER FATHER IS IDENTIFIED AS PARENT 2 (IDP2).

6) IF THERE IS NO ONE IN THE HOUSEHOLD IDENTIFIED AS A MOTHER OR FATHER, THEN A FEMALE PARENT FIGURE IS IDENTIFIED AS PERSON 1. IF THE FEMALE PARENT FIGURE HAS A MALE SPOUSE OR PARTNER, THE SPOUSE/PARTNER IS IDENTIFIED AS PERSON 2. FOR EXAMPLE, IF A CHILD LIVES WITH HIS GRANDMOTHER (THE RESPONDENT) AND GRANDFATHER, AND NEITHER HIS MOTHER NOR FATHER ALSO LIVE IN THE HOUSEHOLD, THEN THE GRANDMOTHER IS IDENTIFIED AS PARENT 1 AND THE GRANDFATHER IS IDENTIFIED AS PARENT 2. IF ONLY THE GRANDFATHER LIVES IN THE HOUSEHOLD, THE GRANDFATHER WOULD BE PARENT 1.

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.

ASK for each member of the household WHO is 16 years old or older (B010a=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

B015 (B02m.) Who is the primary caregiver (provides the most care) for {CFNAME}?

Select all that apply.

5020200

 {HH2FNAME} {HH2LNAME} #

 {HH#FNAME} {HH#LNAME} #

 {HH#FNAME} {HH#LNAME} #

PROGRAMMER BOX b015

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 {CFNAME}, please select the two members that you know the most about.

SOFT CHECK: IF B015=NO RESPONSE; Your response is important for this survey. Please provide an answer for this question.

FILL: HH#FNAME HH#LNAME with IDP1

B020A (B03a.) Is {HH#FNAME HH#LNAME (IDP1)} married to someone in the household?

5020301

 Yes 1

 No 2

ASK IF B020a = 1

FILL: HH#FNAME HH#LNAME

B020B (B03b.) Here is a list of household members who are 16 years old or older. From this list, please pick the person {HH#FNAME HH#LNAME (IDP1)} is married to.

5020302

 {HH#FNAME HH#LNAME} (IDP2) 1

 {HH#FNAME HH#LNAME} 2

PROGRAMMER BOX B020b

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 b020a and b020b) AS well as a ‘None of the above’ option.

if any b010a = m then list HH#FNAME HH#LNAME FOR B020B.

loop b020a and b020b for IDP2 if not already matched based on prior loops of b020a and b020b.

FILL: HH#FNAME HH#LNAME with IDP1, if B020a=2 (no)

B025A (B04a.) Is {HH#FNAME HH#LNAME (IDP1)} in a domestic partnership or civil union with someone in the household?

5020401

 Yes 1

 No 2

ASK IF B025a = 1

FILL: HH#FNAME HH#LNAME

B025B (B04b.) Here is a list of household members who are 16 years old or older. From this list, please pick the person {HH#FNAME HH#LNAME} is in a domestic partnership or civil union with.

5020402

 {HH#FNAME HH#LNAME} 1

 {HH#FNAME HH#LNAME} 2

C. FAMILY AND PARENT BACKGROUND

ASK FOR IDP1

CFNAME= Child’s first name

{HH#FNAME IDP1} = FIRST NAME OF PARENT 1

IF RESPONDENT IS IDP1 OR IDP2, THEN USE “YOU HAVE”.

Now we would like to know about the educational background of {CFNAME}’s family.

C001 (C04a.) What is the highest level of education {HH#FNAME IDP1} completed?

Select one only.

5030401

 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 FOR IDP2

{HH#FNAME IDP2} = FIRST NAME OF PARENT 2

IF RESPONDENT IS IDP1 OR IDP2, THEN USE “YOU HAVE”.

C005 (C04b.) What is the highest level of education {HH#FNAME IDP2} completed?

Select one only.

5030402

 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 RESPONDENT IS IDP1 OR IDP2. IF RESPONDENT IS NOT IDP1 OR IDP2, THEN GO TO C020.

C010 (C05.) What is the highest level of education your mother completed?

Select one only.

5030500

 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

 Did not live with mother growing up 15

ASK IF RESPONDENT IS IDP1 OR IDP2. IF RESPONDENT IS NOT IDP1 OR IDP2, THEN GO TO C020.

C015 (C06.) What is the highest level of education your father completed?

Select one only.

5030600

 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

 Did not live with father growing up 14

ASK FOR IDP1

CFNAME= Child’s first name

{HH#FNAME IDP1} = FIRST NAME OF PARENT 1

C020 (B02j). During the past week did {HH#FNAME IDP1} work at a job for pay?

5022010

 Yes 1

 No 2

NO RESPONSE M

ASK FOR IDP2

{HH#FNAME IDP2} = FIRST NAME OF PARENT 2

C025 (B02j). During the past week did {HH#FNAME IDP2} work at a job for pay?

5022110

 Yes 1

 No 2

NO RESPONSE M

All

Next, we would like to know about languages used in your home.

C030 (C01.) Is English the primary language used in your home?

5030100

 Yes 1 C035

 No 2 C045

NO RESPONSE M C035

ASK IF C030=1 OR M

C035 (C02a.) Is any language other than English used in your home?

5030201

 Yes 1 C040

 No 2 D001

NO RESPONSE M D001

ASK IF C035=1

C040 (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

5032204

 c. Farsi 3

5032205

 d. Filipino language 4

5032206

 e. French 5

5032207

 f. German 6

5032208

 g. Greek 7

5032209

 h. Hmong 8

5032214

5032212

5032211

5032210

 i. Italian 9

 j. Japanese 10

 k. Korean 11

5032213

 l. Polish 12

 m. Portuguese 13

5032215

 n. Sign Language 14

5032216

 o. Spanish 15

5032217

 p. Vietnamese 16

5032218

 q. Some other language 99

Specify (STRING (50))

NO RESPONSE M D001

ASK IF C030=2

C045 (C03C.) Please select the language(s) that are used in your home from the alphabetical list below. You may select more than one.

5033301-5033318

To

PROGRAMMER BOX

USE LIST FROM C040, BEING SURE TO INCLUDE ENGLISH.

ASK IF C030=2 AND C045 = more than one language

C050 (C03A). What is the primary language used in your home?

Select one only.

5033100

 a. Arabic 1

 b. Chinese language/dialect 2

 c. English 3

 d. Farsi 4

 e. Filipino language 5

 f. French 6

 g. German 7

 h. Greek 8

 i. Hmong 9

 j. Italian 10

 k. Japanese 11

 l. Korean 12

 m. Polish 13

 n. Portuguese 14

 o. Sign Language 15

 p. Spanish 16

 q. Vietnamese 17

 r. Some other language 99

Specify (STRING (50))

 s. More than one language used equally 18

NO RESPONSE M

PROGRAMMER BOX C050

display languages that were selected in c045 as response options here.

D. CHILD'S SCHOOL EXPERIENCES

All

CFNAME=Child’s first name;

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. Please think about the current school year as you consider each statement.

D001 (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;

D005 (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	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;

D010 (E03.) Now we would like to know how often you or someone in your household talked with any staff at {CFNAME}'s school. In this set of questions, when we say “you,” we mean you or someone in your household. How many times this school year did you talk with the staff at 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	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, vocational, or technical school after completing high school?	1 	2 	3 	4 

All

CFNAME=Child’s first name;

D015 (E03A.) For each of the following statements, please tell me how well {CFNAME}'s school has done with each activity during this school year…

	Please select one response per row.	Does this very well	Just OK	Doesn’t do it at all
5050321	The school lets you know between report cards how {CFNAME} is doing in school.	1 	2 	3 
5050322	The school helps you understand what children at {CFNAME}'s age are like.	1 	2 	3 
5050323	The school provides workshops, materials, or advice about how to help {CFNAME} learn at home.	1 	2 	3 
5050324	The school provides information on community services to help {CFNAME} or your family.	1 	2 	3 

All

CFNAME=Child’s first name;

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

D020 (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

5050400

▼

NO RESPONSE M

PROGRAMMER BOX

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

IF D020=0 GOTO D035.

ASK IF D020. >0

IF D020>1 INSERT “most recent”; DO NOT DISPLAY D025 IF D020= Don’t know

D025 (E05A.) What was the reason for the [IF D020>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

 h. Threatening to use or making a false report of the use of an explosive

5050509

device at school 8

5050510

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

5050511

 j. Other 10

Specify (STRING (50))

5050512

 k. Don’t know 11

NO RESPONSE M

ASK IF D020. >0

CFNAME=Child’s first name;

IF D020>1 INSERT “most recent”

D030 (E06.) How many days was the [IF D020>1 INSERT “most recent”] suspension or expulsion?

5050600

Days for most recent suspension or expulsion

 Check this box if {CFNAME} was expelled permanently 2

PROGRAMMER BOX D030

PROGRAMMER NOTE: PROGRAM SO EITHER text is entered in “days for most recent suspension or expulsion” or the check box is selected. cannot do both.

All

CFNAME=Child’s first name;

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

D035 (E07.) What grades, if any, has {CFNAME} repeated since starting school?

5050700

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;

D040 (E08.) What grade level, if any, has {CFNAME} skipped since starting school?

Select all that apply.

5050800

 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.

D045 (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?

5050900

 Yes 1 D050

 No 2 D055

NO RESPONSE M D055

ASK IF D045 = 1

D050 (E10.) Is {CFNAME} currently enrolled in a program for English language learners (ELLs) such as English as a Second Language (ESL), English immersion, or bilingual education?

5051000

 Yes 1

 No 2

All

CFNAME=Child’s first name;

D055 (E11.) Does {CFNAME} receive free or reduced price meals at school?

5051100

 Yes 1 D060

 No 2 D065

 Don’t know 3 D065

ASK IF D055 = 1

D060 (E12.) Are these meals free or reduced price?

5051200

 Free 1

 Reduced price 2

PROGRAMS THAT CHILD PARTICIPATES IN

All

5051301

D065 (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 D070

 No 2 D075

 Don’t know 3 D075

ASK IF D065=1

D070 (E13b.) During the current school year, how many times did {CFNAME} 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

5051302

NUMBER OF TIMES

PROGRAMMER BOX D070

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

All

D075 (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

5051303

NUMBER OF TIMES

PROGRAMMER BOX D075

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

All

D080 (E14a.) During the current school year, has {CFNAME} taken a field trip focused on the arts, for example to visit an art museum or center, or to see a live music, dance, or theater performance?

5051304

 Yes 1 D085

 No 2 D085

 Don’t know 3 D085

All

D085 (E14b). Other than field trips, have you or someone in your household taken {CFNAME} to visit an art museum or center, or to see a live music, dance, or theater performance during the current school year?

5051305

 Yes 1 E001

 No 2 E001

 Don’t know 3 E001

E. PARENTAL DISCUSSIONS WITH CHILD

All

CFNAME=Child’s first name

This section asks about your expectations for {CFNAME}'s future and conversations you may have had with {CFNAME} about school or {CFNAME}’s future plans.

E001 (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

E005 (I02.) How far in school do you expect {CFNAME} to go? Would you say you expect {CFNAME} …

Select one only.

5090200

 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

 Don’t know 7

F. CHILD HEALTH AND WELL-BEING

Now, we would like to ask you about {CFNAME}'s health.

All

CFNAME=Child’s first name;

F001 (F01.) In general, would you say that {CFNAME}'s health is...

Select one only.

5060100

 Excellent 1

 Very good 2

 Good 3

 Fair 4

 Poor 5

All

CFNAME=Child’s first name;

F005. Does {CFNAME} have difficulty seeing objects in the distance, letters on paper, or the board in the classroom?

5060200

 Yes 1

 No 2

 Don’t know 3

All

CFNAME=Child’s first name;

5060210

F010. Has {CFNAME}’s vision ever been evaluated by an eye care professional?

 Yes 1 F015

 No 2 F020

 Don’t know 3 F020

ASK IF F010=1, ELSE GO TO F020

CFNAME=Child’s first name;

F015. Has {CFNAME} been prescribed glasses or contact lenses to improve {CFNAME}’s vision?

5060211

 Yes 1

 No 2

 Don’t know 3

All

CFNAME=Child’s first name;

F020. How often does {CFNAME} wear eyeglasses or contact lenses to help {CFNAME}’s see better?

5060212

 Always/Most of the time 1

 Often 2

 Sometimes 3

 Rarely 4

 Never 5

All

CFNAME=Child’s first name;

F025 (F03.) Has a doctor, nurse, or other medical professional ever told you that {CFNAME} has had a concussion?

5060300

 Yes 1 F030

 No 2 F035

ASK IF F025 = 1

CFNAME=Child’s first name;

F030 (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;

F035 (F05.) Has a doctor, nurse, or other medical professional ever told you that {CFNAME} has asthma?

5060500

 Yes 1 F040

 No 2 F045

ASK IF F035. = 1

CFNAME=Child’s first name;

F040 (F06.) Has {CFNAME} ever been taken to an emergency room or hospitalized for at least one night because of asthma?

5060600

 Yes 1

 No 2

All

CFNAME=Child’s first name;

“His/her”; ”he/she”; “himself/herself” fills will be determined by the answer to A050: if A050=1 all gender fills are masculine, if A050=0 all gender fills are feminine; if A050=MISSING, “his/her” “he/she” or “himself/herself” will display.

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

F045 (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	Reading, learning, thinking, or solving problems?	1 	2 
5060704	Difficulty coordinating or moving {CFNAME}'s 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	{CFNAME}’s activity level?	1 	2 
5060708	{CFNAME}’s 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 the 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 F045a=1 OR F045b=1 OR F045c=1 OR F045d=1 OR F045e=1 OR F045f=1 OR F045g=1 OR F045h=1 OR F045i=1 OR F045j=1 OR F045k=1 OR F045l=1 OR F045m=1 OR F045n=1 OR F045o=1, GO TO F050.

ELSE IF F045a NE 1 AND F045b NE 1 AND F045c NE 1 AND F045d NE 1 AND F045e NE 1 AND F045f NE 1 AND F045g NE 1 AND F045h NE 1 AND F045i NE 1 AND F045j NE 1 AND F045k NE 1 AND F045l NE 1 AND F045m NE 1 AND F045n NE 1 AND F045o NE 1, GO TO F085 .

PROGRAMMER BOX F045

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 F045A-O = 1.

CFNAME= Child’s first name; Fill text from any items in F045A-O=1

F050 (F08.) You said that {CFNAME} was evaluated by a professional for {TEXT FROM F045A-O}.

Did a professional give you a diagnosis or diagnoses?

5060800

 Yes 1 F055

 No 2 F085

PROGRAMMER BOX

{TEXT FROM F045A-O} : Insert ALL options selected from F045 as a list (IF ANY OF F045A-O= 1). Only display F50 once.

PROGRAMMER BOX F050

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 F050=1.

F055 (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.

Select all that apply.

