Teacher Survey with Initiave Letter

Impact Evaluation of Departmentalized Instruction in Elementary Schools

Appendix B Teacher_Letter_Survey_Followup Matls

Impact Evaluation of Departmentalized Instruction in Elementary Schools

OMB: 1850-0942

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APPENDIX B
TEACHER SURVEY WITH INVITATION LETTER
AND NONRESPONSE FOLLOW-UP MATERIALS

OMB Number: [XXXXXX]
Expiration Date: [XXXXX]

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Phone: (202) 484-9220
Fax: (202) 863-1763
www.mathematica-mpr.com

[Month, 2019]
Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
As you may know, [School District] is participating in the Impact Evaluation of Departmentalized Instruction
in Elementary Schools. The study is sponsored by the U.S. Department of Education and is being conducted by
Mathematica Policy Research. The study examines the effect of switching from self-contained instruction to
departmentalized instruction, and will provide important information for states and districts considering this
transition. You are one of about 600 teachers from 12 districts across the country participating in this important
study. We are writing to ask you to take part in a brief online survey that will contribute information that is
vital to the study.
The survey should take about 30 minutes to complete. It asks about your background and teaching experience,
professional development, instruction and planning time, interactions with students and parents, and
satisfaction with teaching. We ask that you please complete the survey within the next two weeks. Once the
survey is complete, Mathematica will send you a $30 check in appreciation for your time.
To access the survey online, please enter the survey web address (URL) below and then enter your log-in ID
and password. These are secure and should not be shared with anyone. Using the log-in ID and password
ensures that your responses will be protected.
We encourage you to complete the survey online at:
SURVEY URL: [SURVEY URL]
LOG-IN ID: XXXXXX
PASSWORD: XXXXXX
Your responses are protected from disclosure per the policies and procedures required by the Education
Sciences Reform Act of 2002, Title I, Part E, Section 183. Mathematica Policy Research will present the
information collected as part of this study in an aggregate form, and will not associate responses with any of
the individuals who participate. We will not provide information that identifies you, your students, your
school, or your district to anyone outside the study team, except as required by law. Your responses will be
used only for research purposes. Additionally, no one in your school or district will see your responses.
Mathematica staff will be happy to answer any questions about the study and to assist you with the survey if
needed. You can contact us toll-free at [TOLL FREE NUMBER] or email us at [STUDY EMAIL]. If you have
questions about your rights as a study participant, please call the New England Institutional Review Board tollfree at 1-800-232-9570. Thank you in advance for your help with this important study!
Sincerely,
Sheila Heaviside, Survey Director

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is
estimated to average 30 minutes, including the time to review instructions and complete the request. If you have any comments concerning the accuracy of
the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have comments or
concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education
Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer

OMB Control No.: XXXX-XXXX
Expiration Date: XX/XX/XXXX
Mathematica Reference No.: XXXXX

U.S. DEPARTMENT OF EDUCATION
Impact Evaluation of Departmentalized Instruction in
Elementary Schools

TEACHER SURVEY
SPRING 2019

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless
such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxxxxxx. The time required to complete this information collection is estimated to average 30 minutes, including the time to
review instructions and complete the request. If you have any comments concerning the accuracy of the time estimate or
suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you have
comments or concerns regarding the content or the status of your individual submission of this form, write directly to: U.S.
Department of Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.

You have been selected to participate in a study that Mathematica Policy Research is conducting on behalf
of the U.S. Department of Education. The study is focusing on differences between self-contained
instruction (where a teacher instructs the same group of students all or most of the day in multiple subjects)
and departmentalized instruction (where a teacher instructs several classes of different students in one or
more subjects). This survey includes questions about your background and teaching experience,
professional development, instruction and planning time, interactions with students and parents, and
satisfaction with teaching.
We would like you to know that:


This survey is voluntary, but your response is critical for producing valid and reliable data. You may
skip any questions you do not wish to answer; however, we hope that you answer as many
questions as you can.



