Explanation

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A B C

Worksheet Name Instrument

App A Spring 3rd Child Quex Spring Third-Grade Child Questionnaire, Appendix A

App B Spring 3rd Hearing Eval Spring Third-Grade Child Questions for Hearing Evaluations, Appendix B

App C Spring 3rd Parent Interview Spring Third-Grade Parent Interview, Appendix C

App D Spring 3rd TQA (Class) Spring Third-Grade General Classroom Teacher Classroom-Level Questionnaire, Appendix D

App D Spring 3rd TQS (Subject) Spring Third-Grade General Classroom Teacher Subject-Level Questionnaire, Appendix D

App D Spring 3rd TQC (Child) Spring Third-Grade General Classroom Teacher Child-Level Questionnaire, Appendix D

App E Spring 3rd SpEd TQA Spring Third-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix E

App E Spring 3rd SpEd TQB (Child) Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E

App F Spring 3rd School Adm A Spring Third-Grade School Administrator Questionnaire, Appendix F

App F Spring 3rd School Adm B Spring Third-Grade School Administrator Questionnaire For Continuing Schools, Appendix F

This file contains a listing of every question asked of study children, parents, general classroom teachers, special 

education teachers, and school administrators in the spring second grade data collection round (with the exception 

of the direct assessment items). For each question, the question wording is provided, along with the item source, 

the construct the item measures, and the specific research question in Part C of this OMB package for which the 

item is intended to provide information. 

Each worksheet in this file pertains to one instrument. The worksheet name notes the specific instrument, as well as 

the appendix within the OMB package in which the full instrument can be found. Below is a list of the worksheet 

name and a full description of the instrument to which the worksheet pertains. 

Page 1 of 1
Spring Third-Grade Parent Interview, Appendix C

Section Item #

Introduction

CLQ005

CLQ006
CLQ012

CLQ015

CLQ025
CLQ028

Self-Description Questionnaire

CLQ030

CLQ035

CLQ050

CLQ055

CLQ060

CLQ065

CLQ075

CLQ085

CLQ090

CLQ095
CLQ100

CLQ105

CLQ120

CLQ130

CLQ135

CLQ140

CLQ145

CLQ155

CLQ160

CLQ165

CLQ170
Peer Victimization

CLQ180

CLQ185

CLQ190

CLQ200

Fear of negative evaluation

CLQ205, 220, 

235

Prosocial Behavior

CLQ215

Prosocial Behavior

CLQ230
Prosocial Behavior

CLQ245

Life satisfaction

CLQ250

CLQ255

CLQ260

CLQ265

CLQ270

CLQ275

Closing

CLQ280
Item Stem Source

PLUG HEADPHONES INTO THE COMPUTER. POSITION LAPTOP IN 

FRONT OF THE CHILD.

SAY: Now you are going to use the computer to tell us a little 

more about yourself. The computer will read

some sentences and questions to you while you listen on the 

headphones [HOLD UP HEADPHONES].

SAY: Then you will pick the answer that best describes you by 

touching your answer on the computer screen

[TOUCH THE MIDDLE OF THE COMPUTER SCREEN WITH ONE 

FINGER]. If you don’t want to pick an answer,

you don’t have to.

ECLS-K:2011 Pilot Test (modified)

POINT TO THE VOLUME CONTROL BUTTONS ON THE BOTTOM 

RIGHT CORNER OF THE COMPUTER SCREEN.

SAY: To make the sound louder, [POINT TO THE RIGHT BUTTON] 

press the right button. To make the sound

softer, [POINT TO THE MIDDLE BUTTON] press the middle button. 

If you want to turn the sound off, just turn

the volume all the way down.

SHOW THE CHILD HOW TO ADJUST THE SIZE OF THE 

HEADPHONES.

SAY: Once you put the headphones on, you will hear directions 

about what to do. Do you have any questions?

[PAUSE 23 SECONDS AND ANSWER ANY QUESTIONS.]

SAY: Ok, go ahead and put these headphones on now. [HAND THE 

CHILD THE HEADPHONES.] Do the

headphones fit OK? [ADJUST HEADPHONES IF NECESSARY.]

ECLS-K:2011 Pilot Test (modified)
Hello. Before we begin, let’s make sure the volume on the 

headphones is right for you. This is how loud it will be when the 

sentences are read to you. If it is too loud or too soft please 

change the volume now or ask for help.

In a minute, sentences will appear on the screen, and they will be 

read to you along with a list of answers.

Think about each sentence and decide how well it describes you. 

Once you've decided, touch your answer on the computer screen. 

You can touch your answer even if the computer is still reading to 

you.

For these questions, there are no right or wrong answers, and all 

your answers are private. No one will be

told the answers that you pick. And remember, be sure your 

answers tell me about YOU.

Please touch the "Next" button and move to the next screen.

ECLS-K:2011 Pilot Test (modified)

For each sentence, decide how well it describes you. Is the 

sentence "Not at all true; A little bit true; Mostly

true; or Very true" for you?

A student, Maria, has already given an answer for one sentence 

to show you how to do it. The sentence read

to Maria was

I am neat and tidy.

Maria touched the button on the screen with the answer "A little 

bit true" because she is not very neat, but

she is not very messy either.

Please touch the "Next" button and move to the next screen.

ECLS-K:2011 Pilot Test (modified)

If you want to change an answer, touch the "Erase" button and 

then touch the new answer you want to pick.

If you want to go back and change any of the answers you already 

gave, touch the "Back" button and move

to the past screen. Once there, touch the "Erase" button and 

then touch the new answer you want to pick.

Now, let's practice. Listen to the following statement. Choose the 

answer that best describes you. After you

choose, remember to touch the "Next" button.

I like to watch TV.

ECLS-K:2011 Pilot Test (modified)
Great, thank you for practicing with me.

One last thing before we begin: If there is a question that you do 

not want to answer, just touch the “Next”

button to skip over it. When you touch the “Next” button without 

answering, the computer will ask if you want to skip the question, 

just to make sure you didn’t skip the question by accident.

Please touch the "Next" button and move to the next screen.

ECLS-K:2011 Pilot Test (modified)

Let's begin.

I have lots of friends.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am good at SCIENCE.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I enjoy doing work in SCIENCE.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I like READING.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I make friends easily.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I cannot wait to do MATH each day.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I like SCIENCE.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am interested in READING.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I get along with kids easily.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I cannot wait to READ each day.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 
I am interested in MATH.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am easy to like.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

Other kids want me to be their friend.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I like MATH.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I have more friends than most other kids.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am good at READING.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am interested in SCIENCE.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I enjoy doing work in MATH.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I cannot wait to do SCIENCE.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I enjoy doing work in READING.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 

I am good at MATH.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

 Marsh, H.W. (1992). 
 The next set of questions and sentences are about how often 

things happen to you. Think about the question

or sentence and decide if these things happen "Never; Rarely; 

Sometimes; Often; or Very often."