5060902

5060903

 a. Learning disability LD -- Reading disability (or dyslexia) 1 F060

 b. Learning disability LD -- Math disability 2 F060

5060901

 c. Learning disability (LD) - other 3 F060

5060904

 d. Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) 4 F060

• 

  5060905

  e. Autism Spectrum Disorder (ASD); such as Autistic Disorder/Asperger’s Disorder/Pervasive
  Developmental Disorder (PDD)…………………………………………………… 5 F060

• 

  5060907

  5060906

  f. Speech or language disorder 6 F060

 g. Intellectual disability* (or severe cognitive disability) 7 F060

5060908

 h. Health impairment (such as seizures, asthma, diabetes) 8 F060

5060909

 i. Physical disability (such as cerebral palsy, spina bifida, amputee, contractures) 9 F060

5060910

 j. Sensory impairment (such as hypersensitivity; sensory processing problems; sensory
integration problems; sensory deficit, or sensory organization problems) 10 F060

5060911

5060912

 k. Emotional disturbance 11 F060

5060923

 l. Conduct disorder or oppositional defiant disorder 12 F060

5060914

 m. Post Traumatic Stress Disorder [PTSD] 13 F060

5060915

 n. Anxiety disorder or phobia 14 F060

5060916

 o. Obsessive compulsive disorder (OCD) 15 F060

 p. Eating disorder 16 F060

5060917

 q. Depression 17 F060

5060918

 r. Bipolar disorder 18 F060

5060919

5060920

 s. Tourette’s syndrome 19 F060

 t. Traumatic brain injury 20 F060

5060921

 u. Diagnosis not yet determined 21 F085

5060922

 v. Other 99 F060

5060924

Please specify (STRING (50))

NO RESPONSE M F085

*Previously called “mental retardation”

PROGRAMMER BOX F055

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 “post traumatic stress disorder” CONTAIN THE HYPERLINK TO THE BELOW HELP TEXT:

Post Traumatic Stress Disorder, also known as PTSD, is a condition that some people develop after experiencing a shocking, terrifying, or dangerous event. PTSD can cause high anxiety, nightmares, flashbacks to the event, and can interfere with a child’s ability to function.

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 F055=1-20 OR IF F055=99

CFNAME=Child’s first name;

IF F055=1-20 INSERT ITEM TEXT; IF F055 = 99 INSERT TEXT ENTERED AT F055_specify

F060. What was {CFNAME}’s first diagnosis?

5061304

▼

{CFNAME}’s FIRST DIAGNOSIS

5061305

Other (Please Specify) (STRING (50))

PROGRAMMER BOX F065

PROGRAMMER NOTE: PROGRAM a DROPdown menu of responses selected in f055, i.e., IF F055=1-20 INSERT ITEM TEXT; IF F055 = 99 INSERT TEXT ENTERED AT F055_specify.

INCLUDE AN “OTHER” FIELD THAT WILL ALLOW RESPONDENTS TO FILL IN OTHER RESPONSE IF RESPONDENT WANTS TO ADD AN ADDITIONAL DIAGNOSIS THAT WAS NOT ORIGINALLY LISTED IN F055. IF “OTHER” IS SELECTED FROM THE DROPDOWN DISPLAY “PLEASE SPECIFY” OPEN RESPONSE OPTION.

ASK IF F055=1-20 OR IF F055=99

CFNAME=Child’s first name;

F065 (F13B.) How old was {CFNAME} when {CFNAME} received the first diagnosis?

▼

5061303

AGE OF DIAGNOSIS

AGE

ASK IF F055. = 4

CFNAME=Child’s first name;

F070 (F14a.) Is {CFNAME} now taking prescription medication for ADD or ADHD?

5061401

 Yes 1 F075

 No 2 F080

NO RESPONSE M F080

ASK IF F070.= 1

CFNAME=Child’s first name;

F075 (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

ASK IF F055.=1-3 OR 5-99

CFNAME=Child’s first name;

F080 (F14.) Is {CFNAME} now taking any prescription medicine for the condition related to any other {diagnosis/diagnoses)?

5061400

 Yes 1

 No 2

NO RESPONSE M

PROGRAMMER BOX F080

PROGRAMMER NOTE:

• If only one diagnosis is selected in f055 (i.e., within the range of f055=1-3 or 5-20 or 99, excluding 21 or Missing), then autofill “diagnosis”

• If multiple diagnoses are selected in f055 (i.e., within the range of f055=1-3 or 5-20 or 99, excluding 21 or Missing), then autofill “diagnoses”

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).

F085 (F16.) Does {CFNAME} currently have a 504 plan based on section 504 of the Rehabilitation Act that describes accommodations to support {CFNAME}’s learning?

5061600

 Yes 1

 No 2

 Don’t know 3

PROGRAMMER BOX F085

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.

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

Individualized Education Program (IEP): 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 students without disabilities, and lists accommodations or modifications needed to measure what the student knows through tests.

All

CFNAME=Child’s first name;

F090 (F17.) Has {CFNAME} ever had an Individualized Education Program (IEP)?

5061700

 Yes 1 F095

 No 2 G001

 Don’t know 3 G001

PROGRAMMER

IF F090 = 2, 3, or M GO TO SECTION G.

PROGRAMMER BOX F090

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 students without disabilities, and lists accommodations or modifications needed to measure what the student knows through tests.

ASK IF F090.=1

CFNAME=Child’s first name;

F095 (F18.) Does {CFNAME} still have an IEP?

5061800

 Yes 1 F105

 No 2 F100

 Don’t know 3 F105

NO RESPONSE M F105

PROGRAMMER BOX F095

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 students without disabilities, and lists accommodations or modifications needed to measure what the student knows through tests.

ASK IF F095.=2

CFNAME=Child’s first name;

F100 (F19.) Why does {CFNAME} no longer have an IEP?

Select all that apply.

5061901

5061902

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

5061903

 b. {CFNAME} met IEP goals 2

5061904

 c. School says {CFNAME} does not need 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

 h. {CFNAME} has a 504 Plan 8

5061909

 i. Other 99

Specify (STRING (50))

NO RESPONSE M

PROGRAMMER

FOR ANY RESPONSE AT F100, GO TO SECTION G.

ASK IF F095. NE 2.

CFNAME=Child’s first name;

F105 (F20.) In the last 12 months, has there been an IEP meeting about {CFNAME}'s special education program or services?

5062000

 Yes 1 F110

 No 2 F120

 Don’t know 3 F120

NO RESPONSE M F120

ASK IF F105.=1

F110 (F21.) Did you or another adult in the household go to the meeting?

5062100

 Yes 1

 No 2

 Don’t know 3

ASK IF F105.=1

CFNAME=Child’s first name;

F115 (F22.) Did {CFNAME} go to the meeting?

5062200

 Yes 1

 No 2

 Don’t know 3

ASK IF F095.=1

CFNAME=Child’s first name;

F120 (F25.) How active was {CFNAME} in developing {CFNAME}’s IEP? For example, did {CFNAME} participate in discussions about {CFNAME}’s disability, {CFNAME}’s strengths, {CFNAME}’s needs, the accommodations that would help {CFNAME} achieve in class, {CFNAME}’s goals for the future, and the goals {CFNAME} feels are most important for {CFNAME} to work on?

Select one only.

5062500

 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 F095.=1

CFNAME=Child’s first name;

F125 (F26.) Overall, how satisfied are you with the progress {CFNAME} has made towards {CFNAME}’s IEP goals this year? Are you...

Select one only.

5062600

 Completely satisfied 1

 Very satisfied 2

 Neither satisfied, nor dissatisfied 3

 Somewhat dissatisfied 4

• Very dissatisfied. 5

ASK IF F095.=1

CFNAME=Child’s first name;

5062800

F130 (F27.) During the past 12 months, did {CFNAME} have any services to help {CFNAME} with academics (schoolwork), 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 (F130)

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 F095=1

CFNAME=Child’s first name;

F135 (F28.) The next questions ask how often you discussed with {CFNAME}’s school staff about developing {CFNAME}'s skills in different areas

		Never	Rarely	Sometimes	Often	Very often
5062801	How often did you talk with the school about how {CFNAME} can learn to advocate for {CFNAME} and decide about {CFNAME}’s own future goals?	1 	2 	3 	4 	5 
5062802	How often did you talk about how {CFNAME} can increase social and community support networks?	1 	2 	3 	4 	5 
5062803	How often did you talk about how {CFNAME} can learn “soft” skills for getting a job (such as appropriate dress, working well in a group, following instructions)?	1 	2 	3 	4 	5 
5062804	How often did you talk about how {CFNAME} can 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	How often did you talk about how {CFNAME} can prepare for change (for example, change in schools; graduating; and moving to adulthood)?	1 	2 	3 	4 	5 

Programmer Box F135

The following help text should link to “advocate”:

To tell others about what is needed to be successful and to explain the disability that child has.

G. HOME LIFE

All

CFNAME=Child’s first name;

Now we have some questions about how much parents and guardians keep an eye on children around this age.

G001 (D00a.) How many of {CFNAME}’s friends do you know?

Select one only.

5040001

 None 1

 Some 2

 About half 3

 Most 4

 All or almost all 5

All

CFNAME=Child’s first name;

G005 (D00b.) Please think about all of {CFNAME}’s friends. About how many parents of {CFNAME}’s friends do you talk or text with regularly, either in person, online, or on the phone?

5040002

NUMBER OF PARENTS

All

CFNAME=Child’s first name;

G010 (D00c.) Now, please think about the children {CFNAME} goes to school with. 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

All

CFNAME=Child’s first name;

G015 (D01.) How often do you…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)	Never	Rarely	Sometimes	Often	Very often	Always
5040101	Know what {CFNAME} does during {CFNAME}’s 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 
5040103	Know what {CFNAME} spends {CFNAME}’s money on?	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

PROGRAMMER: CODE ONE PER ROW

G020. During this school year, how often…

	(Please select one response per row.)	Never	Rarely	Sometimes	Often	Very often	Always
5040107	a. Does {CFNAME} do homework at home?	1 	2 	3 	4 	5 	6 
5040108	b. Do you or someone else in your household help {CFNAME} with {CFNAME}’s homework?	1 	2 	3 	4 	5 	6 
5040109	c. Do you check that {CFNAME} completed all homework?	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

G025 (D01.) How often does {CFNAME} tell you about…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)	Never	Rarely	Sometimes	Often	Very often	Always
5041101	a. {CFNAME}’s friends without you asking (for example, which friends {CFNAME} hangs out with and how {CFNAME}’s friends feel about things)?	1 	2 	3 	4 	5 	6 
5041102	b. School without you asking (for example, how each subject is going or {CFNAME}’s relationships with teachers)?	1 	2 	3 	4 	5 	6 

All

CFNAME=Child’s first name;

G030 (D01i.) How often does {CFNAME} keep secrets from you about what {CFNAME} does during {CFNAME}’s free time?

Select one only.

5041201

 Never 1

 Rarely 2

 Sometimes 3

 Often 4

 Very often 5

 Always 6

 Don’t know 7

All

CFNAME=Child’s first name;

G035 (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;

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

G040 (D02.) Have any of the following things happened to {CFNAME}? Has {CFNAME}…

PROGRAMMER: CODE ONE PER ROW

	(Please select one response per row.)		Yes	No
5040201	Gotten involved with the wrong kinds of people around {CFNAME}’s age?		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 
5040207	Run away?		1 	2 

All

G045. During this school year, how often have other children…

	(Please select one response per row.)	Never	Rarely	Sometimes	Often	Very often	Always
5040205	Teased, made fun of, or called {CFNAME} names?	1 	2 	3 	4 	5 	6 
5040206	Told lies or untrue stories about {CFNAME}?	1 	2 	3 	4 	5 	6 
5040208	Pushed, shoved, slapped, hit, or kicked {CFNAME}?	1 	2 	3 	4 	5 	6 

All

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

G050 (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 G050

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.

All

SECTION H ITEMS WILL LOOP WITH SHIFTING FILLS TO CAPTURE RESPONDENT AND/OR CHILD’S MOTHER (IDP1) AND FATHER (IDP2) (IF THEY LIVE IN THE HOUSEHOLD) BASED ON RESPONSES TO B010c (mother’s relationship to CFNAME), AND B020a, B025a (spouse or partner in the household). PROGRAM ITEMS WILL INCLUDE A LOOP FOR EACH SCENARIO POSSIBILITY.

H. EMPLOYMENT AND INCOME

Programmer Box H001

If C020 or C025= NE 1

loop H001 through H020_Other for IDP1 and IDP2

If C020 or C025= 1

GO TO H025 AND LOOP FOR IDP1 and IDP2

H001 FILL: When the respondent is answering about himself, FILL "Were you", ELSE FILL "Was [IDP1]” or “Was [IDP2]”

Now we have a few questions about jobs and work people in {CFNAME}’s household do for a living.

H001 (G02.) During the past week, [were you/was [IDP1]/was [IDP2]] on leave or vacation from a job?

5070200

 Yes 1 H025

 No 2 H005

NO RESPONSE M H005

ASK IF C020/C025 = 2 AND H001 NE 1

H005 FILL: When the respondent is answering about himself, FILL "Have you", ELSE FILL "Has [IDP1]” or “Has [IDP2]”

H005 (G03.) [Have you/Has [IDP1]/Has [IDP2]] been actively looking for work in the past 4 weeks?

5070300

 Yes 1 H010

 No 2 H015

NO RESPONSE M H015

PROGRAMMER BOX

please note IDP1 and IDP2 will be filled according to first and last names filled in C020/C025.

H005 = 1

H010 FILL: When the respondent is answering about himself, FILL "Have you", ELSE FILL "Has [IDP1]” or “Has [IDP2]”

H010 (G04.) What [have you/has [IDP1]/has [IDP2]] been doing in the past 4 weeks to find work?

Select all that apply.

5070401

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

 d. Checked with friends or relatives 4

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

• 

  5070406

  5070405

  f. Contacted school/university employment center 6

5070408

5070407

 g. Checked a union register or professional register 7

 h. Attended a job training 8

5070409

 i. Read want-ads/internet search 9

5070410

 j. Something else 10

Specify (STRING (50))

5070411

 k. Don’t know 11

PROGRAMMER BOX

please note IDP1 and IDP2 will be filled according to first and last names filled in C020 AND C025.

SOFT CHECK: IF H010=10 (Something else) is checked and the specify other text is MISSING: “[What {have you/has [IDP1]/has [IDP2]} been doing the past 4 weeks to find work]?

ASK IF H005 NE 1

H015 FILL: When the respondent is answering about himself, FILL " you", ELSE FILL "was [IDP1]” or “was [IDP2]”

H015 (G05.) Could {you/[IDP1]/ [IDP2]} have taken a job last week if one had been offered?

5070510

 Yes 1

 No 2

 NO RESPONSE M

ASK IF H005 NE 1

H020 FILL: When the respondent is answering about himself, FILL "were you", ELSE FILL "was [IDP1] or “was [IDP2]”

H020 (G06.) What [were you/was [IDP1]/ was [IDP2]] doing most of last week? Would you say…

5070500

 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 H020 = 91

H020_Other FILL: When the respondent is answering about himself, FILL "you were", ELSE FILL "[IDP1] was” or “[IDP2] was"

H020_Other (G06_other.) Please enter what [you were/[IDP1] was/ [IDP2] was doing most of last week.

5070600

PROGRAMMER: INSERT TEXT BOX

(STRING (100)) H040

NO RESPONSE M

IF C020/C025 = 1 OR IF H001=1, GO TO H025.

ELSE go to H045.

H025 FILL: When the respondent is answering about himself, FILL "do you", ELSE FILL "does [IDP1]” or “does [IDP2]"

H025 (G07.) How many jobs [do you/does [IDP1]/does [IDP2]] have now?

5070700

|___|___| Number of jobs

NO RESPONSE M H040

PROGRAMMER BOX

please note IDP1 and IDP2 will be filled according to first and last names filled in H001 for C020/C025 = 2 and according to b005 for C020/C025 = 1.

