Instrument 2—Staff Collaboration Survey

Intro [To ALL Respondents]

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The Paperwork Reduction Act Statement: This collection of information is voluntary and will be
used to help better understand how Head Start programs, elementary schools, and community
organizations are supporting children and families as they transition into kindergarten. Public
reporting burden for this collection of information is estimated to average of 15 minutes, including
the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number.
The OMB number and expiration date for this collection are OMB #: 0970-XXXX, Exp: XX/XX/
XXXX. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to Stacy Ehrlich, [email protected] or 1155 E. 60th Street, Chicago, IL 60637.

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Q1: [To ALL Respondents]

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Q2_HS [To Respondents who selected Q1: “Staff at a Head Start grantee or delegate agency,” “Head
Start Center Director,” “Head Start Teacher,” “Head Start Manager/Coordinator,” or “Other Head Start
Staff (please specify)”]

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Q2_ELEM [To Respondents who selected Q1: “District Administrator,” “K-12 District Staff,” “Elementary
School Principal,” “Kindergarten Teacher,” or “Other Elementary School Staff (but not Head Start staff,
even if you are located in a school) (please specify)”]

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Q2_CMTY [To Respondents who selected Q1: “Staff at a community organization that works with Head
Start and/or elementary schools. Please describe.”]

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Q3_HS [To Respondents who selected Q1: “Staff at a Head Start grantee or delegate agency,” “Head
Start Center Director,” “Head Start Teacher,” “Head Start Manager/Coordinator,” or “Other Head Start
Staff (please specify)”]

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Q3_ELEM [To Respondents who selected Q1: “District Administrator,” “K-12 District Staff,” “Elementary
School Principal,” “Kindergarten Teacher,” or “Other Elementary School Staff (but not Head Start staff,
even if you are located in a school) (please specify)”]

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Q3_ CMTY [To Respondents who selected Q1: “Staff at a community organization that works with Head
Start and/or elementary schools. Please describe.”]

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Q3_1 [To Respondents who Selected Q3 “Other, please specify” for specific persons named]

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Q4_HS [To Respondents who selected Q1: “Staff at a Head Start grantee or delegate agency,” “Head
Start Center Director,” “Head Start Teacher,” “Head Start Manager/Coordinator,” or “Other Head Start
Staff (please specify)”]

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Q4_ELEM [To Respondents who selected Q1: “District Administrator,” “K-12 District Staff,” “Elementary
School Principal,” “Kindergarten Teacher,” or “Other Elementary School Staff (but not Head Start staff,
even if you are located in a school) (please specify)”]

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Q4_CMTY [To Respondents who selected Q1: “Staff at a community organization that works with Head
Start and/or elementary schools. Please describe.”]

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Q5 [To ALL Respondents]

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Q5_1 [To Respondents who Selected Q5 “Other, please specify” for specific persons named]

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Q6 [To ALL Respondents]

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Q7 [To ALL Respondents]

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END PAGE [To ALL Respondents]