During this school year, how often have other students teased 

you, made fun of you, or called you names?

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Espelage and Holt (2001) (modified)

During this school year, how often have other students told lies 

or untrue stories about you?

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Espelage and Holt (2001) (modified)

During this school year, how often have other students pushed, 

shoved, slapped, hit, or kicked you?

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Espelage and Holt (2001) (modified)

During this school year, how often have other students left you 

out from playing with them on purpose?

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Espelage and Holt (2001) (modified)

Social Distress. Items not included due to copyright restrictions (3 

items total)

LaGreca and Stone (1993)

I try to cheer up other classmates who are upset or sad about 

something.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Zimmer-Gembeck, Geiger, and Crick 

(2005)

I help out other kids when they need it.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Zimmer-Gembeck, Geiger, and Crick 

(2005)
I say or do nice things for other classmates.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

Zimmer-Gembeck, Geiger, and Crick 

(2005)

The next set of sentences are about how you feel about your life. 

Think about the sentence and decide how

well it describes you. Does the sentence describe you "Not at all; 

A little bit; Somewhat; Quite a bit; or Very

much"?

I am happy with my hobbies and free time activities.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

I am happy with the clothes, games, toys, and other things I have.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

I am happy with how much attention I get from my parents.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

I am happy with the friends I have.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

I am happy with my skills and talents.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

I am happy with the neighborhood and community in which I live.

Please pick an answer and then touch the "Next" button or just 

touch the "Next" button to skip this question.

NIH Toolbox for the Assesment of 

Neurological and Behavioral Function 

(NIH Toolbox) (modified)

Thank you for working with me. You are done answering 

questions on the computer. Please take off the headphones now.

ECLS-K:2011 Pilot Test
Construct Research Question

Introduction NA

Introduction NA
Introduction NA

Introduction NA

Introduction NA
Introduction NA

Peer relationships C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Peer relationships C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Peer relationships C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2
Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Peer relationships C1, C2

Peer relationships C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Peer relationships C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2

Interest in Reading, 

Math, and Science 

Subjects

C1, C2
Peer victimization C3, C4

Peer victimization C3, C4

Peer victimization C3, C4

Peer victimization C3, C4

Social distress C3

Life Satisfaction and 

Prosocial Behavior

C5

Life Satisfaction and 

Prosocial Behavior

C5
Life Satisfaction and 

Prosocial Behavior

C5

Life Satisfaction and 

Prosocial Behavior

C6

Life Satisfaction and 

Prosocial Behavior

C6

Life Satisfaction and 

Prosocial Behavior

C6

Life Satisfaction and 

Prosocial Behavior

C6

Life Satisfaction and 

Prosocial Behavior

C6

Life Satisfaction and 

Prosocial Behavior

C6

 Closing NA
Section Item # Item Stem Source Construct Research Question

Pre-Test 

Questionnaire

PTQ001 Do you have a cold or a runny nose today? ECLS-K:2011 fall 2nd 

grade

Child Health and 

Well-Being

PQ1; PQ2

PTQ002 Did you have a cold or a runny nose yesterday? ECLS-K:2011 fall 2nd 

grade

Child Health and 

Well-Being

PQ1; PQ2

PTQ003 Have you had an earache today? ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ004 Did you have an earache yesterday?

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ005 Which ear(s) hurt?

ECLS-K:2011 fall 2nd 

grade

Child Health and 

Well-Being

PQ1; PQ2

PTQ006

Have you listened to sounds today that were so 

loud you would have to shout so someone close 

by could hear you?

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ007

Did you listen to any sounds that were that loud 

yesterday? [Did you listen to any sounds 

yesterday that were so loud you would have to 

shout so someone close by could hear you?]

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ008

Do you have tubes in your ears now that a doctor 

put there [to keep you from getting earaches]?

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ009

Do you have to wear earplugs when you swim or 

take a bath or shower?

ECLS-K:2011 fall 2nd 

grade

Child Health and 

Well-Being

PQ1; PQ2

PTQ010 In which ear do you have the tube(s)?

ECLS-K:2011 fall 2nd 

grade

Child Health and 

Well-Being

PQ1; PQ2

PTQ011 In which ear do you wear the earplug(s)?

New Child Health and 

Well-Being

PQ1; PQ2

PTQ012

Is it easier for you to hear out of one ear than the 

other?

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

PTQ013 Which ear is easier to hear with?

ECLS-K:2011 fall 2nd 

grade - Revised

Child Health and 

Well-Being

PQ1; PQ2

Spring Third-Grade Child Questions for Hearing Evaluations, Appendix G
App C Spring 3rd Parent Intervi

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A B C D E F

Section Item # Item Stem Source Construct Research Question

Introduction

INQ.005 {In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 

2012/In the fall of 2012/In the spring of 2013}, we spoke with {NAME OF 

RESPONDENT} who took part in the Early Childhood Longitudinal Study, 

Kindergarten Class of 2010-2011 on {DATE OF LAST INTERVIEW}. Am I talking 

to the same person?

ECLS-K Introduction NA

INQ.010 May I please speak with {NAME OF PREVIOUS ROUND RESPONDENT}? ECLS-K Introduction NA

INQ.015 Are you the parent or guardian in this household who knows the most about 

{CHILD}'s care, education, and health?

NHES:2007 (modified) Introduction NA

INQ.020 May I please speak with the parent or guardian in the household who knows 

the most about {CHILD}'s care, education, and health?

NHES:2007 (modified) Introduction NA

INQ.025 May I please speak with a household member who is 18 or older and knows 

about {CHILD}'s care, education, and health?

NHES:2007 (modified) Introduction NA

INQ.030 May I have your name please? ECLS-K Introduction NA

INQ.060 [May I have your name, please?] ECLS-K Introduction NA

INQ.070 [May I have your name, please?] ECLS-K Introduction NA

INQ.080/080b (As I mentioned earlier), you and {CHILD} were selected to take part in the 

Early Childhood Longitudinal Study Kindergarten Class of 2010-2011, which is 

sponsored by the U.S. Department of Education, National Center for Education 

Statistics. I have some questions for you that ask about {CHILD}’s school and 

home experiences. The information I collect in this interview will be extremely 

valuable in understanding the development of children and how their school 

experiences can be improved.

All responses that relate to or describe identifiable characteristics of 

individuals 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.

This call will be recorded for quality control purposes.