ASK IF C020/C025 = 1 OR (C020/C025 = 2 AND H001=1) AND H025 NE 0 or M.

IF H025=M OR H025=0 GO TO H040

H030 FILL: When the respondent is answering about himself, FILL "do you", ELSE FILL "does [IDP1]” or “does IDP2]"

H030 (G08.) About how many total hours per week [do you/does [IDP1]/does [IDP2]] usually work for pay?

5070800

|___|___| Enter number of weekly hours

NO RESPONSE M

PROGRAMMER BOX

please note IDP1 and IDP2 will be filled according to first and last names filled in H001 for C020/C025 = 2 and according to b005 for C020/C025 = 1.

ASK IF C020/C025= 1 OR H001=1

H035 (G09, G11.) What {are/were} the title and duties of {/your/[IDP1]/[IDP2]} job? If {you/[IDP1]/[IDP2] have/has} more than 1 job, please answer this question for the job where [you/[IDP1]/[IDP2] work/works} the most hours.

5071101

PROGRAMMER: INSERT TEXT BOX

A. Type in job title (STRING (100))

5071111

PROGRAMMER: INSERT TEXT BOX

B. Type in job duties (STRING (100))

NO RESPONSE M

SOFT CHECK: IF H035A or B = MISSING, Please enter the job title in the textbox and then

click the ENTER button.

PROGRAMMER BOX

please note IDP1 and IDP2 will be filled according to first and last names filled in H001 for C020/C025 = 2 and according to b005 for C020/C025 = 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 C020/C025 = 1 OR (C020/C025 = 2 AND H001=1)

H040 FILL: When the respondent is answering about himself, FILL "have you", ELSE FILL "has [IDP1]” or “has [IDP2]"

H040 (G12a.) Since {CFNAME} was born}, {have you/has [IDP1]/has [IDP2]} served on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

5071203

 Yes 1

 No 2

 NO RESPONSE M

Programmer Box H040

The following help text should link to “active duty”:

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

activation, for example, for the war in Afghanistan.

ASK IF H040. NE 2

H045 FILL: When the respondent is answering about himself, FILL "you", ELSE FILL "Is [IDP1] or “Is [IDP2]"

H045 (G12b.) {Are you/Is [IDP1]/Is [IDP2]} currently on active duty in the U.S. Armed Forces, military Reserves, or National Guard?

5071204

 Yes 1

 No 2

 NO RESPONSE M

Programmer Box H045

The following help text should link to “active duty”:

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

activation, for example, for the war in Afghanistan.

All

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

H050 (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 H050

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

I. MORE QUESTIONS ABOUT {CFNAME}’S HOUSEHOLD

All

CFNAME=Child’s first name

I001 (B02). Now we have a few more questions about members of your household.

	[IDP1]	[CFNAME]	[IDP2]
I001a (B02e1.) Which of the following best describes [you/IDP1/{CFNAME}/IDP2}]?	5022005 Select…	5022105 Select…	5022205 Select… …
I001b (B02e2.) Which of the following best describes [you/IDP1/IDP2]?	5022015 Select…	Select… 5022115	5022215 Select… …
I001c (B02k.) In which country [were you/was IDP1/was IDP2] born?	5022011 Select…	5022111 Select…	5022211 Select country…
I001d (B02l.) In what year did [you/IDP1/IDP2] move to the United States permanently?	5022012 Select year…	5022112 Select year…	5022212 Select year…

PROGRAMMER BOX HOUSEHOLD ROSTER

Loop through this section starting with

1. IDP1

2. CFNAME

3. IDP2

row I001A and I001B will be populated based on responses to B010E and B01F. If a person is reported to be hispanic/latino/latina, have response options in I001A 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 B010E, then row I001B 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 C. A list will be generated detailing a presumably exhaustIve 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 D will only be asked of persons who were reported to be born somewhere other than the United states in row d. 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 MISSING, populate row e 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 INSTRUCTED on how to route 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.

All

CFNAME=Child’s first name

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

I005 (H01.) How long has {CFNAME} lived in {CFNAME}’s 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 I005

Insert dropdown menu including options from < 1 years to > 15 years. Hide any years greater than the child’s age (as calculated from A055 or A065).

If I005< 5, ASK I010, ELSE GOTO I015

CFNAME=Child’s first name

I010 (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 I010

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

I015 (H03A.) How many times has {CFNAME} changed schools since {CFNAME} started kindergarten as a

result of grade promotion?

5080301

▼

Select number of times

NO RESPONSE M

PROGRAMMER BOX I015

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

I020 (H03B.) How many times has {CFNAME} changed schools since {CFNAME} started kindergarten for a reason other than grade promotion?

5080302

▼

Select number of times

NO RESPONSE M

PROGRAMMER BOX I020

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

I025 (H04.) Is {CFNAME} attending a different school this year than the one {CFNAME} attended last school year?

5080400

 Yes 1

 No 2

All

I030 (H05.) Will {CFNAME} be attending [SCHNAME] next year?

5010056

 Yes 1 I040

 No 2 I035

IF I030=2

I035 (H06.) What is the name of the school you expect (CFNAME) to be attending next year?

5010057

First type in school name: [ ] (STRING 255)

5010061

Then choose a state: [DROPDOWN]

5010060

Next type in city: [___________________](STRING 255)

Last click [ENTER]

5010063

 Don’t know

ALL

I040 (I03.) Relative or Close Friend Contact.

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= $0, GO TO THANK

IF INCENTIVE FILL > $0, GO TO INCENTIVE_ADDRESS.

INCENTIVE_ADDRESS.

You’re finished! The 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. If you do not want to receive a check, please click the box below, and then press Next to continue.

5010050

5010051

1 Name: [ ] (STRING 255)

5010052

2 Street address1: [___________________](STRING 255)

5010053

3 Street address2: [___________________](STRING 255)

5010054

4 City: [___________________](STRING 255)

5010055

5010055

5 State: [___________________]

6 Zip code: [___________________](STRING 5)

5010064

 I do not want to receive this check.

All

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

(FINISH)

Appendix MS1-U3. Mathematics Teacher Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

the OFT1 number is shown in parentheses.

Programmer boxes refer to OFT1 numbering.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 20 minutes for the teacher-level information and 10 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

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

MS1 Math Teacher Survey

ALL

A001. (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 some background questions about yourself and your school. The survey will also ask questions about your classroom(s) and about specific student(s) who are participating in our study. Some 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 you teach math to.

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 20 minutes]:

We’re very sorry!

Your session has been idle for more than 20 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

A005. (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 20 minutes.

PROGRAMMER BOX 2

Next

A010. (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, your name, and the math classes you teach that have MGLS students. You will be able to correct your name at the end of the survey, if needed. 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

B001 WILL BEGIN A SHORT CONFIRMATION LOOP WHICH IS TO INCLUDE AN ITERATION FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT.

B001. (SC01.) Do/did you teach math to [FILL PRELOADED STUDENT NAME] during this school year (2016-2017)?

6000100

 Yes, and I am the current math teacher for
[FILL PRELOADED STUDENT NAME] 1 [SKIP TO B010]

 Yes, although I am not the current math teacher for
[FILL PRELOADED STUDENT NAME] 2 [SKIP TO B005]

 No 3 [SKIP TO B020]

NO RESPONSE M

HARD CHECK: IF B001=NO RESPONSE; Please provide an answer to this question and then click “Next”.

B001 = 2

B005. (SC01a.) In what month and year did you last teach math to [FILL PRELOADED STUDENT NAME]?

6000101

• Month

• Year

Go to B010.

SOFT CHECK: If future date is selected:

You selected a date in the future. Please select a month and year when you last taught math to this student. Press "Next" to continue.

B001 = 1,2

B010. (SC01b.) Do/did you teach [FILL PRELOADED STUDENT NAME] in [FILL PRELOADED CLASS/PERIOD]?

6000102

 Yes 1 [SEE BELOW]

 No 2 [SKIP TO B015]

NO RESPONSE M [SKIP TO B015]

IF B010=1 then do:

IF B001 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B001 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B001 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B001 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING C001).

ELSE TEACHER IS INELIGIBLE; GOTO B030.

B010 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 F.

B015. (SC01c.) In which of the following classes do/did you teach [FILL PRELOADED STUDENT NAME]?

6000103

• First preloaded class/period

• Second preloaded class/period

• Third preloaded class/period

• Etc.

• Etc.

• Other (specify)

IF B001 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B001 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B001 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B001=YES FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING C001).

ELSE TEACHER IS INELIGIBLE; GOTO B030.

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

B001 =3,2

FILL PRELOADED STUDENT FIRST NAME AND LAST NAME

B020. (SC02.) Does/Did anyone else at your school teach math to [FILL PRELOADED STUDENT NAME] during this school year (2016-2017)?

6000104

 Yes 1 [SKIP TO B025]

 No 2 [SEE BELOW]

NO RESPONSE M [SEE BELOW]

SOFT CHECK: IF B020=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 B020 in (2, M) then do:

IF B001 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B001 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B001 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B001 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING C001).

ELSE TEACHER IS INELIGIBLE; GOTO B030.

B020 = 1

FILL PRELOADED STUDENT NAME

B025. (SC03.) You indicated that [FILL PRELOADED STUDENT NAME] has a different math teacher. What is the name of this student’s math teacher?

6000105

NAME (STRING (50))

NO RESPONSE M

SOFT CHECK: IF B025=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 B001 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B001 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B001 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B001 in (1,2) FOR AT LEAST ONE STUDENT, GO TO THE PROGRESS SUMMARY SCREEN (IMMEDIATELY PRECEDING C001).

ELSE TEACHER IS INELIGIBLE; GOTO B030.

B030(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.

First we have some questions about your background and then we have some questions about the classes and students you are currently teaching or have taught this school year (2017-2018). 

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 C001.

ALL

The next several questions ask about your educational background and teaching experience.

6040100

C001. (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 C001 = 2 or =3 or =4 or =5 or =6 or=7, go to C005; Else go to C020.

FILL = C001 RESPONSE if C001 = 2 or =4 or =5 or =6 or =7; FILL = “college or technical or vocational school training” if C001 =3

6040200

C005. (D02.) In what year did you receive your [FILL WITH HIGHEST DEGREE LISTED IN C001]?

YEAR HIGHEST DEGREE RECEIVED

(1940-2017)

NO RESPONSE M

PROGRAMMER BOX 18

format C005 as drop-down ranging from 1945 to 2017. Note the upper range of year may need to be updated accordingly.

IF C001 >= 3, go to C010; Else go to C020.

C010. (D03.) Did you have a major, minor, or special emphasis in any of the following areas 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 
6040303	b. Middle grades education	1 	3 	2 
6040302	c. 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 C001 >= 3, go to C015

C015. (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

C020. (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 C020 a, b, c, or d are non-numeric; Please enter a numeric value that is 0 or greater.

HARD CHECK: IF C020 < 0; Please enter a value that is 0 or greater.

SOFT CHECK: IF ANY C020 >40; You entered [C020 a, b, c, or d RESPONSE] years. Select “Edit" to adjust the number of years or select “Next" if this is correct.

SOFT CHECK: IF C020a < C020 b,c, or d, or their sum; You entered [C020a RESPONSE] years as the number of years you taught grade K-12 in any subject, which is less than [C020 b, c, or d RESPONSE] years you taught math. Select “Edit" to adjust the number of years.

PROGRAMMER BOX 18A

Programmer note: Omit blanks from soft check.

ALL

C025 (D06.) Which of the following best describes the teaching certificate you currently hold?

6040600

 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

6040601

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF C025=99 and no response specified; “You have selected "Other". Please provide a response to the "Please specify" prompt." 

C025 NE 5 OR NE M

C030. (D07.) In which grades does this certificate allow you to teach math?

Select all that apply.

6040714

6040704

6040711

6040705

6040702

6040701

6040707

6040703

6040708

6040709

 n. This certificate does not allow me to teach math 14

 a. Kindergarten 1

 b. Grade 1 2

 c. Grade 2 3

 d. Grade 3 4

6040706

 e. Grade 4 5

 f. Grade 5 6

 g. Grade 6 7

 h. Grade 7 8

 i. Grade 8 9

6040710

 j. Grade 9 10

 k. Grade 10 11

6040712

 l. Grade 11 12

6040713

 m. Grade 12 13

NO RESPONSE M

ALL

C035. (D08.) Have you taken the exam for National Board Certification?

6040800

 Not taken 1

 Taken and passed 2

 Taken and awaiting results 3

 Taken and have not yet passed 4

NO RESPONSE M

C030=2

C040. (D09.) In what content area(s) do you hold a National Board for Professional Teaching certificate?

Select all that apply.

6040901

 a. Generalist, Early Childhood 1

6040902

 b. Generalist, Middle Childhood 2

6040903

 c. Mathematics, Early Adolescence 3

6040904

 d. Mathematics, Adolescence and Young Adulthood 4

6040905

 e. Other (Please specify) 99

6040906

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF C040=99 and no response specified; “You have selected "Other". Please provide a response to the "Please specify" prompt." 

ALL

C045. (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.

6041000

 Yes 1

 No 2

NO RESPONSE M

ALL

This set of questions asks about you and your background.

6041100

C050. (D11.) In what year were you born?

YEAR BORN

(RANGE 1925-1997)

NO RESPONSE M

PROGRAMMER BOX 19

format C050 as drop-down ranging from 1925 to 1997. Note the upper range of year may need to be updated accordingly.

ALL

C055. (D12.) What is your sex?

6041200

 Male 1

 Female 2

NO RESPONSE M

ALL

C060. (D13.) Are you of Hispanic or Latino/Latina origin?

6041300

 Yes 1

 No 2

NO RESPONSE M

PROGRAMMER BOX 20

Help text for C060 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

C065. (D14.) Which of the following best describes your race?

Select all that apply.

6041401

6041402

 a. American Indian or Alaska Native 1

6041403

 b. Asian 2

6041404

 c. Black or African American 3

 d. Native Hawaiian or other Pacific Islander 4

6041405

 e. White 5

NO RESPONSE M

PROGRAMMER BOX 21

Help text for C065 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.

ALL

The next questions ask about professional development and interactions with your colleagues.

D001. (C03A.) How many hours of professional development did you receive this year that was focused on math?

Please enter whole numbers only.

6030310

NUMBER OF HOURS

NO RESPONSE M

HARDCHECK: ”Please enter a whole number."

ALL

6030313

D005. (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

6030312

D010. (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

6030311

D015. (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

6030331

D020. (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

E001. (B01.) This section focuses on the content you cover in your math classes, as well as your teaching practices.

The curriculum used for your math classes is...

Select all that apply.

6020101

 a. Locally or district-designed 1

6020103

6020102

6020104

 b. State-designed 2

 c. Nationally-designed 3

 d. Other 99

6020105

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF E001=99 and no response specified; "You have selected "Other". Please provide a response to the "Please specify" prompt."

ALL

E005. (B04.) In addition to your primary math curriculum, which of the following do you use as a supplement for any of your math classes?

Select all that apply.

6020401

 a. Textbook (Print) 1

6020403

6020402

 b. E-book 2

 c. District or state educational content repository 3

6020407

6020404

 d. Open educational resources 4

6020405

Specify (STRING (120))

6020408

 e. Other 99

Specify (STRING (120))

6020406

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

NO RESPONSE M

SOFT CHECK: IF E005=4 and no response specified; You have selected "Open educational resources". Please provide a response to the "Please specify" prompt.