Refusal to participate in the survey will not affect your employment or relationship with your school
or the evaluation partners, including the U.S. Department of Education, in any way. However, the
quality of the study findings depends upon our ability to gather data from each study teacher.



The study will provide important information that can be used by you and your district. Specifically,
we will learn whether departmentalized instruction affects teachers’ classroom practices and
student achievement.



Your answers will be completely confidential; no information that identifies you, your
school, or your students will be reported. Your responses are protected from disclosure per the
policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E,
Section 183. Mathematica Policy Research will present the information collected as part of this
study in an aggregate form, and will not associate responses with any of the individuals who
participate. We will not provide information that identifies you, your students, your school, or your
district to anyone outside the study team, except as required by law. Your responses will be used
only for research purposes. Additionally, no one in your school or district will see your responses.



Participation in the survey does not pose any special risks to you as a respondent other than
accidental disclosure of information. Safeguards are in place to ensure individual respondent’s
confidentiality, including restricted access to survey data and separating identifying information
such as teacher and school names from survey responses. All Mathematica staff sign a
confidentiality pledge, and all staff with access to identifiable study data have received clearance
from the U.S. Department of Education and are subject to severe legal consequences for any
breach of confidentiality.



The survey takes about 30 minutes to complete. and once you have completed it, we will send you
$30 as a thank you for your time.



An Institutional Review Board (IRB) has reviewed and approved this study. If you have any
questions about your rights as a research participant, you can contact New England IRB at 1-800232-9570.

I have read and I understand the above statements and agree to participate in the survey

If you would like a copy of this disclosure statement, please contact Sheila Heaviside by email
at [email protected], or by phone at 202-484-3096.

Thank you very much for your help with this survey!

A. TEACHING EXPERIENCE
A1.

Including the current school year (2018-2019), how many years have you worked as a teacher?
Please do not count time as a substitute or student teacher.
If this is your first year teaching, enter “01”.

|

|

|

TOTAL YEARS AS A TEACHER

A2.(Web) Are you currently teaching at [NAME OF CURRENT SCHOOL FROM SMS]?
1

 Yes

GO TO A3

0

 No

GO TO A2a

A2a.(Paper or Web A2=No) Please record the name of the school where you are currently teaching.
Name of school: _____________________________________________________________________
A3.

Including the current school year (2018-2019), how many years have you worked as a teacher at this
school? Please do not count time as a substitute or student teacher.
If this is your first year teaching, enter “01”.

|
A4.

|

|

YEARS TEACHING AT THIS SCHOOL

Including the current school year (2018-2019), how many years have you worked as a teacher in this
district? Please do not count time as a substitute or student teacher.
If this is your first year teaching, enter “01”.

|
A5.

|

|

YEARS TEACHING IN THIS DISTRICT

How would you classify your current teaching position at this school?
SELECT ONE ONLY
1

 Regular full-time teacher

2

 Regular part-time teacher

3

 Substitute teacher

4

 Other (Specify): _________________________________________________________________

Prepared by Mathematica Policy Research

1

A6.

Please indicate the grade(s) of the students you currently teach at this school.
SELECT ALL THAT APPLY

A7.

1

 Pre-kindergarten or Kindergarten

2

 1st grade

3

 2nd grade

4

 3rd grade

5

 4th grade

6

 5th grade

7

 6th grade

8

 7th grade or above

9

 Ungraded

During the 2018-2019 school year, which of the following types of classes have you taught?
SELECT ALL THAT APPLY

A8.

1

 English as a Second Language (ESL)

2

 Special instruction in subject areas for English Language Learners (ELL)

3

 Bilingual classes (taught partly in English and partly in Spanish or some other language)

4

 Special education

5

 General education

During the 2018-2019 school year, which of the following subjects have you taught?
SELECT ALL THAT APPLY
1

 Math

2

 English language arts/reading

3

 Science

4

 Social studies/history

5

 Other (Specify): ________________________________________

Prepared by Mathematica Policy Research

2

A9.