ECLS-K Introduction NA

Spring Third-Grade Parent Interview, Appendix C

Page 1 of 29
App C Spring 3rd Parent Intervi

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A B C D E F

INQ.090/090b {In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 

2012/In the fall of 2012/In the spring of 2013}, you took part in the Early 

Childhood Longitudinal Study Kindergarten Class of 2010-2011, which is 

sponsored by the U.S. Department of Education, National Center for Education 

Statistics. I have some questions for you that ask about {CHILD}’s school and 

home experiences since our last interview. The information I collect in this 

interview will be extremely valuable in understanding the development of 

young children and how their early school experiences can be improved.

All responses that relate to or describe identifiable characteristics of 

individuals 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.

This call will be recorded for quality control purposes. 

ECLS-K Introduction NA

INQ.130 Before we begin the interview, I would like to verify some information. I have 

recorded {CHILD's FIRST, MIDDLE, AND LAST NAME} as {CHILD}'s full name. Is 

this correct? 

ECLS-K Introduction NA

INQ180 I have recorded that {CHILD}'s home address is...Is this still correct? ECLS-K Introduction NA

INQ190 What is {CHILD}'s home address? Introduction NA

INQ.200 I have recorded that {PHONE NUMBER} is {CHILD}'s family's current home 

phone number. Is this correct?

ECLS-K Introduction NA

INQ.205 {What is {CHILD}'s family's current home phone number?} ECLS-K Introduction NA

INQ.300 Next, I have a few questions about {CHILD}'s background. Was {CHILD} born in 

this country, that is, in any of the fifty states or the District of Columbia?

ECLS-K Country of origin for 

sample child

PQ1, PQ3

INQ.310/312OS In what country or territory was {CHILD} born? ECLS-K Country of origin for 

sample child

PQ1, PQ3

INQ.320 In what year did {CHILD} come to the United States to stay? ECLS-K Length of residence in U.S. 

for sample child

PQ1, PQ3

INQ.330 Is {CHILD} a U.S. citizen? ECLS-K Citizenship of child PQ1, PQ3

Parent's Involvement with 

Child's School

PIQ.051 Now, I'd like to ask you about {CHILD}'s school. To what extent did you or 

someone else in your household choose where to live so that {CHILD} could 

attend {his/her} current school? Would you say that {CHILD} being able to go 

to {his/her} current school was ...

ECLS-K Parent's choice of school 

for child

PQ5

PIQ.060 Is {CHILD} attending {his/her} regularly assigned school or a school that you or 

someone else in your household chose?

ECLS-K Parent's choice of school 

for child

PQ5

Page 2 of 29
App C Spring 3rd Parent Intervi

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30

31

32

33

34

A B C D E F

PIQ.065 Does {CHILD} attend a school? ECLS-K School attendance by 

homeschooled child

PQ5

PIQ.066 How many hours each week does {CHILD} usually go to a school for 

instruction? Please do not include time spent in extracurricular activities.

ECLS-K School attendance by 

homeschooled child

PQ5

PIQ.120

How far in school do you expect {CHILD} to go? Would you say you expect 

{him/her} ... 

ECLS-K

Parent’s educational 

expectations for child PQ3, PQ5

PIQ.127 Since the beginning of this school year, how many times have any of {CHILD}’s 

teachers or {his/her} school contacted (you/any adult in your household) 

about any behavior problems {he/she} is having in school?

NHES

School communication 

with parents

PQ5

PIQ.128

[Since the beginning of this school year, how many times have any of {CHILD}’s 

teachers or {his/her} school contacted (you/any adult in your household) 

about...] How about any problems {he/she} is having with school work? 

NHES

School communication 

with parents

PQ5

PIQ.129 [Since the beginning of this school year, how many times have any of {CHILD}’s 

teachers or {his/her} school contacted (you/any adult in your household) 

about...] How about anything {CHILD} is doing particularly well or better in 

school? 

NHES

School communication 

with parents

PQ5

PIQ.130 Since the beginning of this school year, have you or the other adults in your 

household attended an open house or a back-to-school night?

ECLS-K Parent participation in 

school activities

PQ5

PIQ.140 [Since the beginning of this school year, have you or the other adults in your 

household...] Attended a meeting of a PTA, PTO, or Parent-Teacher 

Organization?

ECLS-K Parent participation in 

school activities

PQ5

PIQ.150 [Since the beginning of this school year, have you or the other adults in your 

household...] Gone to a regularly-scheduled parent-teacher conference with 

{CHILD}'s teacher or meeting with {CHILD}'s teacher?

ECLS-K Parent attendance at 

parent-teacher 

conferences and meetings

PQ5

PIQ.160 [Since the beginning of this school year, have you or the other adults in your 

household...] Attended a school or class event, such as a play, sports event, or 

science fair?

ECLS-K Parent participation in 

school activities

PQ5

PIQ.170 [Since the beginning of this school year, have you or the other adults in your 

household...] Served as a volunteer in {CHILD}’s classroom or elsewhere in the 

school?

NHES:2007 Parent participation in 

school activities

PQ5

Page 3 of 29
App C Spring 3rd Parent Intervi

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40

41

42

A B C D E F

PIQ.185 During this school year, how many times have you or other adults in your 

household gone to meetings or participated in activities at {CHILD}'s school?

ECLS-K Parent participation in 

school activities

PQ5

PIQ190 For each of the following statements, please tell me how well {CHILD}'s school 

has done with each activity during this school year. The school lets you know 

between report cards how {CHILD} is doing in school. Would you say {CHILD}'s 

school... 

Does this very well 

Just OK, or 

Doesn't do this at all?

ECLS-K School communication 

with parents

PQ5

PIQ210 The school makes you aware of chances to volunteer at the school. Would you 

say {CHILD}'s school... 

Does this very well 

Just OK, or

Doesn't do this at all? 

ECLS-K School communication 

with parents

PQ5

PIQ300 About how many parents of children in {CHILD}'s class do you talk with 

regularly, either in person, on the phone, or by texting, e-mailing, or using a 

social networking site?

ECLS-K Parent networks PQ5

PIQ.490 Would you say that you are very satisfied, somewhat satisfied, somewhat 

dissatisfied, or very dissatisfied with the school {CHILD} attends this year?

NHES

Parent's satisfaction with 

the teachers and school PQ5

PIQ.510 How often does {CHILD} do homework at home? Would you say... ECLS-K Frequency child does 

homework at home

PQ4, PQ5

PIQ.550 How often do you check that {CHILD} has completed all homework? Would 

you say never, rarely, sometimes, or always?