IF E005 =99 and no response specified; “You have selected "Other". Please provide a response to the "Please specify" prompt.

PROGRAMMER BOX 6

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

ALL

E010. (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 one or more of your math classes.

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

 p. Other (Please specify) 99

Specify (STRING (120))

6021217

 q. No technology devices are available for teacher use in the classroom 12

NO RESPONSE M

SOFT CHECK: IF E010=99 and no response specified; “You have selected "Other". Please provide 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

E015. (B13.) Please indicate if the following technology devices are available for student use in one or more of your math classes.

Select all that apply.

6021301

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

 k. Student or audience response system for polling 11

6021313

6021312

 p. Other (Please specify) 99

Specify (STRING (120))

6021317

 q. No technology devices are available for student use in the classroom 12

NO RESPONSE M

SOFT CHECK: IF E015=99 and no response specified; You have selected "Other". Please provide 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.

If E015=1-11 OR =99, go to E020; If E015=12 or “M” no response and E010=1-11 or =99 got to E030; Else if E015=12 or “M” no response, and E010 = 12 or “M” no response go to E060.

CLASS NAME, PERIOD = FILL FROM PRELOAD

E020. (B14.) In your math classes, how often do your students use technological resources to do each of the following? If the frequency is different for different math classes that you teach, please respond with an average across all math classes.

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 
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.

E015=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =99

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.

E025. (B14A.) Please list any other ways students in your math classes use technological resources and indicate how often they use technological resources in these ways. If the frequency is different for different math classes that you teach, please respond with an average across all math classes.

If there are no other uses, then please click “Next.”

		Rarely	Monthly	Weekly	Daily
6021422 6021421	a. Other use 1 (Please specify)	2 	3 	4 	5 
6021424 6021423	b. Other use 2 (Please specify)	2 	3 	4 	5 
6021426 6021425	c. Other use 3 (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.

E010=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =99

E030. (B15.) In your math classes, how often do you use technological resources to do each of the following? If the frequency is different for different math classes that you teach, please respond with an average across all math classes.

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 
6021541	e. Other assessment activities such as formative assessments, documenting student work	1 	2 	3 	4 	5 
6021550	f. Send reminders or class information to students.	1 	2 	3 	4 	5 
6021560	g. Provide homework help or learning support outside of class.	1 	2 	3 	4 	5 
6021570	h. Develop videos of classroom instruction.	1 	2 	3 	4 	5 
6021580	i. Compile links to external resources.	1 	2 	3 	4 	5 
6021590	j. 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.

E010=1 OR =2 OR =3 OR =4 OR =5 OR =6 OR =7 OR =8 OR =9 OR =10 OR =11 OR =99

E035. (B15A.) Please list any other ways you use technological resources in your math classes, and indicate how often you use them in this way. If the frequency is different for different math classes that you teach, please respond with an average across all math classes.

If there are no other uses, then please click “Next.”

		Rarely	Monthly	Weekly	Daily
6021522 6021521	a. Other use 1 (Please specify)	2 	3 	4 	5 
6021524 6021523	b. Other use 2 (Please specify)	2 	3 	4 	5 
6021526 6021525	c. Other use 3 (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

E040. (B16.) How easily can you access the internet in your math classes?

 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

E045. (B17.) How easily can your students access the internet in your math classes?

 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

E050. (B18.) How often do you connect to the internet in your math classes?

 Not at all 1

 Rarely 2

 Sometimes 3

 Often 4

NO RESPONSE M

ALL

6021564

E055. (B19.) How often do your students connect to the internet in your math classes?

 Not at all 1

 Rarely 2

 Sometimes 3

 Often 4

NO RESPONSE M

ALL

6021565

E060. (B20.) In your math classes, how often do you assign homework that requires your students to connect to the internet? If the frequency is different for different math classes that you teach, please respond with an average across all math classes.

 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 F001.

[ClassName, Period]

ALL ELIGIBLE RESPONDENTS (B001 = 1 or 2 FOR AT LEAST ONE STUDENT)

[ASK ONCE FOR EACH CLASSROOM SELECTED IN B010/B015.]

CLASS NAME, PERIOD = FILL FROM PRELOAD

F001. (A01.) {This section asks specific questions}/ {Now we would like to know} about your [CLASS NAME, PERIOD] class.

How many students are enrolled in this class?

6010101

STUDENTS

(RANGE 1-50)

NO RESPONSE M

HARD CHECK: IF F001 = 0. You entered that 0 students are in this class. Adjust the number of students then click the “Next” button.

SOFT CHECK: IF F001 > 50; You entered that [F001 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 ITEMS F005, F010, F015, F020, F025, F030, F035, and F040. THEN TSR ITEMS FOR STUDENTS IN THE CLASS FOR WHICH THEY JUST ANSWERED items F001, F005, F010, F015, F020, F025, F030, F035, and F040 in the survey. IF MORE THAN ONE CLASSROOM, THEN after last TSR for the previous class, LOOP SURVEY items F001, F005, F010, F015, F020, F025, F030, F035, and F040 FOR Next CLASSROOM with TSRs for students WITHIN that CLASSROOM in the LOOP, Repeat for each classroom. After all classrooms and tsrs within are complete, move to section “Your school and your teaching”.

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

6010102

F005. (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 basic/remedial mathematics 3

 Grade 7 general mathematics 4

 Grade 7 honors mathematics 5

 Grade 7 basic/remedial mathematics 6

 Grade 8 general mathematics 7

 Grade 8 honors mathematics 8

 Grade 8 basic/remedial mathematics 9

 Introduction to algebra/ pre-algebra 10

 Algebra 11

 Algebra II 12

 Geometry 13

6010103

 Other 99

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF F005=99 and no response entered; You have selected "Other". Please provide a response to the "Please specify" prompt."

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

F010. (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 F010a+F010b+F010c 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.

[Class Name, Period]: Content and teaching practices

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

ALL

6020200

F015. (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

6020201

Specify (STRING (120))

 Other 99

6020202

Specify (STRING (120))

NO RESPONSE M

SOFT CHECK: IF F015=4 and no response specified; go to F020.

IF F015 =99 and no response specified; "You have selected "Other". Please provide a response to the "Please specify" prompt."

F020. (B02OER.) What open educational resources do you use as your primary basis for instruction for this [CLASS NAME, PERIOD] class?

Please specify:

Specify

IF F015=1 OR =2

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

F025. (B03a.) Please indicate the publication year of your primary textbook or e-book.

6020302

 2011 or earlier 1

 2012 2

 2013 3

 2014 4

 2015 5

 2016 6

 2017 7

 2018 8

NO RESPONSE M

PROGRAMMER BOX 5

format F025 as drop-down ranging from 2011 or earlier to 2018. Note the upper range of year may need to be updated accordingly.

ALL

[ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT]

CLASS NAME, PERIOD = FILL FROM PRELOAD

F030. (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 

F030 (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 each row.	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

F035. (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

F040. (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 each row.	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

FILL CLASS NAME, PERIOD FROM B010 OR B015.

Student information

G001. (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 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 B001 = 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.

G005. (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

G010. (A02aTSR.) Have you taught [FILL PRELOADED STUDENT NAME] math before this year?

 Yes 1

 No 2

NO RESPONSE M

ALL

G015. (A03aTSR.)Have you taught [FILL PRELOADED STUDENT NAME] in other academic areas before this year?

6110111

 Yes 1

 No 2

NO RESPONSE M

ALL

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

FILL: HIS OR HER FROM SEX IN PRELOAD

G020. (A04aTSR.)How often does [FILL PRELOADED STUDENT NAME] wear eyeglasses or contact lenses to improve {his/her} vision?

6110201

 ALL/MOST OF THE TIME 1

 SOMETIMESS/RARELY 2

 NEVER/ MAY NOT NEED CORRECTION 3

NO RESPONSE M

ALL

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

G025. (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: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

FILL: HIS OR HER FROM SEX IN PRELOAD

G030. (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

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

G035. (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: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

FILL: HIS OR HER FROM SEX IN PRELOAD

G040. (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

FILL: STUDENT FIRST NAME= FIRST NAME SELECTED FROM B001

FILL: STUNDENT LAST NAME=LAST NAME SELECTED FROM B001

FILL: HE OR SHE FROM SEX IN PRELOAD

These questions ask about how [FILL PRELOADED STUDENT NAME] behaves in your classroom.

H001. (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 for each row.	Not at all true	A little bit true	Somewhat true	Mostly true	Very true
6130101	a. In my class, [STUDENT FIRST NAME] works as hard as [he/she] can.	1 	2 	3 	4 	5 
6130102	b. When working on classwork in my class, [STUDENT FIRST NAME] appears involved.	1 	2 	3 	4 	5 
6130103	c. When I explain new material, [STUDENT FIRST NAME]listens carefully.	1 	2 	3 	4 	5 
6130104	d. In my class, [STUDENT FIRST NAME]does more than required.	1 	2 	3 	4 	5 
6130105	e. When [STUDENT FIRST NAME]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

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

Next are some questions about [FILL PRELOADED STUDENT NAME] attendance.

H005. (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

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

H010. (C03aTSR.)Over the last month, how often did [FILL PRELOADED STUDENT NAME]...

PROGRAMMER: CODE ONE PER 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

FILL: STUDENT NAME= FIRST NAME AND LAST NAME SELECTED FROM B001

This last section asks about any special supports or opportunities [FILL PRELOADED STUDENT NAME] receives at school.

I001. (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

I005. (D02TSR.)Have you recommended [FILL PRELOADED STUDENT NAME] for academic honors, advanced placement, or honors classes?

6140200

 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 B001 in (1,2) ARE IN THIS CLASS, LOOP BACK TO G005.

ELSE IF ADDITIONAL STUDENTS WHERE B001 in (1,2), BUT THEY ARE IN A DIFFERENT CLASS, LOOP BACK TO THE PROGRESS SUMMARY SCREEN (immediately preceding C001).

ELSE GO TO J001 (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

J001. (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

J005. (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

J010. (C03C.) The next set of questions is about use of assessment data in [FILL SCHOOL NAME].

In this class, how often do you use a formal assessment in MATH for the following purposes?

PROGRAMMER: CODE ONE PER ROW

	Select one answer for each row.	Never	Once per year	Twice per year	3-4 times per year	5-8 times per year	1-2 times per month	3-4 times per month
6030391	a. To evaluate how well each student is responding to the core curriculum provided in the general education classroom	1 	2 	3 	4 	5 	6 	7 
6030392	b. To monitor each student’s progress on specific skills over the school year	1 	2 	3 	4 	5 	6 	7 
6030393	c. To identify the deficits in specific skills of struggling students	1 	2 	3 	4 	5 	6 	7 
6030394	d. To monitor the progress of students who fall below benchmark levels	1 	2 	3 	4 	5 	6 	7 
6030395	e. To determine whether students need placement in a more or less intensive level of instruction	1 	2 	3 	4 	5 	6 	7 

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

J015. (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.

	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].

J020. (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

J025. (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

J030. (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

J035. (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

6010300

J040. (A03.) At this point in the school year, how would you rate the behavior of the students in your math classes?

 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

ALL

The next two questions ask about your school’s technology policies and practices.

J045. (C09.) Does [FILL SCHOOL NAME] lend or provide computers, tablets, or similar devices to individual students?

6030900

 Yes 1

 No 2

NO RESPONSE M

ALL

J050. (C10.) Thinking about students, is this a bring your own device (BYOD) school?

6031000

 Yes 1

 No 2

NO RESPONSE M

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 “Finish” to end the survey.

Appendix MS1-U4. Special Education Teacher Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 10 minutes for the teacher-level information and 25 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

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

A001. (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.

1. Please record your answers by checking the box next to the appropriate answer or entering information as directed.

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

3. Press the "Next" button to move forward.

4. Press the "Previous" button to go back.

5. The “Log out” link can be used to save your responses and finish later.

6. To protect your answers, your responses will be automatically saved and you will be logged off if you are idle for more than 20 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, your name, and the classes you teach that have MGLS students. You will be able to correct your name at the end of the survey if needed. Press “Next” to continue.

School: [SCHOOL FILL]

Teacher: [TEACHER FILL]

SCREENER

aLL

A005. (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?

7010100

 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

7010101

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, “You have selected "Other," but have not provided a response to the "Please specify" prompt .”

aLL

A010. (A02)

7010201

.) 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 teacher 7

 Teacher aide or paraprofessional 8

 Other (please specify) 99

7010202

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

PROGRAMMER BOX

If A005= 4 OR A010 = 8, Go to B015

ALL

B001. (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>>

B005. (SC01.) Have you served as the teacher or special education provider for [STUDENT NAME] at any point during this school year (2017-18)?

7010203

 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 B010]

 No 3 [SKIP TO B015]

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

IF B005=1 then do:

IF B005 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B005 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B005 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B005 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding C001).IF B005=2, GO TO B010.

ELSE IF B005=3

GO TO B015

B005 = 2

<<FILL STUDENT NAME>>

RESPONSE OPTIONS WILL BE PRESENTED AS DROPDOWN LISTS.

B010. (SC01a.) In what month and year did you last serve as the teacher or special education provider for [STUDENT NAME]?

7010204

• Month

• Year

IF B010 MONTH=SEPTEMBER OR OCTOBER OR YEAR<2017, GO TO B015

ELSE IF B005 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B005 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B005 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B005 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding C001) THEN PROCEED TO A01.

ELSE TEACHER IS INELIGIBLE; GOTO END2.

B005 = 3

<<FILL STUDENT NAME>>

B015. (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 (2017-18)?

7010205

 Yes 1 [SKIP TO B020]

 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 B015=1/YES THEN GO TO B020.ELSE IF B005 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B005 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B005 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B005 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding C001).

ELSE GO TO END2

B005= 3 and B015=1 or M

<<FILL STUDENT NAME>>

B020. (SC03.) What is the name of the special education 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 B005 HAS NOT YET BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, LOOP BACK TO B005 AND ADMINISTER FOR THE NEXT PRELOADED STUDENT.

ELSE IF B005 HAS BEEN ADMINISTERED FOR EACH PRELOADED STUDENT ASSOCIATED WITH THE TEACHER RESPONDENT, AND B005 in (1,2) FOR AT LEAST ONE STUDENT, GO TO PROGRESS SUMMARY SCREEN (immediately preceding C001).

ELSE TEACHER IS INELIGIBLE; GOTO END2.

C. 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 C001.

B005 in (1,2)

<<FILL STUDENT NAME>>

C001. (D01.) These first questions are about [STUDENT NAME]'s individualized services and grade.

7040100

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.

B005 in (1,2)

<<FILL STUDENT NAME>>

C005. (D02.) Is [STUDENT NAME] currently receiving special education services based on an IEP or has [STUDENT NAME] received such services during this school year?

7040200

 Yes 1

 No 2

NO RESPONSE M

PROGRAMMER BOX

If D02 = 2 OR M, Go to CONFIRM

C005=1

C010. (D02A.) Are you a member of [STUDENT NAME]’s IEP team?

7040210  Yes 1

 No 2

NO RESPONSE M

C005=1

<<FILL STUDENT NAME>>

C015. (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 7040306	 e. Provide case management? 5  f. Other
	Specify

(STRING (255 default))

7040307

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

C005=1

<<FILL STUDENT NAME>>

C020. (D04.) In which grade is [STUDENT NAME] enrolled?