Prior to the 2018-2019 school year, have you ever taught using departmentalized instruction?
Departmentalized instruction is teaching multiple classes of different students in one or more
academic subjects.
SELECT ONE ONLY

A10.

1



Yes, at the elementary level (grades K-5) only

GO TO A10

2



Yes, at both the elementary level (grades K-5) and at the
middle or high-school level (grades 6-12)

GO TO A10
SKIP TO B1

3



Yes, at the middle or high-school level (grades 6-12) only

4



No

Prior to the 2018-2019 school year, for how many years did you teach using departmentalized
instruction (where you taught multiple classes of different students in one or more academic
subjects) at the elementary level (grades K-5)?

|
A11.

SKIP TO B1

|

|

YEARS USING DEPARTMENTALIZED INSTRUCTION

Prior to the 2018-2019 school year, in which subjects did you teach using departmentalized
instruction (where you taught multiple classes of different students in one or more academic
subjects) at the elementary level (grades K-5)?
SELECT ALL THAT APPLY
1

 Math

2

 English language arts/reading

3

 Science

4

 Social studies/history

5

 Other (Specify): ________________________________________

Prepared by Mathematica Policy Research

3

B. PROFESSIONAL DEVELOPMENT
B1.

Have you received any professional development during the 2018-2019 school year, including
summer 2018?
Include all training, formal education, or other professional learning to advance content knowledge or improve
teaching practices.

B2.

1

 Yes

0

 No

About how many hours of professional development have you received in total during the 20182019 school year, including summer 2018?
|

B3.

B4.

|

B6.

|

| TOTAL HOURS OF PROFESSIONAL DEVELOPMENT

Have you received any professional development related to mathematics during the 2018-2019
school year, including summer 2018?
1

 Yes

0

 No

SKIP TO B5

About how many hours of your professional development during the 2018-2019 school year,
including summer 2018, have been related to mathematics?
|

B5.

SKIP TO C1

|

|

| HOURS

Have you received any professional development related to English language arts/reading during
the 2018-2019 school year, including summer 2018?
1

 Yes

0

 No

SKIP TO B7

About how many hours of your professional development during the 2018-2019 school year,
including summer 2018, have been related to English language arts/reading?
|

|

|

| HOURS

Prepared by Mathematica Policy Research

4

B7.

Overall, to what extent did the professional development in which you participated during the 20182019 school year, including summer 2018, focus on the following topics?
SELECT ONE RESPONSE PER ROW

Professional development topics

NONE

A LITTLE

SOMEWHAT

A GREAT
DEAL

a.

Use of technology for instruction ...............................................

1

2

3

4

b.

Student discipline and classroom management ........................

1

2

3

4

c.

Strategies for teaching diverse student populations ..................

1

2

3

4

d.

General teaching methods ........................................................

1

2

3

4

e.

Mathematics curriculum (e.g., units, texts, standards) ..............

1

2

3

4

f.

Subject-specific teaching methods in mathematics ...................

1

2

3

4

g.

Deepening your knowledge of mathematics ..............................

1

2

3

4

h.

How students learn mathematics ..............................................

1

2

3

4

i.

English language arts/reading curriculum (e.g., units, texts,
standards) .................................................................................

1

2

3

4

j.

Subject-specific teaching methods in English language
arts/reading ...............................................................................

1

2

3

4

k.

Deepening your knowledge of English language arts/reading ...

1

2

3

4

l.

How students learn English language arts/reading ...................

1

2

3

4

m. Other topic .................................................................................
(Specify):_______________________________

1

2

3

4

Prepared by Mathematica Policy Research

5

C. INSTRUCTION AND PLANNING TIME
C1.

Which statement best describes the way your classes at this school are organized during the 20182019 school year?
SELECT ONE ONLY

C2.

1



I instruct multiple classes of different students in one or more
subjects (sometimes called Departmentalized Instruction).