ECLS-K Homework monitoring by 

parents

PQ4, PQ5

Family Structure

FSQ.010 Now I have a few questions about your household. We have listed that (READ 

NAMES FROM MATRIX) lived in this household at the time of our last 

interview. 

As I read each person's name again, please tell me if he or she still lives in this 

household.

Does {NAME} still live in this household?

ECLS-K Household roster: current PQ1, PQ3

Page 4 of 29
App C Spring 3rd Parent Intervi

43

44

45

46

47

48

49

50

51

52

A B C D E F

FSQ.015/015OS Why is {NAME} no longer living in this household? ECLS-K Household roster: former 

household member's 

status

PQ1, PQ3

FSQ020 {Other than the people I just asked about, is there anyone else currently living 

in this household? For example, anyone who has moved in or any babies born 

since our last interview? Please tell me the names and ages of all the other 

people who normally live here. Please do not include anyone staying here 

temporarily who usually lives somewhere else.}

{Now I have a few questions about your household. We have noted that you 

and {CHILD} currently live in this household. First I’d like to ask you some 

questions about yourself, then I’d like you to please tell me the names and 

ages of all the other people who normally live here. Please do not include 

anyone staying here temporarily who usually lives somewhere else.} 

ECLS-K Household roster: current PQ1, PQ3

FSQ.025 ENTER LAST NAME OF {NAME}. ECLS-K Household roster: current PQ1, PQ3

FSQ.030 How old {are you/is {NAME}}? ECLS-K Household roster: current PQ1, PQ3

FSQ.040 CODE IF OBVIOUS. OTHERWISE, ASK: {Are you/Is {NAME} male or female?} ECLS-K Household roster: current PQ1, PQ3

FSQ.045 CHECK HOUSEHOLD MATRIX. ECLS-K Household roster: current PQ1, PQ3

FSQ.060 Have we missed anyone who usually lives here who is temporarily away from 

home or living in a dorm at school, or any babies or small children?

ECLS-K Household roster: current PQ1, PQ3

FSQ.110 Do you have a spouse or partner who lives in this household? ECLS-K Marital status of the 

primary caretakers

PQ1, PQ3

FSQ.120 Who in the household is your spouse or partner? ECLS-K Marital status of the 

primary caretakers

PQ1, PQ3

FSQ.121 During our last interview with this household (family), it was reported that you 

were {the girlfriend or female partner of {CHILD}’s parent or guardian}/the 

boyfriend or male partner of {CHILD}’s parent or guardian/the female guardian 

of {CHILD}/the male guardian of {CHILD}/{CHILD}’s relative, but not a 

guardian/not related to {CHILD}/{CHILD}'s {RELATIONSHIP}}. Has there been a 

change in your relationship to {CHILD}?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

Page 5 of 29
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54

55

56

57

58

59

A B C D E F

FSQ.122 During our last interview with this household (or family), it was reported that 

{NAME OF SPOUSE/PARTNER} was {the girlfriend or female partner of 

{CHILD}’s parent or guardian/the boyfriend or male partner of {CHILD}’s parent 

or guardian/{CHILD}’s relative, but not a guardian/the female guardian of 

{CHILD}/the male guardian of {CHILD}/not related to {CHILD}/{CHILD}'s 

{RELATIONSHIP}}. Has there been a change in the relationship of {NAME OF 

SPOUSE/PARTNER} to {CHILD}?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.130 What is {your/{NAME}'s} relationship to {CHILD}? ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.140 {Are you/Is {NAME}} {CHILD}'s...

Biological or birth mother,

Adoptive mother,

Step mother,

Foster mother or female guardian, or

Other female parent or guardian?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.150 {Are you/Is {NAME}} {CHILD}'s...

Biological or birth father,

Adoptive father,

Step father,

Foster father or male guardian, or

Other male parent or guardian?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.160 {Are you/Is {NAME}} {CHILD}'s...

Full sister,

Half sister,

Step sister,

Adoptive sister, or

Foster sister?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.170 {Are you/Is {NAME}} {CHILD}'s...

Full brother,

Half brother,

Step brother,

Adoptive brother, or

Foster brother?

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

FSQ.180/181 {Are you/Is {NAME}} {CHILD}'s...

CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE DESCRIPTIVE.

ECLS-K Change in family 

relationship of key parent 

figures to child

PQ1, PQ3

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61

62

63

64

65

A B C D E F

FSQ.190 {Are you/Is {NAME}} Hispanic or Latino? ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.195 What is {your/{NAME}'s} race? You may name one or more races to indicate 

what {you/NAME} {consider/considers} {yourself/himself/herself} to be.

ECLS-K Race of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.196a Though we may have asked you about {CHILD}'s race and ethnicity in the past, 

I do have a few more questions I'd like to ask about that now. Is {CHILD} a 

member of a Spanish, Hispanic, or Latino group?

ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.196b Which of the following Spanish, Hispanic, or Latino groups best describes 

{CHILD}'s origin? Is {he/she}...

ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.197a Is {CHILD} a member of an Asian group? ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.197b Which of the following Asian groups best describes {CHILD}'s origin? Is 

{he/she}...

ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

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67

68

69

70

71

72

73

74

75

76

77

A B C D E F

FSQ.198a Is {CHILD} a member of a Pacific Islander group? ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.198b Which of the following Pacific Islander groups best describes {CHILD}'s origin? 

Is {he/she}...

ECLS-K Ethnicity of child, parent 

figures, respondent and 

respondent's spouse (if no 

mother or father figures) 

PQ1, PQ3

FSQ.200a {FILL 1} currently married, separated, divorced, widowed, in a domestic 

partnership, or {FILL 2} never been married {FILL 3}?

ECLS-K Marital status of the 

primary caretakers

PQ1, PQ3

FSQ.200b See matrix. ECLS-K Marital status of the 

primary caretakers

NA

FSQ.212/212OS Now I have a few questions about {your/{NAME}'s} country of birth. In what

country {were/was} {you/{NAME}} born?

ECLS-K Country of origin for 

parents

PQ1, PQ3

FSQ.213 How old {was/were} {you/{NAME}} when {you/{he/she}} first moved to {any of 

the fifty states in the United States or the District of Columbia/the United

States}?

ECLS-K Length of residence in U.S. 

for parents

PQ1, PQ3

Primary Language(s) Spoken

PLQ.020 Is any language other than English regularly spoken in your home? ECLS-K Languages spoken in the 

home

PQ1, PQ3

PLQ.083 How often {do/does} {you/NAME} use a language other than English in

speaking to {CHILD}? Would you say never, sometimes, often, or very often?

ECLS-K Languages spoken in the 

home

PQ1, PQ3

PLQ.090 How often does {CHILD} use a language other than English in speaking to

{you}/{NAME}? Would you say never, sometimes, often, or very often?