7040400

 Sixth grade 1

 This is an ungraded classroom 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

C005=1

<<FILL STUDENT NAME>>

C025. (D05.) When did [STUDENT NAME] first have an IEP?

7040500

 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.

C005=1 AND (C020 +1 > OR = C025)

C030. (D06.) Is this [STUDENT NAME]'s first year enrolled at this school?

7040600

 Yes 1

 No 2 [SKIP TO C045]

 Don’t know d [SKIP TO C045]

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

C030=1, M, go to C035; Else, skip to C045

<<FILL STUDENT NAME>>

C035. (D07.) To what extent were you involved in planning the transition from the previous school's special education program for [STUDENT NAME]?

7040700

 Not at all 1 [SKIP TO C045]

 Somewhat 2

 Extensively 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

C035=2, 3, M

<<FILL STUDENT NAME>>

FILL HIS OR HER FROM SEX IN PRELOAD

C040. (D08.) To what extent did you communicate with the person who provided special education for [STUDENT NAME] at [HIS/HER] previous school?

7040800

 Not at all 1

 Somewhat 2

 Extensively 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

If C025=1, go to C045; Else, go to D005.

<<FILL STUDENT NAME>>

C045. (D09.) Have you reviewed [STUDENT NAME]’s records related to special education services provided before this school year?

7040900

 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.

D. SERVICES RECEIVED

C005=1

<<FILL STUDENT NAME>>

<<FILL HE/SHE>>

FILL HIS OR HER FROM SEX IN PRELOAD

D001. (H01.) Next we would like to know about this student’s disability and the services [STUDENT NAME] may receive.

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
7080111	(STRING (255 default))

7080112  k. Don’t know 11

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

<<FILL STUDENT NAME>>

FILL: HIS OR HER FROM SEX IN PRELOAD

D005. (E01.)

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
7050113	(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
7050114	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1; IF D005 HAS MORE THAN 1 RESPONSE CHECKED, GO TO D010; ELSE GO TO D015.

<<FILL STUDENT NAME>>

FILL HIS OR HER FROM SEX IN PRELOAD

D010. (E02.) What is [STUDENT NAME]’s primary disability as identified on [HIS/HER] IEP?

7050200

 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

7050201 (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)

7050202 (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

D015. (E03.) Has [STUDENT NAME] received any special education or related services because of Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)?

7050300

 Yes 1

 No 2

 Don’t know 3

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

C005=1

<<FILL STUDENT NAME>>

D020. (E04.) Consider the IEP goals for [STUDENT NAME] during this school year.

Select all of the areas in which this student has IEP goals.

Academics

7050404

7050403

7050402

7050419

 a. Reading 1

 b. Mathematics 2

 c. Language Arts 3

 d. Science 4

7050405

 e. Social Studies 5

Speech and Language

7050410

7050409

7050407

7050408

 f. Auditory processing 6

 g. Listening comprehension 7

 h. Oral expression 8

 i. Voice/speech articulation, quality, or fluency 9

7050411

 j. Language pragmatics 10

Social-Emotional

7050413

 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

7050426

Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

<<FILL STUDENT NAME>>

D025. (E05.) Which of the following related services has the school provided to [STUDENT NAME] during this school year? Include all services paid for by the school, including contracted services, whether they are received in the school or at another location.

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 and mobility services 10
7050512	 l. Rehabilitation services 12
7050513	 m. Other (please specify) 99
7050514	(STRING (255 default))

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

<<FILL STUDENT NAME>>

D030. (E06.) Has [STUDENT NAME] received any of the following during the school year?

PROGRAMMER: CODE ONE PER ROW

Select all that apply.

		Yes
7050601	a. Adaptive physical education	1 
7050602	b. Assistance from classroom aides or paraprofessionals (e.g., teacher aide, behavioral assistant, special education aide)	1 
7050603	c. Interpreter for the deaf or hard of hearing (oral or sign)	1 
7050604	d. Materials provided in Braille or Nemeth code to support learning/instruction	1 
7050605	e. Student was taught how to use Braille and/or the Nemeth code	1 
7050606	f. Instruction provided in American Sign Language	1 
7050607	g. Student was taught how to use American Sign Language	1 
7050608	h. Instruction provided in Manual English	1 
7050609	i. Student was taught how to use Manual English	1 
7050610	j. Instruction provided in Cued Speech	1 
7050611	k. Student was taught how to use Cued Speech	1 
7050612	l. Mental health services, personal/group counseling, therapy, or psychiatric care provided to the student	1 
7050613	m. Tutoring/remediation from special education teacher	1 
7050614	n. Training, counseling, and other supports/services provided to this student's family	1 
7050615	o. Assistive technology	1 
7050616	(STRING (255 default)) p. Other (please specify)	1 
7050617

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

E. INSTRUCTIONAL SETTINGS AND MATERIALS

C005=1

<<FILL STUDENT NAME>>

E01. (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?

7060100

 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.

C005=1

<<FILL STUDENT NAME>>

E05. (F02A.) In what setting does [STUDENT NAME] primarily receive mathematics instruction?

7060201

 General education classroom 1

 Special education classroom 2

 Resource room 3

 Some other setting (specify) 99

7060210 Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

<<FILL STUDENT NAME>>

E010. (F02AB.) Does [STUDENT NAME] receive mathematics instruction in any additional setting or settings?

7060202

 Yes 1

 No 2 GO TO E020

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

E010=1

<<FILL STUDENT NAME>>

E015. (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

7060206

7060205

 c. Resource room 3

 d. Some other setting (specify) 99

7060207 Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (E05=1 and E015=1) OR (E05=2 and E015=2) OR (E05=3 and E015=3); "You answered [Fill the answer in E05] in the previous question. Your answer to this question includes the same mathematics instruction setting. Please change your answer to this question or the previous question. To continue without changing your answer, select “Next”.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1

<<FILL STUDENT NAME>>

E020. (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 provided to [STUDENT NAME] by the school 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.

Programmer, display the following help text for “direct special education services”:

“This means you give services directly to the student in a group or individually. This is not consulting with others about the student.”

C005=1

E025. (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?

7060400

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.

IF E01 NE 1 and E025 =0, “You reported earlier that this student’s placement is [RESPONSE TO E01]. Now you have reported that 0 hours of the instruction/services are provided outside of a general education classroom (but in the school building). Please confirm if 0 hours of service are provided in a different place in the school setting.”

HARD CHECK: IF E025>E020; 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.”

IF D030b=1, THEN GO TO E025.

ELSE GO TO E035.

E030. (F04a.) How many hours per week does [STUDENT NAME] receive paraprofessional support services?

7060410 HOURS PER WEEK

(NUMBER RANGE ALLOW 0 – 70 AND UP TO ONE DECIMAL PLACE)

NO RESPONSE M

C005=1

<<FILL STUDENT NAME>>

E035. (F05.)What teaching practices and methods have you and/or other special education service providers or the mathematics teacher (accommodations) used with [STUDENT NAME] to meet [his/her] special education needs?

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
7060517 7060518		p.. Other practices or accommodations (please specify) 16 (STRING (255 default))
7060516		q. Student did not receive instruction from me and/or other special education service providers 17

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF P=YES AND (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

C005=1; E05=1 OR E015=1

<<FILL STUDENT NAME>>

E040. (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.

C005=1

<<FILL STUDENT NAME>>

E045. (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.

C005=1

<<FILL STUDENT NAME>>

E050. (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

Hearing assistance

7060806

 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

7060812

 l. Electronic Braille devices 12

7060813

 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

7060825

 y. Reading 25

7060826

 z. Writing 26

7060827

 aa. Mathematics 27

Other

7060828  ab. Other (please specify)29

7060829

Specify (STRING (255 default))

Student did not use any assistive technologies

7060831

 ac. Student did not use any assistive technologies 28

7060830

 ad. Don’t know 99

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

PROGRAMMER BOX:

Please program so respondent can either select “STUDENT DID NOT USE ANY ASSISTIVE TECHNOLOGIES” or any other response category but not both.

C005=1

<<FILL STUDENT NAME>>

FILL HIM OR HER FROM SEX IN PRELOAD

E055. (F09.)Does [STUDENT NAME] have a computer, laptop, tablet, or word processing device assigned to [HIM/HER] for use full time?

7060900

 Yes 1

 No 2

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

F. Communication with teachers and parents

C005=1

<<FILL STUDENT NAME>>

F001. (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?

7070100

 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 F010]

 Not applicable to my work with this student 7 [SKIP TO F010]

 Not applicable as student receives all instruction from me 8 [SKIP TO F010]

NO RESPONSE M [SKIP TO F010]

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

F001=1, 2, 3, 4, 5

<<FILL STUDENT NAME>>

F005. (G02.) On average, how long were the meetings with the general education teacher(s) to discuss [STUDENT NAME]’s IEP or progress?

7070200

 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.

C005=1

<<FILL STUDENT NAME>>

F010. (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)?

7070300

 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.

G. GOALS AND EXPECTATIONS

C005=1

<<FILL STUDENT NAME>>

G001. (H02.) To what extent is [STUDENT NAME] expected to achieve the same general education goals as other students at [HIS/HER] grade level?

7080200

 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.

C005=1

<<FILL STUDENT NAME>>

G005. (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?

7080400

 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.

C005=1

<<FILL STUDENT NAME>>

G010. (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?

7080500

 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.

C005=1

<<FILL STUDENT NAME>>

G015. (H06A.) Overall, at what grade level is [STUDENT NAME] performing in language and literacy skills?

7080600

 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.

C005=1

<<FILL STUDENT NAME>>

G020. (H06B.) Overall, at what grade level is [STUDENT NAME] performing in mathematical skills?

7080601

 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>>

I001. (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>>

I005. (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

I010. (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.

7090400

 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>>

I015. (I07.) [STUDENT NAME] reads words with regular vowel sounds. For example, reads “coat,” “junk,” “lent,” “chimp,” “halt,” or “bite.”

7090700

 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>>

I020. (I08.) [STUDENT NAME] reads words with irregular vowel sounds. For example, reads "through," "point," "enough," or "shower."

7090800

 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

I025. (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>>

I030. (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.

7090300

 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>>

I035. (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.

7090600

 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 I010; IF I010 = 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.

I040. (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.

7091000

 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 I010; IF I010 = 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.

I045. (I09.) [STUDENT NAME] reads grade {STUDENT GRADE FILL} books fluently. For example, easily reads words in meaningful phrases rather than reading word by word.

7090900

 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

I050. (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.

7091100

 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>>

I055. (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.

7090200

 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>>

I060. (I01.)

7090100

[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.

J001. (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.

7100300

 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>>

J005. (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).

7100200

 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>>

J010. (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."

7100100

 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>>

J015. (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?"

7100900

 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>>

J020. (J11.) [STUDENT NAME] subtracts numbers that require regrouping. For example, 1300 - 579, or 2302 - 947, or 2603 - 1594.

7101100

 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>>

J025. (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.

7100500

 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>>

J030. (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.

7100700

 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>>

J035. (J08.)[STUDENT NAME] reduces fractions to lowest denominator. For example, reduces 27/63 to 3/7, or 41/6 to 6 5/6.

7100800

 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>>

J040. (J12.) [STUDENT NAME] divides a 3-digit number by a 1-digit number. For example, 348÷4 or 228÷6.

7101200

 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>>

J045. (J06.) [STUDENT NAME] shows understanding of place values with decimals. For example, compares decimals to the thousandths place (1.04 > 1.009).

71006000

 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>>

J050. (J13.) [STUDENT NAME] divides multi-digit problems with remainders in the quotient. For example, computes 536÷30 or 6135÷7.

7101300

 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>>

J055. (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.

7101000

 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

J060. (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.

7101400

 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.

K001. (K01.) Which of the following best describes [STUDENT NAME]’s expressive communication?

7110100

 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>>

K005. (K02.) Does [STUDENT NAME] use an augmentative communication system in addition to or in place of oral speech?

7110200

 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>>

K010. (K03.) Which of the following best describes [STUDENT NAME]’s vision?

7110300

 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.

Programmer, display the following help text for response option 2: Corrected vision refers to how the student sees when wearing glasses or contact lenses. Choose this option if wearing glasses or contact lenses are able to correct the student's vision to within normal limits.

Programmer, display the following help text for response option 3: Low vision indicates that the student’s vision is not within normal vision even with glasses or contact lenses. Choose this option if wearing glasses or contact lenses is not able to correct the student's vision to within normal limits.

ALL

<<FILL STUDENT NAME>>

K015. (K04.) Which of the following best describes [STUDENT NAME]’s hearing?

7110400

 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.

Programmer, display the following help text for response option 2: Corrected hearing refers to how the student hears when using a hearing aid. Choose this option if using a hearing aid is able to correct the student's hearing to within normal limits.

Programmer, display the following help text for response option 3: Hearing loss aided, but still with a significant loss indicates that the student’s hearing is not within normal hearing even with a hearing aid. Choose this option if using a hearing aid is not able to correct the student's hearing to within normal limits.

ALL

<<FILL STUDENT NAME>>

K020. (K05.) Which of the following best describes [STUDENT NAME]’s motor abilities?

7110500

 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

K025. (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 B005 in (1,2), THEN GO TO L001.

ELSE LOOP BACK TO THE PROGRESS SUMMARY SCREEN (immediately preceding C001) TO ADMINISTER STUDENT-SPECIFIC QUESTIONS FOR THE NEXT STUDENT WHERE B005 in (1,2).

L. YOUR TEACHING ASSIGNMENT AND YOUR SCHOOL

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

L001. (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?

7010300

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

IF L001 = 2 OR M, GO TO L010

{L001=1}

L005. (A04.) Which of the following models best describes your current coteaching arrangement?

7010401

 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

7010402 Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF OTHER (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

L010. (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
7010506	(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, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

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 A005 IS 1 or 2}

L015. (A07A.) Do you teach academic content to students who have IEPs?

7010700

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF L015 = 1 }]

L020. (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 
7010717	h. Other (please specify)	1 	2 	3 	4 	5 	6 
7010718	STRING 255 default	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 L020 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 A005 IS NOT 4} and {A010 IS NOT 8}

L025. (A06.) Do you teach mathematics to students who have IEPs?

7010600

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

If L025=1, go to L030;

Else, go to L035.

L030. (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 
7010719 7010720	j. Other (please specify:) STRING 255 default	1 	2 	3 	4 	5 	6 

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

[{IF A005 IS 1 or 2}

L035. (A07C.) When teaching 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 
7010731 7010732	k. Other (please specify) STRING 255 default	1 	2 	3 	4 	5 	6 

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

L040. (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 A005 IS NOT 4} and {A010 IS NOT 8}]

L045. (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 A005 IS NOT 4} and {A010 IS NOT 8}]

L050. (A08B.) Please indicate how strongly 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 
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 
7010837	g. General education teachers who are teaching my students regularly use Response to Intervention (RTI) for learning.	1 	2 	3 	4 	5 
7010838	h. General education teachers who are teaching my students regularly use universal design for learning.	1 	2 	3 	4 	5 

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

L055. (A09.) During this school year, how many students with IEPs have you worked with or provided services for, on average, each week?

7010900

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

M. BACKGROUND AND EDUCATION

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

M001. (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 A005 IS NOT 4} and {A010 IS NOT 8}]

M005. (B02.) In what year were you born?