2



I instruct a single group of students in multiple subjects
(sometimes called a Self-Contained Class).

For each subject listed below, provide the total number of different students you taught in that
subject during the most recent full week of teaching.
If you don’t teach a particular subject, please enter “000”.

TOTAL NUMBER OF STUDENTS
TAUGHT DURING MOST RECENT
FULL WEEK

C3.

a. English language arts/reading .....................................

|

|

|

|

b. Mathematics ................................................................

|

|

|

|

c.

Science ........................................................................

|

|

|

|

d. Social studies/history ...................................................

|

|

|

|

e. All other subjects .........................................................

|

|

|

|

What is the total number of different students you currently teach at this school?
|

C4.

|

|

| TOTAL NUMBER OF STUDENTS

What is the average number of students in the classes or sections you currently teach at this
school?
If you teach only one class, please provide the number of students in that class.
|

C5.

|

| AVERAGE NUMBER OF STUDENTS PER CLASS

Approximately how much time do your students currently spend transitioning between their class
periods at this school?
Do NOT count time scheduled for formal breaks such as homeroom, lunch, recess, or study hall.
a. MINUTES PER TRANSITION

|

|

|

B. NUMBER OF TRANSITIONS PER DAY

|

|

|

c. TOTAL MINUTES PER DAY TRANSITIONING BETWEEN CLASSES |

Prepared by Mathematica Policy Research

6

|

|

C6.

During your most recent full week of teaching, approximately how many total minutes per week did
you spend teaching students in each of the following subjects?
Record all time actually teaching including whole group, small group, and individual instruction. If you do
not teach a specific subject listed below, enter “000”.
TOTAL MINUTES IN MOST
RECENT FULL WEEK

C7.

a. English language arts/reading .......................................................

|

|

|

|

b. Mathematics ..................................................................................

|

|

|

|

c.

Science ..........................................................................................

|

|

|

|

d. Social studies/history .....................................................................

|

|

|

|

e. All other subjects ...........................................................................

|

|

|

|

During your most recent full week of teaching, approximately how many total minutes did you
spend individually planning (not with others) to teach your classes in each of the following
subjects?
Record all time preparing to teach, not including time to grade students’ work. If you did not teach a specific
subject, enter “000”.
TOTAL MINUTES IN MOST
RECENT FULL WEEK

C8.

a. English language arts/reading ..............................................................

|

|

|

|

b. Mathematics .........................................................................................

|

|

|

|

c.

Science .................................................................................................

|

|

|

|

d. Social studies/history ............................................................................

|

|

|

|

e. All other subjects ..................................................................................

|

|

|

|

During the 2018-2019 school year, about how many times, if any, have you participated in
common planning time (or other periods involving collaboration) with other teachers from your
school?
SELECT ONE ONLY
1

 Never

2

 Once or twice this year

3

 Monthly or several times per year

4

 Weekly or several times per month

5

 Daily or several times per week

Prepared by Mathematica Policy Research

SKIP TO D1

7

C9.

On average, how many minutes was each of the common planning periods in which you have
participated during the 2018-2019 school year?
|

C10.

|

|

| MINUTES

Overall, during these common planning periods, to what extent did you and the other teachers do
each of the following?
SELECT ONE RESPONSE PER ROW

Common Planning Period Activities

NONE

A LITTLE

SOMEWHAT

A GREAT
DEAL

a.

Jointly plan lessons, assignments, assessments,
or other aspects of instruction in mathematics .....

1

2

3

4

b.

Jointly plan lessons, assignments, assessments,
or other aspects of instruction in English
language arts/ reading? .......................................

1

2

3

4

Jointly plan lessons, assignments, assessments,
or other aspects of instruction in subjects other
than mathematics or English language arts/
reading?...............................................................

1

2

3

4

d.

Discuss classroom management strategies? ......

1

2

3

4

e.

Review individual student needs and progress? ..

1

2

3

4

f.

Discuss parent communications? ........................