ECLS-K Languages spoken in the 

home

PQ1, PQ3

Home Environment, Activities, 

and Cognitive Stimulation

HEQ.040 About how many books does {CHILD} have in your home now, including library

books? Please only include books that are for children.

ECLS-K Literacy materials in the 

home

PQ4

HEQ.210 In the past week, how often did {CHILD} read to {himself/herself} or to others 

outside of school? Would you say...

Never

Once or twice a week

3 to 6 times a week, or

Every day?

ECLS-K Frequency of reading 

activities with child

PQ2, PQ4

HEQ.215 Generally, how many minutes did {CHILD} read at each of these times? ECLS-K Frequency of reading 

activities with child

PQ2, PQ4

Page 8 of 29
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79

80

81

82

83

84

85

86

87

88

89

90

A B C D E F

HEQ.225 In an average week, how often does {CHILD} use a home computer or other 

electronic device to play with programs that teach {him/her} something, like 

math or reading skills?

Would you say ...

Never,

Once or twice a week,

3 to 6 times a week, or

Every day

ECLS-K:2011 (modified) Use of 

electronic/computer 

devices

PQ4

HEQ.280 Is {CHILD} tutored on a regular basis, by someone other than you or a family

member, in a specific subject, such as reading, math, science, or a foreign

language?

ECLS-K Tutoring PQ5

HEQ.290/290OS What is {CHILD} tutored in? ECLS-K Tutoring PQ5

HEQ300 Outside of school hours in the past year, has {CHILD} participated in: Academic 

activities, like science, computers, math lab, or taking a class to learn a 

language other than English?

NHES 2007 (modified) Child activities outside of 

school hours

PQ4

HEQ305 As part of {CHILD}’s participation in that activity, did {he/she} ever take a field 

trip focused on science activities, for example to a science museum or center, 

a science lab, a planetarium, or a nature center?

NCES Child activities outside of 

school hours: science 

related field trips

PQ4

HEQ310 [Outside of school hours in the past year, has {CHILD} participated in:] 

Organized athletic activities, like basketball, soccer, baseball, or gymnastics?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ320 [Outside of school hours in the past year, has {CHILD} participated in:] 

Organized clubs or recreational programs, like scouts?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ325 As part of {CHILD}’s participation in that program, did {he/she} ever take a 

field trip focused on science activities, for example to a science museum or 

center, a science lab, a planetarium, or a nature center?

NCES Child activities outside of 

school hours: science 

related field trips

PQ4

HEQ330 [Outside of school hours in the past year, has {CHILD} participated in:] Music 

lessons, for example, piano, instrumental music, or singing lessons?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ340 [Outside of school hours in the past year, has {CHILD} participated in:] Drama 

classes?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ350 [Outside of school hours in the past year, has {CHILD} participated in:] Art 

classes or lessons, for example, painting, drawing, or sculpture?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ370 [Outside of school hours in the past year, has {CHILD} participated in:] 

Organized performing arts programs, such as children's choirs, dance 

programs, or theater performances?

ECLS-K Child activities outside of 

school hours

PQ4

HEQ.391 [Outside of school hours in the past year, has {CHILD} participated in:] 

Religious activities or instruction?

ECLS-K Child activities outside of 

school hours

PQ4

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92

93

94

95

96

97

98

99

100

101

102

103

A B C D E F

HEQ.393 Did {CHILD}’s participation in {academic activities /organized athletic 

activities/ organized clubs or recreational programs/ music lessons/ drama 

classes / art classes or lessons/ organized performing arts programs/ religious 

activities or instruction /any of these activities} help to cover the hours when 

you needed adult supervision for {him/her}?

ECLS-K Whether child activities 

serve as child care

PQ6

HEQ.520 Now, I have a question about meals. In a typical week, please tell me the 

number of days your family eats the evening meal together.

ECLS-K (modified) Frequency of family dinner 

together

PQ4

HEQ.600a/b

On an average school night, how many hours of sleep does {CHILD} get? 

Youth Risk Behavior 

Survey (YRBS)

Amount of sleep PQ4

Social Skills, Problem 

Behaviors, and Approaches 

Toward Learning

SSQ020 a/b/c/d

Items asking how often the child has had problems with four behaviors related 

to working memory over the past 6 months. Items not included due to 

copyright restrictions (4 items total). 

Behavior Rating 

Inventory

of Executive Function 

(BRIEF)

Child's working memory PQ1, PQ2

Child Care

CCQ.005 Next, I'd like to talk with you about the child care arrangements you have for 

{CHILD} this year. First, I'd like to talk to you about all the child care {CHILD} 

now receives on a regular basis from someone other than {you/{his/her} 

parents} {or {his/her} guardians}. This does not include occasional baby-sitting 

or backup care providers.

ECLS-K Participation in child care PQ6

CCQ010 Is {CHILD} now receiving care from a relative on a regular basis (including care 

provided before or after school)? This may include grandparents, brothers and 

sisters, or any relatives other than {you/{CHILD}'s parents} {or {CHILD}’s 

guardians}.

ECLS-K Participation in relative 

care

PQ6

CCQ.060 How many different regular care arrangements do you currently have with 

relatives?

ECLS-K Participation in relative 

care

PQ6

CCQ.065 {Let's talk about the relative who provides the most care for {CHILD} now.} 

Who is the relative who cares for {CHILD}? 

ECLS-K Participation in relative 

care

PQ6

CCQ.070 Is the care provided by {{CHILD}'s {RELATIVE}/that relative} in your home or 

another home?

ECLS-K Participation in relative 

care

PQ6

CCQ.075 Does {CHILD} receive that care before school, after school, or on weekends? ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.080 Is the care that {CHILD} receives from {{his/her} {RELATIVE}/that relative} 

regularly scheduled at least once each week?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.085 How many days each week does {CHILD} receive care from {{his/her} 

{RELATIVE}/that relative}?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.090 How many hours each week does {CHILD} receive care from {{his/her} 

{RELATIVE}/that relative}?

ECLS-K Time child spends in care 

arrangements

PQ6

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105

106

107

108

109

110

111

112

113

114

115

116

117

118

A B C D E F

CCQ.110 You said that {CHILD} was cared for by {NUMBER} other {relatives/relative} on

a regular basis. How many hours each week does {CHILD} receive care from

{these/this} other {relatives/relative}?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.115 {Now I'd like to ask you about any care {CHILD} receives from nonrelatives in a 

private home, not including child care centers.} Is {CHILD} now receiving care 

in a private home on a regular basis from someone who is not related to 

{him/her} (including care provided before or after school)? This includes 

home child care providers, regular sitters or neighbors. {It does not include 

child care centers.} 

ECLS-K Participation in nonrelative 

care

PQ6

CCQ.165 How many different regular care arrangements do you currently have with 

nonrelatives?