7020200

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 A005 IS NOT 4} and {A010 IS NOT 8}]

M010. (B03.) Are you of Hispanic or Latino/Latina origin?

7020300

 Yes 1

 No 2

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

PROGRAMMER BOX M010

HYPERLINK THE WORDS “Hispanic or Latino/Latina” FOR M010 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 A005 IS NOT 4} and {A010 IS NOT 8}]

M015. (B04.) Which of the following best describes your race?

Select all that apply.

7020401

7020402

 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 M015 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 A005 IS NOT 4} and {A010 IS NOT 8}]

M020. (B05.) What is the highest level of education you have completed?

7020500

 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

 An 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 A005 IS NOT 4} and {A010 IS NOT 8}]

M025. (B06.) Which of the following credentials, licenses, or certificates do you have for working with students with disabilities?

Select all that apply.

7020601

 a. Emergency credential 1

7020602

 b. Provisional or temporary credential 2

7020603

 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

7020606

 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

7020609

 i. Social work license or certification 9

7020610

 j. School psychology license or certification 10

7020611

 k. Clinical psychology license or certification 11

7020612

 l. Certificate of Clinical Competence 12

7020613

 m. Other professional license, credential, or endorsement (please specify) 13

7020614 Please specify (STRING 255 default)

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

M030. (B07.) Which of the following describes the teaching certificate you currently hold?

7020700

 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.

{M030=1, 2, 3, 4}

M035. (B08.) In what area(s) and subject(s) are you certified?

Select all that apply.

Areas

7020802

7020803

7020801

7020804

 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

7020818 Please Specify (STRING (255 default))

7020807

 g. Instruction for English Language Learners (e.g., English for Speakers of Other Languages or bilingual education 7

Subjects

7020810

 j. English/Language arts 10

7020811

 k. Reading 11

7020813

7020814

 m. Mathematics 12

 n. Science (including general science, biology or life sciences, earth science, and other natural sciences) 13

7020815

 o. Social studies (including history, government or civics, geography) 14

7020816

 p. Social or behavioral science (including psychology, sociology, anthropology, and other social sciences) 15

7020817

 q. Other (please specify) 99

7020819 Please Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

[{IF A005 IS NOT 4} and {A010 IS NOT 8}

M040. (B09.)Have you received any training related to Response to Intervention (RTI) from any of the following sources?

Select all that apply.

7020904

7020901

7020902

7020903

 a. College courses 1

 b. Professional development 2

 c. Personal reading and study 3

 d. I have not received any training on issues related to Response to Intervention 4

7020905

 e. Other training (please specify) 99

7020906 Specify (STRING (255 default))

NO RESPONSE M

SOFT CHECK: IF Q#=NO RESPONSE; see earlier programmer note.

SOFT CHECK: IF (SPECIFY) = MISSING, “You have selected "Other," but have not provided a response to the "Please specify" prompt.”

PROGRAMMER BOX M040

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

N. PROFESSIONAL EXPERIENCE

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

N001. (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.

7030300

YEARS WORKED WITH STUDENTS

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF N001 <1 or N001 > 45; Just to confirm, you answered [N001] 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 A005 IS NOT 4} and {A010 IS NOT 8}]

N005. (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.

7030200

YEARS WORKED WITH SPECIAL EDUCATION STUDENTS

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF N005 <1 or N005 > 45; Just to confirm, you answered [N005] 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 N001 < N005; Your total years working with any students ([N001]) is inconsistent with the number of years you have worked with special education students ([N005]). Please change your response to this question or go back and change your response for years worked with any students.

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

N010. (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.

7030400

YEARS WORKED TEACHING MATH 6-12

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF N010 <1 or N010 > 45; Just to confirm, you answered [N010] 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 N001 < N010; Your total years working with any students ([N001]) is inconsistent with the number of years you have taught math ([N010]). Please change your response to this question or go back and change your response for years worked with any students.

[{IF A005 IS NOT 4} and {A010 IS NOT 8}]

N015. (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.

7030100

YEARS WORKED IN CURRENT SCHOOL

YEARS

(1-70)

NO RESPONSE M

SOFT CHECK: IF N015 <1 or N015 > 45 Just to confirm, you answered [N015] 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 N001 < N015; Your total years working with any students ([N001]) is inconsistent with the number of years you have worked in your current school ([N015]). 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:

SOFT CHECK: IF NAME and STREET ADDRESS and ZIP CODE and CITY and STATE=MISSING; We need your address information in order to send you your incentive.

SOFT CHECK: IF NAME or STREET ADDRESS or ZIP CODE or CITY or STATE=MISSING; You have not provided a [name, address, zip, city, state]. Without a complete name and address, we may not be able to send your incentive check to you. If this information is available, please select 'Edit.'

SOFT CHECK: IF ZIP CODE is not a whole number; Please enter only numbers for the ZIP code.

SOFT CHECK: IF ZIP CODE is not recognized in database; The ZIP code you have provided is not in our database. Please click "Next" to confirm [zip] as the correct ZIP code or "EDIT" to change your response.

HARD CHECK: IF CITY contains numbers; The city you have entered contains numbers. Please revise so you may continue

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.

END2:

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.

Appendix MS1-U5. School Administrator Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

Gray shading of item numbers indicates the item is part of the MS1 Abbreviated Administrator Survey.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 40 minutes , 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

OMB # 1850-0911

Expiration: 09/30/2018

Reference No.: 40215.005

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

School Administrator Questionnaire

Welcome to the Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) School Administrator Questionnaire.

Please refer to the instructions you received in your survey invitation letter to find your User Name and password. To begin the survey, enter your User Name and password in the fields below, and then click Next. If you do not have your User Name and password, please call 1-855-500-1432, or email us at [email protected].

User Name:

Password: _______________________________

Questions? Contact the Help Desk at [email protected]

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 40 minutes, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

PROGRAMMER BOX All

1. Question numbers appear in the specs for programming purposes (i.e., routing, skip logic, etc.) but the question numbers should be displayed in upper right hand corner of survey window.

2. Allow respondents to select an answer by clicking any part of the response text.

3. All questions will generally have the same soft check message(s):

Missing 3 items in a row: It appears that the last three questions were left blank. Your answers are extremely important. Please go back and provide an answer or press Next to continue.

Missing 3 items in a grid: It appears that a few questions were left blank. Your answers are extremely important. Please provide an answer or press Next to continue.

4. Program the screen to automatically scroll to the top when an error message is displayed.

5. Please timeout the survey after 20 minutes of inactivity. When the instrument times out, return the respondent to the login page with the following warning displayed:

Your session has timed out due to inactivity. Please login again and continue.

A. INTRODUCTION

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.

8010116

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/ Thank you very much for participating! Gathering information on the number of students in sixth grade who are English language learners in advance will help you complete the questionnaire more quickly.]:

8010117

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 2016-17 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.

IF ABBREVIATED SURVEY, PLEASE DISPLAY ONLY “Thank you very much for participating! Gathering information on the number of students in sixth grade who are English language learners in advance will help you complete the questionnaire more quickly.”

All

A01c. How to Complete the Survey:

8010118

• 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. You will not be able to use the progress bar to jump to the Administrator Background section until you have answered the first question in that 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

A05a (A02a). Please confirm that you are a person at this school who is knowledgeable about sixth-grade students, teachers, programs, and services.

8010201

 Yes 1 A03

 No 2 A02c

HARD CHECK: IF A02a= NO RESPONSE; Please provide an answer to this question and then click Next.

A05A = 2

A05b (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) 8010203

Last Name: (STRING 50) 8010204

Title: (STRING 50) 8010205

Phone: (STRING 10) 8010206

Email: (STRING 50) 8010207

SOFT CHECK: IF A05b= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOx A05b

PLEASE VALIDATE PHONE NUMBER BY AREA CODE AND EXCHANGE NUMBER.

PLEASE VALIDATE EMAIL ADDRESS.

A05a=2

If text entered at A05b, fill TITLE, FIRST NAME, and LAST NAME

A05c(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 a05c

PROGRAM A “next” BUTTON ON THE SCREEN. The button will close down the interface in which the survey was displayed. EXIT SURVEY.

A05a = 1

A10(A03). What is your title or position at this school?

Select the one that best describes you.

8010300

 Principal/Administrator 1 B01

 Vice Principal 2 B01

 Counselor 3 B01

 School administrative personnel 4 B01

 Other (Please specify) 99 B01

Specify (STRING 250)

8010301

SOFT CHECK: IF A10= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOX a10

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 B05

 Public school that has a magnet program for some of the students 2 B05

 Public school that is exclusively a magnet school 3 B05

 Charter school 4 B05

 Private school 5 B05

 Other (Please Specify) 99 B05

Specify (STRING 250)

8020101

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

B05(B02). What is the Average Daily Attendance (ADA) for your school this year? Please report as a number or a percent.

8020300

8020301

(NUMBER OF STUDENTS RANGE 0-9999) (PERCENT OF STUDENTS RANGE 0-100)

 Number of students 1 B10

 Percent of students 2 B10

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

B10(B03). What is the maximum yearly tuition to attend your school? Enter "0" if school does not charge tuition.

$

8020400

(RANGE 0-50000)

Please report your answer rounded to the nearest dollar.

B10 > 0

B15(B04). What percentage of your students pay the maximum yearly tuition?

8020500

 0 – 25 percent 1

 26 - 50 percent 2

 51 - 75 percent 3

 76 - 100 percent 4

The next set of questions is about your student population.

All

B20a(B06b). What percentage of the total student body in your school are English language learners (ELLs)?

8020702

Percent

PROGRAMMER box b20a

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.

B20b(B06c). Do any students enrolled in this school attend an alternative program either at your school or off-site?

8020703

 Yes, the program is available 1

 No, the program is not available 2

All

These next questions only ask about sixth grade at your school.

B25(B07). What type of daily schedule is typically used for the sixth-grade level at your school?

8020201

 Self-contained classrooms 1 B30

 Daily periods uniform in length 2 B30

 Daily periods of varying length 3 B30

 Flexible schedule for teams 4 B30

 Other (Please specify) 99 B30

Specify (STRING 250) 8020202

PROGRAMMER BOX B25

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.

B30(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 B35

8020802

 b. The school provides extra assistance to classroom teachers by school staff 2 B35

8020803

 c. The school provides pull-out instruction during the regular school day 3 B35

8020804

 d. The school provides a homework assistance program to students 4 B35

8020806

8020805

 e. The school provides additional support outside the regular school day 5 B35

 f. The school takes other steps to assist struggling students 6 B35

8020807

(Please specify) (STRING 8000) 8020808

 g. The school does not have any programs for students who need extra assistance 7 B35

PROGRAMMER box B30

Please add an information icon next to “THE SCHOOL PROVIDES TUTORING DURING THE REGULAR SCHOOL DAY” that LINKs TO THE HELP TEXT BELOW:

By tutoring we mean extra assistance provided from individuals other than the teacher.

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

B35(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

8020902

 b. Small learning communities for over‐aged students who have not met promotion criteria 2

8020903

 c. Small sixth-grade learning communities separate from the rest of the school 3

8020904

 d. Block scheduling, also called double‐block or extended‐block scheduling, for struggling sixth-graders 4

8020905

 e. Catch‐up courses or “double‐dosing” of classes 5

8020906

 f. Specific professional development, coaches, or technical assistance for teachers working with struggling sixth-graders 6

8020907

 g. Tutoring 7

8020908

 h. Another program (Please specify) 8

(STRING 8000) 8020910

8020909

 i. There are no programs to assist sixth graders who are struggling academically. 9

PROGRAMMER box B35

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.

All

The next set of questions is about instructional programs at your school.

B40a-B40b (B13-B15). For each of the following programs, please indicate whether students in your school receive this program during the current school year.

		Yes, the program is available for Grade 6 students	No, the program is not available for Grade 6 students
8021301	a. Programs that focus on developing students’ literacy solely in English		
8021303	b. Programs that focus on developing students’ literacy in two languages		

PROGRAMMER BOX B40a-B40b

grade level should be 6.

B50 (B15). For each of the following programs, please indicate whether students in your school receive this program during the current school year.

	Percentage of students receiving program		Check here if program is not available
8021305	c. Special education	percent	8021306 

PROGRAMMER BOX B50

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.

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) 8030113

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.

C10(C02). Are the following available to general education teachers in this school when students with IEPs are included in their classes?

8030201

Select all that apply

 Check this box if students with IEPs are not included in general education classrooms at your school 1 C15

8030202	 a. Consultation with or technical assistance from special education or other staff with general special education training, not specific to child's disability
8030203	 b. Special equipment or materials
8030204	 c. Professional development
8030205	 d. Teacher aides, instructional assistants, paraprofessionals, or aides for individual students
8030206	 e. Smaller student load or class size
8030207	 f. Co-teaching with a special education teacher or related services provider
8030208	 g. Team teaching with a special education teacher or related services provider
8030209	 h. Team planning
8030210	 i. Other (Please specify)

Specify (STRING 8000) 8030211

PROGRAMMER BOX C10

C10a-c10i 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 AN 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 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.

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.

C15(C03). For each of the following programs and supports, please indicate whether students with IEPs in your school receive this program or support during the current school year. Please include programs provided by alternate service providers.

Select all that apply

8030301	 a. Referrals to vocational rehabilitation services
8030303	 b. Help developing capability to dress, clean, care for self
8030305	 c. Learning self-determination and self-advocacy skills
8030307	 d. Peer buddy program
8030309	 e. Alternative placements for students who are expelled and/or suspended
8030311	 f. Helping students connect to outside transition services, supports, and activities
8030313	 g. Helping students connect to adult residential providers and day services
8030315	 h. Information bank for parents or guardians with materials and resources relating to independent living
8030317	 i. Instruction for parents or guardians on youth’s rights and responsibilities under disability-related laws
8030319	 j. Other (Please specify)

(STRING 8000) 8030321

PROGRAMMER BOX C15

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.

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

D10(D02). When did your school begin using interdisciplinary team teaching in sixth grade?

 Less than 1 year 01 D03

 1-5 years 02 D03

 More than 5 years 03 D03

 Don’t know 04 D03

PROGRAMMER BOX D10

PLEASE add an information icon to the question text “interdisciplinary team teaching” 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.

D01 = 1

D15(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 D10

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

D20(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.

	Average common planning time per week	Don’t know
8040501	Please select…	8040502 

PROGRAMMER BOX D20

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 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.

D01 = 1

D25(D07). Please indicate the extent to which you agree or disagree with each of the following statements.

	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 their teaching 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 D25

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

D30 (D08). Please indicate which of the following programs or practices are used at your school.

Select all that apply

8040801	 a. Minimum competency tests for promotion to next grade
8040802	 b. Common academic curriculum for all students in the same grade
8040803	 c. Classes organized for cooperative learning
8040804	d. Exploratory mini courses for all students in all grades
8040805	 e. Students from more than one grade level assigned together to the same academic classes
8040806	 f. Information on how to help children with homework and skills provided to parents
8040807	 g. Extracurricular activities for all students
8040808	 h. Schools-within-a-school with their own administrative staffs

all

D35 (D09). The following questions are about math courses.

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. Basic/Remedial math	1 	2 	3 	4 
8040903	b. General math	1 	2 	3 	4 
8040904	c. Honors math	1 	2 	3 	4 
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) 8040924

SOFT CHECK: IF D35a-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 d35

please gray out other specify box is d35m = 4

If D35m= 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.