1

2

3

4

c.

Prepared by Mathematica Policy Research

8

D. STUDENT AND PARENT INTERACTIONS
D1.

To what extent do you agree or disagree with each of the following statements about your school
during the 2018-2019 school year?
SELECT ONE RESPONSE PER ROW
STRONGLY
AGREE

SOMEWHAT
AGREE

SOMEWHAT
DISAGREE

STRONGLY
DISAGREE

a. The level of student misbehavior and noise in this
school interferes with my teaching ..............................

1

2

3

4

b. Most students in this school are engaged and
interested in learning ...................................................

1

2

3

4

Lack of parental involvement is a problem in this
school ..........................................................................

1

2

3

4

d. I receive a great deal of support from parents for the
work I do ......................................................................

1

2

3

4

e. I often have to wait for students to settle down at the
beginning of a class .....................................................

1

2

3

4

c.

D2.

Approximately how many hours per month do you normally spend on each of the following:
a.

Meeting with students outside of classroom time for academic purposes (e.g., providing additional
instruction or clarification about assignments)

|

|

| HOURS PER MONTH

If you do not normally meet with students outside of class for academic purposes, enter “00”.
b.

Meeting with students outside of classroom time for non-academic purposes (e.g., clubs, sports,
counseling, other activities)

|

|

| HOURS PER MONTH

If you do not normally meet with students outside of class for non-academic purposes, enter “00”.
c.

Meeting with parents

|

|

| HOURS PER MONTH

If you do not normally meet with parents, enter “00”.

Prepared by Mathematica Policy Research

9

D3.

For a typical fourth-grade student, approximately how often do you do the following?
SELECT ONE RESPONSE PER ROW

D4.

NEVER

ONCE OR
TWICE A
YEAR

MONTHLY OR
SEVERAL TIMES
PER YEAR

WEEKLY
OR SEVERAL
TIMES PER
MONTH

DAILY OR
SEVERAL
TIMES PER
WEEK

a.

Meet or talk with the student’s parents to
discuss his or her progress ..........................

1

2

3

4

5

b.

Send examples of the student’s classwork
home to his or her parents ...........................

1

2

3

4

5

c.

Invite the student’s parents to visit his or
her class during instructional time................

1

2

3

4

5

d.

Meet with the student to set academic
goals for him or her .....................................

1

2

3

4

5

e.

Provide written feedback on the student’s
work (not counting grades) ..........................

1

2

3

4

5

f.

Provide verbal feedback on the student’s
work .............................................................

1

2

3

4

5

Thinking about your current students and classes, indicate the extent to which you agree or
disagree with the follow statements.
SELECT ONE RESPONSE PER ROW
STRONGLY
AGREE

SOMEWHAT
AGREE

SOMEWHAT
DISAGREE

STRONGLY
DISAGREE

a.

I know my students well enough to incorporate their
interests in learning activities ........................................

1

2

3

4

b.

Students trust me with their personal problems ............

1

2

3

4

c.

I know what services my students receive (e.g.,
IEP/504s/Giftedness)....................................................

1

2

3

4

d.

I know about academic, social, or health challenges my
students may be experiencing ......................................

1

2

3

4

e.

I have standardized test history information for all the
students I teach ............................................................

1

2

3

4

f.

I know my students’ favorite subjects ...........................

1

2

3

4

g.

I know my struggling students’ needs well enough to
adapt my teaching accordingly .....................................

1

2

3

4

h.

I know my strongest students’ needs well enough to
adapt my teaching accordingly .....................................

1

2

3

4

i.

I know my students’ learning styles well enough to
adapt my teaching accordingly .....................................

1

2

3

4

j.

I know my students’ cultural background well enough to
adapt my teaching accordingly .....................................

1

2

3

4

Prepared by Mathematica Policy Research

10

E. TEACHER SATISFACTION
E1.

Please indicate how much you agree or disagree with the following statements about your current
teaching position.
SELECT ONE RESPONSE PER ROW

STRONGLY
AGREE

SOMEWHAT
AGREE

SOMEWHAT
DISAGREE

STRONGLY
DISAGREE

I am satisfied with being a teacher at this
school ................................................................