NHES ECPP and ECLS-B Participation in nonrelative 

care

PQ6

CCQ.170 {Let's talk about the nonrelative who provides the most care for {CHILD} now.}

Is that care provided in your home or another home?

ECLS-K Participation in nonrelative 

care

PQ6

CCQ.175 Does {CHILD} receive that care before school, after school, or on weekends? ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.180 Is the care that {CHILD} receives from that person regularly scheduled at least

once each week?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.185 How many days each week does {CHILD} receive care from that person? ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.190 How many hours each week does {CHILD} receive care from that person? ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.205 You said that {CHILD} was cared for by {NUMBER} other

{nonrelative/nonrelatives} on a regular basis. How many hours each week 

does {CHILD} receive care from {this nonrelative/these nonrelatives}?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.260 {Now I'd like to ask you about any care {CHILD} receives from day care centers

or before- or after-school programs.} Is {CHILD} now attending a day care

center or a before- or after-school program at a school or in a center on a

regular basis?

ECLS-K Participation in centerbased care

PQ6

CCQ.325 How many different day care centers or before- or after-school care programs

does {CHILD} currently go to on a regular basis?

ECLS-K Participation in centerbased care

PQ6

CCQ.330 {Let's talk about the program where {CHILD} spends the most time now.} Is

that program located in the school {CHILD} currently attends?

ECLS-K Participation in centerbased care

PQ6

CCQ.335 Does {CHILD} go to that program before school, after school, or on weekends? ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.340 Does {CHILD} go to that program on a regularly scheduled basis at least once

each week?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.350 How many days each week does {CHILD} go to that program? ECLS-K Time child spends in care 

arrangements

PQ6

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120

121

122

123

124

125

126

127

128

129

130

A B C D E F

CCQ.353 As part of {CHILD}’s participation in that program, did {he/she} ever take a

field trip focused on science activities, for example to a science museum or

center, a science lab, a planetarium, or a nature center?

NCES Science related field trips 

in center-based care

PQ6

CCQ.355 Other than regular school hours, how many hours each week does {CHILD} go

to that program?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.375 You said that {CHILD} attended {NUMBER} other day care {center/centers} or

before- or after-school {program/programs} on a regular basis. How many

hours each week does {CHILD} attend {this program/these programs}?

ECLS-K Time child spends in care 

arrangements

PQ6

CCQ.376 Sometimes children spend time caring for themselves, either at home or 

somewhere else, without an adult or older child responsible for them. Does 

{CHILD} spend time caring for {himself/herself} on a regular basis before or 

after school?

ECLS-K Time child spends in selfcare

PQ6

CCQ.377 How many hours per week does {CHILD} take care of {himself/herself}? ECLS-K Time child spends in selfcare

PQ6

Non-Resident Parents

NRQ.040 How long has it been since {CHILD} last had a visit, a phone call, a video call, 

an e-mail, a text or other electronic message, or received a card or letter from 

{his/her} {biological/adoptive} {father/mother}? 

ECLS-K (modified) Current contact and nature 

of relationship with 

biological/adoptive 

parents no longer living in 

household

PQ1, PQ3, PQ4

NRQ.123 How many times have {CHILD} and {his/her} {biological/adoptive} {father/ 

mother} talked on the telephone or in a video call to each other, e-mailed, 

texted, or had some other type of contact that was not in person in the past 4 

weeks?

ECLS-K (modified) Current contact and nature 

of relationship with 

biological/adoptive 

parents no longer living in 

household

PQ1, PQ3, PQ4

Country of Origin for NonResident Biological Parents

COQ.005/OS In what country was {his/her} biological mother born? ECLS-K Country of origin for 

nonresident parents

PQ1, PQ3

COQ.010 How old was {CHILD’}’s biological mother when she first moved to {any of the 

fifty states in the United States or the District of Columbia /the United States}?

ECLS-K Country of origin for 

nonresident parents

PQ1, PQ3

COQ.020/OS In what country was {his/her} biological father born? ECLS-K Country of origin for 

nonresident parents

PQ1, PQ3

COQ025 How old was {CHILD’}’s biological father when he first moved to {any of the 

fifty states in the United States or the District of Columbia /the United States}?

ECLS-K Country of origin for 

nonresident parents

PQ1, PQ3

Discipline, Warmth and 

Emotional Supportiveness

DWQ.010 {CHILD} and I often have warm, close times together. Please tell me 

whether each statement is never true for you, sometimes true for you, 

often true for you, or very often true for you.

ECLS-K Parent-child relationship: 

warmth

PQ4

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132

133

134

135

A B C D E F

DWQ.015

[Now, I'm going to read some statements. Please tell me whether each 

statement is completely true, mostly true, somewhat true, or not at all 

true.]

Most of the time I feel that {CHILD} likes me and wants to be near me.

ECLS-K Parent-child relationship: 

warmth

PQ4

DWQ.025 [Now, I'm going to read some statements. Please tell me whether each 

statement is completely true, mostly true, somewhat true, or not at all 

true.]

Even when I'm in a bad mood, I show {CHILD} a lot of love.

ECLS-K Parent-child relationship: 

warmth

PQ4

DWQ.035 [Now, I'm going to read some statements. Please tell me whether each 

statement is completely true, mostly true, somewhat true, or not at all 

true.]

I express affection by hugging, kissing and holding {CHILD}.

ECLS-K Parent-child relationship: 

warmth

PQ4

DWQ070a/b/c/d/

e/f

Please tell me whether each statement is never true for you, sometimes true 

for you, often true for you, or very often true for you.

a. Even if I am really busy, I make time to listen to {CHILD}. Would you say it's 

never true, sometimes true, often true, or very often true? 

b. I discourage {CHILD} from talking about {his/her} worries because it upsets 

{him/her}.

c. I encourage {CHILD} to talk about {his/her} troubles. 

d. I encourage {CHILD} to tell me about {his/her} friends and activities. 

e. I encourage {CHILD} to express {his/her} opinions.

f. When I lose my patience with {CHILD}’s questions and demands, I just don’t 

listen to {CHILD} anymore.

ECLS-K Parent-child relationship: 

communication

PQ4

DWQ077a/b/c The following are a number of statements about your family. Please tell me 

how often each typically occurs in your home.

a. You threaten to punish {CHILD} and then do not actually punish {him/her}. 

