G403 EquIPHQ Screening Questions

Q uestions for screener

OMB Control Number: 0651-0080

Expiration Date: XX/XX/XXXX

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0080. Public burden for these screening questions is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].

1. Overview

We are currently recruiting teachers and their classes for classroom testing and teachers for focus group testing. To complement our recruiting efforts, we would like to send an email to the EquIP HQ list, and also place a banner on the EquipHQ.uspto.gov website. Second Avenue will be sending the email and placing the banner on the website.

The purpose of this document is to provide you with the proposed questions that will be asked in a screener.

2. Content

Screener

This screener will be sent to respondents to our call for classroom observations and for focus group participants. The segmentation for both groups is the same.

Copy for review
Thank you for your interest in participating in our study. We would appreciate you providing us with some details about your classroom. This will help us to choose a representative sampling from all submission. We will notify you within 2 weeks to let you know if we would like to move forward with your participation.

Please provide the following information:

-First Name <NOTE: This is a Text box>

-Last Name <NOTE: This is a Text box>

-Email address <NOTE: This is a Text box>

-Organization <NOTE: This is a Text box>

-Grade band you teach (K-2, 3-5, 6-8, 9-12) <NOTE: These are multi-select>

-Region of country (Northeast, South, Midwest, West <NOTE: This is a drop down>

-Are you using EquIP HQ currently (yes, no) <NOTE: These are checkboxes>

- Questions or comments <NOTE: This is a Text box>