1

2

3

4

b.

I receive the support I need to teach students ...

1

2

3

4

c.

Routine duties and paperwork interfere with
my teaching .......................................................

1

2

3

4

I have sufficient instructional time to meet the
needs of all students..........................................

1

2

3

4

Too much of students’ time is spent
transitioning between classrooms

1

2

3

4

My class sizes are reasonable to meet the
needs of all students ........................................

1

2

3

4

g.

I think about transferring to another school .......

1

2

3

4

h.

I am satisfied with the subject or subjects that
I teach................................................................

1

2

3

4

I have opportunities for professional growth ......

1

2

3

4

a.

d.
e.
f.

i.

E2.

Please indicate how much you agree or disagree with the following statements about the school
where you currently teach.
SELECT ONE RESPONSE PER ROW

STRONGLY
AGREE

SOMEWHAT
AGREE

SOMEWHAT
DISAGREE

STRONGLY
DISAGREE

a.

I like the way things are run at this school .........

1

2

3

4

b.

My principal enforces school rules for
students’ conduct and backs me up when I
need it................................................................

1

2

3

4

Staff members cooperate with each other at
this school .........................................................

1

2

3

4

The school sets high standards for academic
performance ......................................................

1

2

3

4

Teachers have a say in which subject or
subjects they teach ............................................

1

2

3

4

Teachers have a say in which grade or
grades they teach ..............................................

1

2

3

4

Teachers have time to collaborate with
colleagues .........................................................

1

2

3

4

Teachers have an appropriate amount of time
for professional development ............................

1

2

3

4

c.
d.
e.
f.
g.
h.

Prepared by Mathematica Policy Research

11

E3.

During the 2018-2019 school year, how well prepared did you feel to handle a range of classroom
behavior or discipline situations?
SELECT ONE ONLY

E4.

1



Not at all prepared

2



Somewhat prepared

3



Well prepared

4



Very well prepared

During the 2018-2019 school year, how well prepared did you feel to teach mathematics?
SELECT ONE ONLY

E5.

1



Not at all prepared

2



Somewhat prepared

3



Well prepared

4



Very well prepared

5



I do not teach mathematics

During the 2018-2019 school year, how well prepared did you feel to teach English language
arts/reading?
SELECT ONE ONLY

E6.

1



Not at all prepared

2



Somewhat prepared

3



Well prepared

4



Very well prepared

5



I do not teach English language arts/reading

During the 2018-2019 school year, how well prepared did you feel to address the needs of the
diversity of learners in your classes?
SELECT ONE ONLY
1

Not at all prepared

2



Somewhat prepared

3



Well prepared

4



Very well prepared

Prepared by Mathematica Policy Research

12

F. YOUR BACKGROUND
F1.

What is the highest degree you have completed?
SELECT ONE ONLY

F2.

1

 Associate’s degree

2

 Bachelor’s degree (B.A., B.S., etc.)

3

 Master’s degree (M.A., M.A.T., M.Ed., M.S., etc.)

4

 Education specialist or professional diploma (at least one year beyond master’s level)

5

 Doctoral degree or equivalent (Ph.D., Ed.D., J.D., M.D., etc.)

For your highest degree completed, did you major or minor in any of the following subjects?
SELECT ALL THAT APPLY

F3.