Would you say this occurs never, almost never, sometimes, often, or always?

b. {CHILD} talks you out of being punished after {he/she} has done something 

wrong.

c. You let {CHILD} out of punishment early, like lift restrictions earlier than you 

originally said? 

Short form of Alabama 

Parenting Questonnaire

Inconsistent Discipline PQ4

Page 13 of 29
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137

138

139

140

A B C D E F

DWQ.080a/b Now I’d like to ask some questions about {CHILD}’s television viewing. We 

want you to include television shows, videos, or DVDs watched on a TV, 

computer, or handheld device like an iPad or cellphone; but not games played 

on gaming systems like Playstation, Wii, Xbox or handheld devices.

On any given weekday, how many hours of television, videotapes, or DVDs on 

average does {CHILD} watch? 

ECLS-K (modified) Time child spent watching 

television

PQ4

DWQ.081 a/b Now I’d like to ask some questions about the amount of time {CHILD} plays 

video games. We want you to include games played on systems like 

Playstation, Wii, or Xbox, or on handheld devices such as a Nintendo DS, Sony 

PSP, iPod, iPad, or cellphone, or games played on the computer.

On any given weekday, how much time does {CHILD} spend playing video 

games? Please do not include time {CHILD} spends on the computer doing 

educational activities or homework. 

ECLS-K (modified) Time child spent playing 

video games

PQ4

Child's Health and Well-Being

CHQ.021 Has {CHILD} had an ear infection since last spring? ECLS-K:2011 (modified) Ear infections since last 

spring

PQ1, PQ2

CHQ.022 Has {CHILD} had an ear ache since last spring? ECLS-K:2011 (modified) Ear aches since 

kindergarten

PQ1, PQ2

CHQ.023 Since last spring, how many times did a doctor, nurse, or other medical

professional tell you that {CHILD} had an ear infection?

ECLS-K:2011 (modified) Ear infections since last 

spring

PQ1, PQ2

Page 14 of 29
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142

143

144

145

146

147

A B C D E F

CHQ.024/024OS How have {CHILD}’s {ear infections/ear aches} been treated by your doctor,

nurse, or other medical professional since last spring?

ECLS-K:2011 (modified) Ear infections/aches 

treatment since last spring

PQ1, PQ2

CHQ.025 Since last spring, were the tubes placed in the right ear, left ear, or both ears

when your child had surgery to place tubes in {his/her} ears?

IF NEEDED: Please consider all surgeries since last spring if {CHILD} had more

than one to place ear tubes.

ECLS-K:2011 (modified) Ear tubes PQ1, PQ2

CHQ.026 Has a doctor, nurse, or other medical professional ever told you that {CHILD} 

has asthma?

ECLS-K Asthma PQ1, PQ2

CHQ.027 Does {he/she} receive treatment for this condition? ECLS-K Asthma PQ1, PQ2

CHQ.040a/b/c What kind of health insurance or health care coverage does {CHILD} have? By 

health insurance I mean any kind of coverage that pays for health care 

expenses. Please do not include private plans that only provide extra cash 

while hospitalized.

a. Does {he/she} have a private health insurance plan (from employer, 

workplace, or purchased directly or through a state or local government 

program or community program).

b. Does {he/she} have a public health insurance plan, such as Medicaid, the 

Children's Health Insurance Program (CHIP), or health care through the 

military? 

c. Does {he/she} have any health insurance?

ECLS-K (modified) Health insurance coverage PQ1, PQ3

CHQ.060 In a typical week, on how many days does {CHILD} get exercise that causes

rapid breathing, perspiration, and a rapid heartbeat for 20 continuous minutes

or more?

ECLS-K Exercise/physical activities PQ1, PQ2

CHQ.070a/b/c/d/

e/f/g/h/OS

What types of exercise or physical activity does {CHILD} get? How about...

a. Group sports?

b. Individual sports?

c. Dance?

d. Recreational sports or outdoor activities?

e. Martial Arts?

f. Playground activities?

g. General exercising?

h. Anything else?

ECLS-K Types of exercise PQ1, PQ2

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150

151

152

153

154

155

A B C D E F

CHQ.095 For the next set of questions, please base your answer on how {CHILD}

compares to other children of the same age. {CHILD} is independent and takes

care of {himself/herself} ...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K Behavioral comparison to 

peers: Independence and 

ability to take care of 

him/herself

PQ1, PQ2

CHQ.100 Does {CHILD} pay attention...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K Behavioral comparison to 

peers: Attention

PQ1, PQ2

CHQ.105 Does {CHILD} learn, think, and solve problems...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K Behavioral comparison to 

peers: Learn, think, solve 

problems

PQ1, PQ2

CHQ.106 Does {CHILD} show good coordination in moving {his/her} arms and legs?

Would you say {he/she} does this...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K Behavioral comparison to 

peers: Child's coordination

PQ1, PQ2

CHQ.107 Would you say {CHILD} behaves and relates to other children...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K (modified) Behavioral comparison to 

peers: Relating to children

PQ1, PQ2

CHQ.108 Would you say {CHILD} behaves and relates to adults...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K:2011 Behavioral comparison to 

peers: Relating to adults

PQ1, PQ2

CHQ.109 Thinking about {CHILD}'s overall activity level, would you say {he/she} is ...

Less active than other children {his/her} age,

About as active,

Slightly more active, or

A lot more active than other children {his/her} age?

ECLS-K Behavioral comparison to 

peers: Overall activity 

level

PQ1, PQ2

CHQ.110 Does {CHILD} have any emotional or psychological difficulties? ECLS-K:2011 Emotional and 

psychological difficulties

PQ1, PQ2

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161

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A B C D E F

CHQ.111 Do you think this is a mild problem, a moderate problem, or a severe

problem?

ECLS-K:2011 Emotional and 

psychological difficulties

PQ1, PQ2

CHQ.115 {Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a

professional because of an issue with {independence and taking care of

{himself/herself} {or}/paying attention {or}/learning, thinking, and solving

problems {or}/ coordination in moving {his/her} arms and legs {or}/behaving

and relating to other children {or}/ behaving and relating to adults

{or}/{his/her} overall activity level {or}/{his/her} emotional or psychological

difficulties}?

ECLS-K:2011 Evaluation of disabilities 

and health conditions

PQ1, PQ2

CHQ.120 {Since last spring, have you obtained/Did you obtain} a diagnosis or diagnoses 

of a problem from a professional?

ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.125/125OS What was the diagnosis or were the diagnoses? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ126/126OS What type of autism spectrum disorder does {CHILD} have? Is it autism,

Asperger's Disorder, Pervasive Developmental Disorder, something else or was

it identified generally as Autism Spectrum Disorder?