ALL

D40 (D11). Please estimate the percentage of sixth-grade students repeating the level of mathematics they took in fifth grade.

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.

8041100

 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

D45a (D15a). Thinking about students who are performing below grade level in math, what is the likely sequence of courses they would take starting in sixth grade and continuing through ninth grade?

8041501

8041502

8041503

8041504

Grade 6	Grade 7	Grade 8	Grade 9
Select course…	Select course…	Select course…	Select course…

PROGRAMMER BOX D45A

“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 D35=4 OR D35 = No Response, then skip D45a.

if all rows D35 = No Response, please program the following soft check to appear at the beginning of the question:

Please go back and complete item D35 before answering this item. To skip the question, click the Next button.

If no response if provided after soft check is triggered at d45a, then skip to d55.

ALL

D45b(D15b). Thinking about students who are performing at grade level in math, what is the likely sequence of courses they would take starting in sixth grade and continuing through ninth 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 D45b

“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 D35=4 D35 = No Response, then skip D45B.

ALL

D45c (D15c). Thinking about students who are performing above grade level in math, what is the likely sequence of courses they would take starting in sixth grade and continuing through ninth grade?

8041512

8041511

8041510

8041509

Grade 6	Grade 7	Grade 8	Grade 9
Select course…	Select course…	Select course…	Select course…

PROGRAMMER BOX D45c

“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 D35=4 D35 = No Response, then skip D45c.

ALL

D50(D16a). Is there any other sequence of courses that is taken by sixth graders?

8041601

 Yes 1

 No 2

PROGRAMMER BOX D50

if all rows in D35=4, then skip D50.

ALL

D55 (D17). The next questions are about courses other than math at your school.

Do you offer these programs to your sixth-grade students?

		Yes, program is offered to Grade 6 students	No, program is not available in Grade 6
8041701	a. Reading instruction for students performing below grade level in reading		
8041703	b. Additional instruction for students performing below grade level in other areas of English language arts		
8041707	d. Gifted and talented or International Baccalaureate® (IB)		

All

The next questions are about assisting students in the transition from one grade to the next.

D60 (D20). Does your school organize the transition from fifth grade to sixth grade in any of the following ways?

Select all that apply

8042002  b. Fifth-grade students visit an assembly of sixth-grade students 2 D65

8042003  c. Fifth-grade students attend regular sixth grade courses 3 D65

8042004  d. Buddy programs that pair new students with an older student in the fall 4 D65

8042005  e. Parents visit the school or sixth-grade section while students are still in fifth grade 5 D65

8042007  g. Meetings for fifth-grade students during the summer prior to beginning the sixth grade 7 D21

8042010  j. Fifth-grade counselors meet with sixth-grade counselors or staff 10 D65

8042013  m. Fifth-grade counselors present information to fifth-grade students’ parents or guardians about sixth-grade courses and registration 13 D65

8042014  n. Fifth-grade counselors place fifth-grade students into sixth-grade courses based on school or district placement policies 14 D65

8042015  o. Fifth-grade counselors present information to fifth-grade students
about sixth-grade courses and registration 15 D65

8042001  a. Sixth-grade students share information with the fifth-grade students 1 D65

8042006  f. Parents can attend an orientation in the fall after students start sixth grade 6 D65

8042008  h. Sixth-grade and fifth-grade teachers meet together on courses and requirements 8 D65

8042009  i. Sixth-grade and fifth-grade administrators meet together on articulation and programs 9 D65

8042011  k. Sixth-grade counselors meet with students while they are still in fifth grade 11 D65

8042012  l. Sixth-grade counselors meet with individual fifth-grade students and assist them with selecting sixth-grade courses while they are still in fifth grade 12 D65

8042016  p. No special activities until students enter sixth grade 16 D65

8042017  q. Other (Please specify.) 99 D65

Specify (STRING 8000) 8042019

8042018  r. No transition – sixth grade seamlessly continues directly from fifth grade 17 D65

PROGRAMMER BOX D60

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 fifth grade to sixth grade.

IF “No transition – sixth grade seamlessly continues directly from fifth grade” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

All

D65 (D21). Does your school provide additional assistance with the transition from fifth grade to sixth grade for students with disabilities?

8042100

 Yes 1

STRING 8000) 8042101

 No. 2

PROGRAMMER BOX D65

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 fifth grade to sixth grade.

all

D70 (D24). Does your school have an advisory program in the sixth grade?

8042401	Yes	 1
	No	 2

PROGRAMMER BOX d70

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 d70 = 2 (i.e., advisory program is not used in any of the middle grades offered by the school), skip respondent to D90.

D70 = 1

D75 (D25). Which of the following best describes the way your school schedules time for the advisory program in sixth grade?

8042501

 We have a separate class period for advising 1 D80

 Advising is part of our homeroom period 2 D80

 We integrate advisory activities within our teams and/or classrooms 3 D80

 Other (Please specify) 99 D80

8042504 Specify (STRING 8000)

PROGRAMMER BOX D75

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.

D70 = 1

D80 (D26). When did your school begin using an advisory program in the sixth grade?

Select one answer.	School year started using advisory program
8042601	Please select…

PROGRAMMER BOX D80

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. this year

2. 1-5 years ago

3. more than 5 years

4. Don’t know

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.

D70 = 1

D85 (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 D85

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.

D90 (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 D90

IF “Instruction was not offered for any of the topics listed.” IF 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 
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

E05 (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 
8050208	h. Gang activities	1 	2 	3 	4 	5 
8050209	i. Cult or extremist group activities	1 	2 	3 	4 	5 

PROGRAMMER BOX E05

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.

E10 (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.
8050302		b. Control access to school buildings during school hours
8050303		c. Control access to school grounds during school hours
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
8050313		m. Block 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 E10

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.

FOR ABBREVIATED SURVEY, PLEASE DISPLAY ONLY:

“During this school year, is it a practice of your school to block access to social networking websites from school computers?”

All

E15 (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?

8050400

 Yes 1 E20

 No 2

PROGRAMMER BOX E15

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

E20 (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?

8050501

Select all that apply.

8050502

 At any time during school hours 1 E06

8050503

 While students are arriving or leaving 2 E06

8050504

 At selected school activities 3 E06

 When school activities are not occurring 4 E06

PROGRAMMER BOX E20

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.

E15=1

E25 (E06-E08).How many full-time equivalent (FTE) of security personnel (such as school resource officer, security guards, police officers) are present in your school during a typical week?

PROGRAMMER: RANGE FOR GRID IS 0-50

	Number of full-time equivalent (FTE)
8050601		FTE

PROGRAMMER BOX E25

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).

All

E30 (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

F05 (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.

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).

8060200

Classrooms teachers F10

(RANGE 0-1000)

NO RESPONSE M F10

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 f05

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

all

F10 (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 F10 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.

F15 (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 

ALL

F20 (F06). 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 following questions are about math courses.

F25(F05). 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 are adequately prepared to assist students who are experiencing difficulties in general mathematics.	1 	2 	3 	4 	5 	6 
8060502	b. Algebra I teachers are adequately prepared to assist students who are experiencing difficulties in Algebra I.	1 	2 	3 	4 	5 	6 
8060503	c. Algebra II teachers are adequately prepared to assist students who are experiencing difficulties in Algebra II.	1 	2 	3 	4 	5 	6 

All

F30 (F07). How many weeks per year are the grade 6 math classes typically held?

8060701

WEEKS

(RANGE (1-52))

NO RESPONSE M

SOFT CHECK: IF 0 < F30 < 9 or F30 > 40; Just to confirm You entered [F30 RESPONSE] weeks per year for this class. Press "Edit" to return to this screen or press "Next" to continue.

HARD CHECK: IF F30 = 0. You entered 0 weeks. Adjust the number of weeks then click the “Next” button.

HARDCHECK IF F30>52 OR NOT A NUMBER: Please enter a number between 1 and 52.

All

8060702702

F35 (F08). How many days per week are the grade 6 math classes typically held?

 One day 1

 Two days 2

 Three days 3

 Four days 4

 Five days 5

 Six days 6

NO RESPONSE M

All

F40 (F09). How many minutes is a typical grade 6 math class?

80607033

NUMBER OF MINUTES

(RANGE (1-200))

NO RESPONSE M

G. ADMINISTRATOR’S BACKGROUND

All

The next set of questions are about your background and experience.

G01. What is your sex?

8070100

Select the one that best describes you.

 Male 1 G02

 Female 2 G02

NO RESPONSE M G02

All

G05 (G02). Are you Hispanic or Latino/Latina?

Select the one that best describes you.

8070200

 Yes 1 G03

 No 2 G03

NO RESPONSE M G03

SOFT CHECK: IF G05 = 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 G05

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

G10 (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 G10 = 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 G10

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

G15 (G04). What is the highest degree you have earned?

8070400

 Associate's degree 1 G20

 Bachelor’s degree 2 G20

 Master’s degree 3 G20

 Educational Specialist degree 4 G20

 Ph.D.,Ed.D., M.D., law degree, or other high level professional degree 5 G20

 I do not have a degree 6 G25

SOFT CHECK: IF G15 = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

G15 NE 6 or g15 is missing

FILL RESPONSE FROM G15

G20 (G05). What was your major(s) or field(s) of study for your [G04]?

8070500

(STRING 250)

PROGRAMMER BOX G20

AUTOFILL FOR g20 BASED ON RESPONSE TO G15>=1 AND G15<=5. IF G15 = MISSING AUTOFILL SHOULD READ “HIGHEST DEGREE EARNED”

all

G25 (G06). What teaching certification(s) have you ever held?

8070601

Select all that apply.

 a. Middle grades certification 1 G30

8070602

 b. Elementary certification 2 G30

8070603

 c. Secondary subject matter certification 3 G30

8070605

8070604

 d. Special education certification 4 G30

 e. Other (Please specify) 99 G30

Specify (STRING 250) 8070605

PROGRAMMER BOX G25

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

G30 (G07). Have you received any specialized training in the instructional and organizational needs of a middle school?

Select all that apply.

8070705

8070704

8070703

8070702

 b. Certification coursework 2 G35

 c. Professional development 3 G35

 d. Master’s degree 4 G35

8070706

 e. Doctoral degree 5 G35

 f. Other (Please specify) 99 G35

Specify (STRING 250) 8070708

8070707

 g. Never received any specialized training 6 G35

PROGRAMMER BOX G30

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

G35 (G08). What other experiences in education have you had in the past?

8070801

Select all that apply.

8070807

8070806

8070802

8070803

8070804

8070805

 a. Principal/school administrator of another elementary school 1 G40

 b. Principal/school administrator of another middle school or junior high school 2 G40

 c. Principal/school administrator of another high school 3 G40

 d. Assistant principal 4 G40

 e. Elementary school teacher 5 G40

 f. Middle school or junior high school teacher 6 G40

 g. High school teacher 7 G40

All

Finally, we would like to ask you about your years of experience.

G40 (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 [A10]] at any school?		Year(s)
8070902	b. How many years have you served [as the [A10]] 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 G40

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

AUTOFILL FOR G40A/G40B BASED ON RESPONSE TO A10>0 AND A10<=4. IF A10 = 99, AUTOFILL FOR G09A/G09B BASED ON RESPONSE TO A10OS. IF A10 = MISSING, MODIFY G40A/G40B TEXT TO replace “as the [A10]” 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:

Intro

School Characteristics

School Programs

School Environment

School's Teachers

Administrator 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. [ITEMS DEFINING “COMPLETE” FOR ABBREVIATED SURVEY ARE TBD.]

For Section A: INTRO to be complete

Questions: A01a, A01b, A01c, 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 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 MS1-V. Facilities Checklist Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

Facilities Checklist

Note: Survey specifications are presented in order of administration. Item numbering is retained between rounds so may not reflect that order.

A (AA). School structure

The following question is about the features at the school.

A1 (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

A2 (A0). Please note the time of day that you observed the items below:

B. General Condition of Neighborhood/Area Around School

The following questions are about the condition of the immediate neighborhood/area around the school.

B1 (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 

C (B). General Upkeep-Main Entrance and Hallways and Displays at the School

9020100

C1 (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 in the school.

C2 (B1). While standing inside the school, 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, ceilings, or lockers	1 	2 	3 	4 	5 
9020106	e. Visible fire alarms or emergency alarms	1 	2 	3 	4 	5 
9020107	f. Chipped paint on the walls, doors, or ceilings	1 	2 	3 	4 	5 
9020108	g. Ceiling in disrepair (e.g., falling in, water damage, missing tiles, or plaster)	1 	2 	3 	4 	5 
9020109	h. Visible exit signs	1 	2 	3 	4 	5 
	Displays
9030104	i. School identity is visible (e.g., mascot, logo, colors, slogan)	1 	2 	3 	4 	5 
9030105	j. Accomplishments of the school are noted	1 	2 	3 	4 	5 
9030101	k. Displays of the works or accomplishments of students on walls or lockers	1 	2 	3 	4 	5 
9030106	l. Student academic work displayed	1 	2 	3 	4 	5 
9030107	m. Expectations for student behavior displayed	1 	2 	3 	4 	5 
9030103	n. Displays of posters encouraging positive behavior choices and well being (e.g., conflict resolution guidance or healthy food choices)	1 	2 	3 	4 	5 
9030102	o. Displays of student activities and opportunities for involvement (e.g., student government, yearbook, or school event committees)	1 	2 	3 	4 	5 
9030108	p. Learning resources for students are displayed (e.g., formulas, abbreviations, steps for reviewing)	1 	2 	3 	4 	5 

J. 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.

K. 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.

P. 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]

C3 (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 

C4 (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.

D1. 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, ceilings, or 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.

E1. 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, ceilings, or 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.

F1. 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 are 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 
9060111	Student uniforms	1	2 	3 	4 	5 
9060112	Signs at exit doors stating alarm will go off if door is opened	1	2 	3 	4 	5 

F2. 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.

	Select one answer for each row	Not at all	A little	Some	A lot	No opportunity to observe
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 

F3. 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.

G1. 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 (e.g., 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 (e.g., 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 (e.g., 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 (e.g., 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 OFT2-U1. Student Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 5 minutes per response, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

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

OFT2 Student Questionnaire

Note: Survey specifications are presented in order of administration. Item numbering is retained between rounds so may not reflect that order.

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

[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.”

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.

ALL

Intro. The first questions are about you.

ALL

Q1. Is English your first language?

4110810

 Yes 1 Q2

 No 0 Q2

NO RESPONSE M Q2

ALL

Q2. How old are you?

4110104

Q3

▼

(9 or younger, 10, 11, 12, 13, 14, 15 or older)

NO RESPONSE M Q3

PROGRAMMER BOX: QUESTION NUMBERING

THE QUESTION (E.G., Q1) NUMBERING 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, “Your responses are very important. Please answer as many questions as possible. Use the PREVIOUS button at the bottom of each page to back up and answer questions that were left blank or press “Next” to continue.”, should appear when three consecutive questions that are select all/select one questions are left blank.

ALL

Q3. What is your sex?

Select the one that best describes you.

4110200

 Male 1 Q4.1

 Female 2 Q4.1

NO RESPONSE M Q4.1

ALL

Next are some more questions about you.

Press "Next" to continue.

ALL

Q4.1. Are you Hispanic or Latino/Latina?