1

 Reading, language arts, or literacy education

2

 English

3

 Other language arts-related subject

4

 Mathematics education

5

 Mathematics

6

 Other mathematics-related subject such as statistics

7

 Education (including elementary or early childhood)

8

 Special education

9

 English language learning

Which of the following statements best describes how you entered the profession?
SELECT ONE ONLY
1

 Entered after completing training for initial teaching certification as part of a bachelor’s or
master’s degree program in education or a related field (considered the traditional route to
teacher certification)
Please enter the name and location of the college or university where you completed this program:
______________________________________________________________________________
COLLEGE OR UNIVERSITY NAME

______________________________________________________________________________
CITY AND STATE OF COLLEGE OR UNIVERSITY

2

 Entered through a program before completing all training and requirements for initial teaching
certification (considered an alternative route to teacher certification).
Please enter the name of this program:
______________________________________________________________________________

Prepared by Mathematica Policy Research

13

F4.

In what area(s) does your teaching certificate allow you to teach in this state?
SELECT ALL THAT APPLY

F5.

1

 Preschool (birth-Pre-K)

2

 Elementary (K-5)

3

 Middle grades (6-8)

4

 Secondary grades (9-12)

5

 Specific subject areas (K-12) (Specify): ______________________________________________

6

 Exceptional children (K-12) (Specify): ________________________________________________

7

 Other (Specify): _________________________________________________________________

Are you male or female?
SELECT ONE ONLY

F6.

1

 Male

2

 Female

Are you of Hispanic or Latino origin?
SELECT ONE ONLY

F7.

1

 Yes

0

 No

What is your race?
SELECT ALL THAT APPLY

F8.

1

 White

2

 Black or African American

3

 Asian

4

 Native Hawaiian or other Pacific Islander

5

 American Indian or Alaska Native

What is your year of birth?

| 1 | 9 |

|

|

Prepared by Mathematica Policy Research

14

G. CONTACT INFORMATION
G1.

Please provide your preferred contact information below. We will use it to reach you in case we
need to clarify any of your responses. We will use the address you provide below to mail your $30
check for completing the questionnaire. If you do not provide an address, we will mail your check to
your attention at your school.
Providing this information is voluntary and will not be shared with anyone outside of the study team or used
for any purpose other than stated above.

Name: ____________________________________________________________________________
Street address: _____________________________________________________________________
City: ______________________________________
Home Telephone: |

Cell Phone: |

|

| | |-|
Area Code
|

|-| | |
Area Code

|

|

|-|

|-| |
Number
| | |
Number

State: _________

|

|

Zip Code: ___________

|

|

Work email: ________________________________________________________________________
Home email: _______________________________________________________________________
Best time to reach you by phone:
Day: ____________________________________

Time: _______________________________

Thank you for completing this survey!

Prepared by Mathematica Policy Research

15

FOLLOW-UP EMAIL REMINDER

TO:
[Email]
FROM:
Sheila Heaviside [HelpDesk Email]
SUBJECT: Survey for the U.S. Department of Education’s Impact Evaluation of Departmentalized Instruction
Dear [Teacher First Name] [Teacher Last Name]:
We recently asked for your help with completing a survey for the Impact Evaluation of Departmentalized
Instruction. Mathematica is conducting this important study on behalf of the U.S. Department of Education
(ED). Your participation will help ED and policy makers learn whether there are differences in teacher practices
or student achievement if elementary students are taught math and reading by one teacher (self-contained
classes) or taught by multiple teachers who teach either math or reading (departmentalized instruction).
We will send you a check for $30 when you complete this survey. The survey is voluntary, and your responses
will be kept strictly confidential (per the policies and procedures required by the Education Sciences Reform
Act of 2002, Title I, Part E, Section 183). Your participation is very important – the validity of the study results
depends on the participation of all teachers in the study. The survey should take 30 minutes to complete and
does not have to be done in one sitting. Please use the link below with your unique log-in ID and password to
access and complete the survey. These are secure and should not be shared with anyone.
Go to [Link]
At the login screen, enter the following:
User ID: [UserID]
Password: [password]
Please do not reply to this email. If you do not have your login information or if you have questions about the
study, please call us toll free at [xxx-xxx-xxxx] between 9a.m. and 9p.m. Eastern Standard Time any day of the
week. You may also email our help desk at [HelpDeskEmail] or contact me directly at [email protected] or 202-484-3096.
If you have already completed this survey, thank you for your support of this important study.