4110300

 Yes 1 Q4.2

 No 2 Q4.2

NO RESPONSE M Q4.2

PROGRAMMER BOX Q4.1

display help text when hovering over THE WORDS “Hispanic or Latino/Latina” for Q4.1.

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.

ALL

Q4.2 Which of the following best describes your race?

Select all that apply.

4110520

4110510

4110530

 White 1 END

 Black or African American 2 END

 Asian 3 END

4110540

 Native Hawaiian or other Pacific Islander 4 END

4110550

 American Indian or Alaska Native 5 END

NO RESPONSE M END

PROGRAMMER BOX Q4.2

Display help text for each response option of Q4.2 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.

End. 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 reading module of the in-school session.

Appendix OFT2-U2. School Administrator Survey Specifications

Note: Items have been renumbered to facilitate review. OFT1 item numbers are shown in parentheses,

and are used in programmer logic boxes.

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 20 minutes per response, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

OMB # 1850-0911

Expiration: 09/30/2018

Reference No.: 40215.005

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

School Administrator Questionnaire

Welcome to the Middle Grades Longitudinal Study of 2017-18 (MGLS:2017) School Administrator Questionnaire.

Please refer to the instructions you received in your survey invitation letter to find your User Name and password. To begin the survey, enter your User Name and password in the fields below, and then click Next. If you do not have your User Name and password, please call 1-855-500-1432, or email us at [email protected].

User Name:

Password: _______________________________

Questions? Contact the Help Desk at [email protected]

NCES is authorized to conduct MGLS:2017 by the Education Sciences Reform Act of 2002 (ESRA 2002, 20 U.S.C. §9543) and to collect students’ education records from education agencies or institutions for the purposes of evaluating federally supported education programs under the Family Educational Rights and Privacy Act (FERPA, 34 CFR §§ 99.31(a)(3)(iii) and 99.35).  The data are being collected for NCES by RTI International, a U.S.-based nonprofit research organization. All of the information you provide may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 U.S.C. §9573 and 6 U.S.C. §151). 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 voluntary information collection is 1850-0911. Approval expires 11/30/2020. The time required to complete this information collection is estimated to average approximately 20 minutes per response, 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 directly to: The Middle Grades Longitudinal Study of 2017-18 (MGLS:2017), National Center for Education Statistics, Potomac Center Plaza, 550 12th St, SW, Room 4002, Washington, DC 20202.

PROGRAMMER BOX All

1. Question numbers appear in the specs for programming purposes (i.e., routing, skip logic, etc.) but the question numbers should be displayed in upper right hand corner of survey window.

2. Allow respondents to select an answer by clicking any part of the response text.

3. All questions will generally have the same soft check message(s):

Missing 3 items in a row: It appears that the last three questions were left blank. Your answers are extremely important. Please go back and provide an answer or press Next to continue.

Missing 3 items in a grid: It appears that a few questions were left blank. Your answers are extremely important. Please provide an answer or press Next to continue.

4. Program the screen to automatically scroll to the top when an error message is displayed.

5. Please timeout the survey after 20 minutes of inactivity. When the instrument times out, return the respondent to the login page with the following warning displayed:

Your session has timed out due to inactivity. Please login again and continue.

A. INTRODUCTION

All

8010116

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 information on the number of students in seventh grade who are English language learners in advance will help you complete the questionnaire more quickly.

8010117

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.

All

A01c. How to Complete the Survey:

8010118

• 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. You will not be able to use the progress bar to jump to the Administrator Background section until you have answered the first question in that 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

A05a (A02a). Please confirm that you are a person at this school who is knowledgeable about seventh grade students, teachers, programs, and services.

8010201

 Yes 1 A03

 No 2 A02c

HARD CHECK: IF A02a= NO RESPONSE; Please provide an answer to this question and then click Next.

A05A = 2

A05b (A02c). Please provide the name and contact information for a person at your school who is knowledgeable about seventh-grade students, teachers, programs, and services. They will be notified to complete the survey.

First Name: (STRING 50) 8010203

Last Name: (STRING 50) 8010204

Title: (STRING 50) 8010205

Phone: (STRING 10) 8010206

Email: (STRING 50) 8010207

SOFT CHECK: IF A05b= NO RESPONSE; Please provide an answer to this question and then click Next.

PROGRAMMER BOx A05b

PLEASE VALIDATE PHONE NUMBER BY AREA CODE AND EXCHANGE NUMBER.

PLEASE VALIDATE EMAIL ADDRESS.

A05a=2

If text entered at A05b, fill TITLE, FIRST NAME, and LAST NAME

A05c (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 a05c

PROGRAM A “next” BUTTON ON THE SCREEN. The button will close down the interface in which the survey was displayed. EXIT SURVEY.

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 B20a

 Public school that has a magnet program for some of the students 2 B20a

 Public school that is exclusively a magnet school 3 B20a

 Charter school 4 B20a

 Private school 5 B20a

 Other (Please Specify) 99 B20a

Specify (STRING 250)

8020101

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.

The next set of questions is about your student population.

All

B20a (B06b). What percentage of the total student body in your school are English language learners (ELLs)?

8020702

Percent

PROGRAMMER box b20a

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 seventh-grade at your school.

8020203

B25 (B07). What type of daily schedule is typically used for the seventh-grade level at your school?

 Self-contained classrooms 1 D01

 Daily periods uniform in length 2 D01

 Daily periods of varying length 3 D01

 Flexible schedule for teams 4 D01

 Other (Please specify) 99 D01

Specify (STRING 250) 8020202

PROGRAMMER BOX B25

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 seventh grade.

Other (Please specify)

(STRING 8000)

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 seventh grade?

8040203

 Yes 1 D20

 No 2 D30

NO RESPONSE M D30

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

D20 (D05). For seventh grade, on average, how much common planning time is regularly scheduled each week for interdisciplinary teaching teams? Your best estimate is fine.

	Average common planning time per week	Don’t know
8040501	Please select…	8040502 

PROGRAMMER BOX D20

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 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):

7. None

8. Less than 30 minutes

9. 30-60 minutes

10. 61-120 minutes

11. 121-180 minutes

12. 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.

D25 (D07). Please indicate the extent to which you agree or disagree with each of the following statements.

	Select one answer for each row.	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly Agree
8040703	Teachers collaborate and provide professional support	1 	2 	3 	4 	5 

PROGRAMMER BOX D25

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

D30 (D08). Please indicate which of the following programs or practices are used at your school.

	Select all that apply
8040801	 a. Minimum competency tests for promotion to next grade
8040802	 b. Common academic curriculum for all students in the same grade
8040804	 d. Exploratory mini courses for all students in all grades
8040805	 e. Students from more than one grade level assigned together to the same academic classes
8040806	 f. Information on how to help children with homework and skills provided to parents
8040807	 g. Extracurricular activities for all students

all

D35 (D09). The following questions are about math courses.

Which of the following math courses are offered to seventh-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
8040906	a. Basic/Remedial math	1 	2 	3 	4 
8040907	b. General math	1 	2 	3 	4 
8040908	c. Honors math	1 	2 	3 	4 

Specify (STRING 250) 8040924

SOFT CHECK: IF D35a-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 d35

please gray out other specify box is d35m = 4

If D35m= 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.

ALL

D40 (D11). Please estimate the percentage of seventh-grade students repeating the level of mathematics they took in sixth grade.

If your school uses a semester or block course system, please indicate the percentage of seventh-grade students repeating the last course section they took in sixth grade.

80411xx

 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

D45. Please estimate the percentage of students demoted to a previous level in mathematics between sixth and seventh grade.

8041300

 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

D55 (D17). The next questions are about courses other than math at your school.

Do you offer these programs to your seventh-grade students?

		Yes, program is offered to Grade 7 students	No, program is not available in Grade 7
80417xx	a. Reading instruction for students performing below grade level in reading		
80417xx	b. Additional instruction for students performing below grade level in other areas of English language arts		
80417xx	d. Gifted and talented or International Baccalaureate® (IB)		

D60 (D20). Does your school organize the transition from fifth grade to sixth grade in any of the following ways?

Select all that apply

8042002  b. Fifth-grade students visit an assembly of sixth-grade students 2 D65

8042003  c. Fifth-grade students attend regular sixth grade courses 3 D65

8042004  d. Buddy programs that pair new students with an older student in the fall 4 D65

8042005  e. Parents visit the school or sixth-grade section while students are still in fifth grade 5 D65

8042007  g. Meetings for fifth-grade students during the summer prior to beginning the sixth grade 7 D21

8042010  j. Fifth-grade counselors meet with sixth-grade counselors or staff 10 D65

8042013  m. Fifth-grade counselors present information to fifth-grade students’ parents or guardians about sixth-grade courses and registration 13 D65

8042014  n. Fifth-grade counselors place fifth-grade students into sixth-grade courses based on school or district placement policies 14 D65

8042015  o. Fifth-grade counselors present information to fifth-grade students
about sixth-grade courses and registration 15 D65

8042001  a. Sixth-grade students share information with the fifth-grade students 1 D65

8042006  f. Parents can attend an orientation in the fall after students start sixth grade 6 D65

8042008  h. Sixth-grade and fifth-grade teachers meet together on courses and requirements 8 D65

8042009  i. Sixth-grade and fifth-grade administrators meet together on articulation and programs 9 D65

8042011  k. Sixth-grade counselors meet with students while they are still in fifth grade 11 D65

8042012  l. Sixth-grade counselors meet with individual fifth-grade students and assist them with selecting sixth-grade courses while they are still in fifth grade 12 D65

8042016  p. No special activities until students enter sixth grade 16 D65

8042017  q. Other (Please specify.) 99 D65

Specify (STRING 8000) 8042019

8042018  r. No transition – sixth grade seamlessly continues directly from fifth grade 17 D65

PROGRAMMER BOX D60

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 fifth grade to sixth grade.

IF “No transition – sixth grade seamlessly continues directly from fifth grade” IS SELECTED, PLEASE DESELECT AND GRAY OUT ALL OTHER RESPONSES.

D65 (D21). Does your school provide additional assistance with the transition from sixth grade to seventh- grade for students with disabilities?

80421xx

 Yes 1

STRING 8000) 8042101

 No. 2

PROGRAMMER BOX D65

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 sixth grade to seventh grade.

all

D70 (D24). Does your school have an advisory program in the seventh-grade?

80424xx	Yes	 1
	No	 2

PROGRAMMER BOX d70

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 d70 = 2 (i.e., advisory program is not used in any of the middle grades offered by the school), skip respondent to D90.

D70 = 1

D75 (D25). Which of the following best describes the way your school schedules time for the advisory program in seventh-grade?

8042502

 We have a separate class period for advising 1 D80

 Advising is part of our homeroom period 2 D80

 We integrate advisory activities within our teams and/or classrooms 3 D80

 Other (Please specify) 99 D80

Specify (STRING 8000)8042504

PROGRAMMER BOX D75

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.

D70 = 1

D80 (D26). When did your school begin using an advisory program in the seventh grade?

Select one answer.	School year started using advisory program
8042603	Please select…

PROGRAMMER BOX D80

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. this year

2. 1-5 years ago

3. more than 5 years

4. Don’t know

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.

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 
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

E05 (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 
8050206	f. Students yelling and screaming at teachers	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 E05

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.

E10 (E03). During this school year, is it a practice of your school to block access to social networking websites from school computers?

8050313

 Yes 1 E15

 No 2 E15

If your school changed its practices during the school year, please answer regarding your most recent practice.

PROGRAMMER BOX E10

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

E15 (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?

8050400

 Yes 1 E20

 No 2 E20

PROGRAMMER BOX E15

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.

E20 (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?

8050501

Select all that apply.

8050502

 At any time during school hours 1 E30

8050503

 While students are arriving or leaving 2 E30

8050504

 At selected school activities 3 E30

 When school activities are not occurring 4 E30

PROGRAMMER BOX E20

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.

All

E30 (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) seventh-grade teachers by subject area. Please give your best estimate.

PROGRAMMER: RANGE FOR GRID IS 0-100

		Number of full-time equivalent (FTE)
8060106	a. Mathematics		FTE
8060107	b. English/Language arts		FTE
8060108	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

F05 (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.

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).

8060200

Classrooms teachers F10

(RANGE 0-1000)

NO RESPONSE M F10

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 f05

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

all

F10 (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
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 F10

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

F20 (F06). 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 

G. ADMINISTRATOR’S BACKGROUND

All

The next set of questions are about your background and experience.

G01. What is your sex?

8070100

Select the one that best describes you.

 Male 1 G05

 Female 2 G05

NO RESPONSE M G05

All

G05 (G02). Are you Hispanic or Latino/Latina?

8070200

Select the one that best describes you.

 Yes 1 G10

 No 2 G10

NO RESPONSE M G10

SOFT CHECK: IF G05 = 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 G05

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

G10 (G03). Which of the following best describes your race? You may choose more than one.

8070304

8070301

8070305

Select all that apply.

 a. White 1 G15

8070302

 b. Black or African American 2 G15

8070303

 c. Asian 3 G15

 d. Native Hawaiian or other Pacific Islander 4 G15

 e. American Indian or Alaska Native 5 G15

NO RESPONSE M G15

SOFT CHECK: IF G10 = 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 G10

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

G15 (G04). What is the highest degree you have earned?

8070400

 Associate's degree 1 G25

 Bachelor’s degree 2 G25

 Master’s degree 3 G25

 Educational Specialist degree 4 G25

 Ph.D.,Ed.D., M.D., law degree, or other high level professional degree 5 G25

 I do not have a degree 6 G25

SOFT CHECK: IF G15 = NO RESPONSE; Please provide an answer to this question and then click “Next”. To continue without providing a response, click the “Next” button.

all

G25 (G06). What teaching certification(s) have you ever held?

8070601

Select all that apply.

 a. Middle grades certification 1 G30

8070602

 b. Elementary certification 2 G30

8070603

 c. Secondary subject matter certification 3 G30

8070604

 d. Special education certification 4 G30

8070605

 e. Other (Please specify) 99 G30

Specify (STRING 250) 8070605

PROGRAMMER BOX G25

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

G35 (G08). What other experiences in education have you had in the past?

8070801

Select all that apply.

8070807

8070806

8070802

8070803

8070804

8070805

 a. Principal/school administrator of another elementary school 1 G40

 b. Principal/school administrator of another middle school or junior high school 2 G40

 c. Principal/school administrator of another high school 3 G40

 d. Assistant principal 4 G40

 e. Elementary school teacher 5 G40

 f. Middle school or junior high school teacher 6 G40

 g. High school teacher 7 G40

All

Finally, we would like to ask you about your years of experience.

G40 (G09). Including this school year…

PROGRAMMER: RANGE FOR GRID IS 0-99

		Number of years
8070902	b. How many years have you served [as the [A10]] at your current school?		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 G40

Please limit the text box to accept numeric responses only, with the exception of the use of the period symbol (“.”).

AUTOFILL FOR G40A/G40B BASED ON RESPONSE TO A10>0 AND A10<=4. IF A10 = 99, AUTOFILL FOR G09A/G09B BASED ON RESPONSE TO A10OS. IF A10 = MISSING, MODIFY G40A/G40B TEXT TO replace “as the [A10]” 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:

Intro

School Characteristics

School Programs

School Environment

School's Teachers

Administrator 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.

[ITEMS TO DEFINE COMPLETE STATUS OF EACH SECTION TBD]

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.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Modified	0000-00-00
File Created	0000-00-00