Sincerely,
Sheila Heaviside
Survey Director
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays
a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information
collection is estimated to average 30 minutes, including the time to review instructions and complete the request. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If
you have comments or concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of
Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.

Prepared by Mathematica Policy Research

1

OMB Approval No. xxxx-xxx
Expiration Date: xx/xx/20xx

Sheila Heaviside
Survey Director

1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com

NONRESPONSE FOLLOW-UP LETTER

[Month Year]

[Teacher First Name] [Teacher Last Name]
[School Name]
[Address]
[City], [ST] [ZIP]
Dear [Teacher First Name] [Teacher Last Name]:
We recently asked for your help with completing a survey for the Impact Evaluation of Departmentalized Instruction.
Mathematica is conducting this important study on behalf of the U.S. Department of Education (ED). Your participation
will help ED and policy makers learn whether there are differences in teacher practices or student achievement if
elementary students are taught math and reading by one teacher (self-contained classes) or taught by multiple teachers who
teach either math or reading (departmentalized instruction).
The survey takes approximately 30 minutes to complete. We will send you a check for $30 when you complete this
survey. Your participation is voluntary but very important – the validity of the study results depends on the participation
of all teachers in the study. The survey should take 30 minutes to complete and does not have to be done in one sitting.
Your responses will be kept strictly confidential (per the policies and procedures required by the Education Sciences
Reform Act of 2002, Title I, Part E, Section 183).
We have included a paper questionnaire and return envelope for your convenience if you prefer to complete the paper
version of the survey and mail it in. Otherwise, you can complete the survey online. Please use the information below with
your unique log-in ID and password to access your teacher survey online. These are secure and should not be shared with
anyone.
Go to [link]
At the login screen, enter the following:
User ID: [UserID]
Password: [password]
If you have any questions, please contact Bryce Onaran, the deputy survey director, toll free at [xxx-xxx-xxxx], or by
email at [Survey Help Desk] – or email me at [email protected].
If you have already completed the survey, thank you for your help.
Sincerely,

Sheila Heaviside
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays
a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information
collection is estimated to average 30 minutes, including the time to review instructions and complete the request. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If
you have comments or concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of
Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.

An Affirmative Action/Equal Opportunity Employer

OMB Approval No. xxxx-xxx
Expiration Date: xx/xx/20xx

Sponsored by the U.S. Department of Education’s Institute of Education Sciences

T

ake part in the survey for the Impact Evaluation of Departmentalized
Instruction being conducted in your school district! This survey is part of
an evaluation that will produce valuable information about the impact of
departmentalized instruction on teaching practices and student achievement.
As one of only 600 teachers selected for the study, your survey responses are
critical for the study to produce meaningful and valid information. We are unable
to replace you with another teacher without compromising the study’s validity.
The information that you provide in this 30-minute survey will be used for
research purposes only and will remain confidential*—no information or reports
will identify you or your school or district. To make this as easy as possible,
Mathematica has created a WEB survey for you to complete. If you have not
already sent your completed questionnaire to Mathematica, I urge you to take a
few moments now to log on to complete the survey on the Web by using the
user name and password that Mathematica created for you.
Go to: [Link]
Web username: [XXXX]
Password: [XXXXXXX]
Mathematica will send you a $30 check to thank you for
your help when you complete the survey.
If you have any questions about the study, contact us:
Sheila Heaviside

Mathematica Policy Research
[email protected]
(202) 484-3096
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays
a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information
collection is estimated to average 30 minutes, including the time to review instructions and complete the request. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If
you have comments or concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of
Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.
*All responses will be kept strictly confidential per the policies and procedures required by the Education Sciences Reform Act of 2002, Title I, Part E,
Section 183.


File Typeapplication/pdf
File TitleTPREP Teacher Surveys
SubjectSAQ
AuthorMATHEMATICA
File Modified2018-03-08
File Created2018-03-08

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