ECLS-K:2011 Diagnoses of disabilities 

and health conditions: 

Autism spectrum disorder

PQ1, PQ2

CHQ.130/131 How old was {CHILD} when the first diagnosis of a problem related to {a 

learning disability/Attention Deficit Disorder (ADD)/Attention Deficit 

Hyperactivity Disorder (ADHD)/a developmental delay/autism, Asperger’s 

disorder, Pervasive Developmental Disorder (PDD), or other autism spectrum 

disorder/dyslexia/dyscalculia/an

intellectual disability, severe cognitive disability, or mental retardation/an 

orthopedic impairment/a serious emotional disturbance/a traumatic brain 

injury/a panic disorder/separation anxiety disorder/obsessivecompulsive 

disorder/a generalized anxiety disorder/an {other} anxiety 

disorder/bipolardisorder/depression/speech/a sensory deficit 

disorder/oppositional defiant disorder/{TEXT FROM OTHER

SPECIFY}} was made?

ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.135a/b What was the month and year when the diagnosis was made? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

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164

165

166

167

A B C D E F

CHQ.140 Is {CHILD} now taking any prescription medicine for the condition related to 

{his/her} {learning disability/Attention Deficit Disorder (ADD)/Attention Deficit 

Hyperactivity Disorder (ADHD)/developmental delay/autism, Asperger’s 

disorder, Pervasive Developmental Disorder (PDD), or other autism spectrum 

disorder/dyslexia/dyscalculia/intellectual disability, severe cognitive disability, 

or mental retardation/orthopedic impairment/serious emotional 

disturbance/traumatic brain injury/panic disorder/separation anxiety 

disorder/obsessive compulsive disorder/generalized anxiety disorder/{other} 

anxiety disorder/bipolar disorder/depression/speech problems/sensory deficit 

disorder/oppositional defiant

disorder{TEXT FROM OTHER SPECIFY}}?

ECLS-K:2011 Prescription medications PQ1, PQ2

CHQ.155 Is {CHILD} medicated for ADD or ADHD at school, at home, or both? ECLS-K:2011 Prescription medications PQ1, PQ2

CHQ.173 How long has {CHILD} taken such prescription medicine for {a learning 

disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity 

Disorder (ADHD)/a developmental delay/autism, Asperger’s disorder, 

Pervasive Developmental Disorder (PDD), or other autism spectrum 

disorder/dyslexia/dyscalculia/an

intellectual disability, severe cognitive disability, or mental retardation/an 

orthopedic impairment/a serious emotional disturbance/a traumatic brain 

injury/a panic disorder/separation anxiety disorder/obsessive compulsive 

disorder/a generalized anxiety disorder/an {other} anxiety disorder/bipolar 

disorder/depression/speech problems/a sensory deficit disorder/oppositional 

defiant disorder/{TEXT FROM

OTHER SPECIFY}}, in total?

Less than one month,

Less than a year,

1 to 2 years,

3 to 4 years, or

ECLS-K:2011 Prescription medications PQ1, PQ2

CHQ.200 For the next question, please base your answer on how {CHILD} compares to

other children of the same age. Does {CHILD} pronounce words, communicate

with and understand others...

Better than other children {his/her} age,

As well as other children,

Slightly less well than other children, or

Much less well than other children?

ECLS-K:2011 Communication: 

comparison to peers

PQ1, PQ2

CHQ.206 e Since last spring, has your child had a problem with stuttering? ECLS-K:2011 Communication problems PQ1, PQ2

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170

171

172

173

174

175

A B C D E F

CHQ.210 {Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a

professional because of {his/her} ability to communicate? 

ECLS-K Evaluation of 

communication problems

PQ1, PQ2

CHQ.215 Did you obtain a diagnosis or diagnoses of a problem related to {his/her}

ability to communicate from a professional?

ECLS-K Diagnoses for 

communication problems

PQ1, PQ2

CHQ.216 Which best describes {CHILD}’s hearing? If {CHILD} has a hearing aid or other

assistive device, please consider {his/her} hearing without the hearing aid or

assistive device. Would you say {CHILD} has...

excellent hearing,

good hearing,

a little trouble hearing,

moderate trouble hearing,

a lot of trouble hearing, or

is {CHILD} deaf?

ECLS-K Hearing ability PQ1, PQ2

CHQ.217 Please indicate whether the following statement describes {CHILD}'s hearing.

If {CHILD} has a hearing aid or other assistive device, please consider {his/her}

hearing without the hearing aid or assistive device. {CHILD} can usually hear 

and understand what a person says without seeing his or her face if that

person whispers to {him/her} from across a quiet room.

ECLS-K Hearing ability PQ1, PQ2

CHQ.218 [Please indicate whether the following statement describes {CHILD}'s hearing.

If {CHILD} has a hearing aid or other assistive device, please consider {his/her}

hearing without the hearing aid or assistive device.] {CHILD} can usually hear 

and understand what a person says without seeing his or her face if that

person talks in a normal voice to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.219 [Please indicate whether the following statement describes {CHILD}'s hearing.

If {CHILD} has a hearing aid or other assistive device, please consider {his/her}

hearing without the hearing aid or assistive device.] {CHILD} can usually hear 

and understand what a person says without seeing his or her face if that

person shouts to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.220 [Please indicate whether the following statement describes {CHILD}'s hearing.

If {CHILD} has a hearing aid or other assistive device, please consider {his/her}

hearing without the hearing aid or assistive device.] {CHILD} can usually hear 

and understand what a person says without seeing his or her face if that

person speaks loudly into {his/her} ears or better ear.

ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.221 Is {CHILD}’s hearing worse in one ear? ECLS-K:2011 Hearing ability PQ1, PQ2

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178

179

180

181

182

183

184

185

A B C D E F

CHQ.222 Which best describes {CHILD}'s hearing in {his/her} worse ear? If {CHILD} has a 

hearing aid or other assistive device, please consider {his/her} hearing without 

the hearing aid or assistive device.

In {his/her} worse ear, would you say {CHILD} has...

Excellent hearing,

Good hearing,

A little trouble hearing,

Moderate trouble hearing,

A lot of trouble hearing, or

is {CHILD} Deaf?

ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.235 {Besides the ECLS-K:2011 hearing evaluation done for this study, {since last

spring has/since the fall of 2012 has/Has}/{Since last spring has/Since the fall

of 2012 has/Has} {CHILD}'s hearing {ever} been evaluated by a professional?

ECLS-K (modified) Evaluated for hearing 

ability

PQ1, PQ2

CHQ.245 Did you obtain a diagnosis of a problem from a professional? ECLS-K Diagnoses for hearing 

ability

PQ1, PQ2

CHQ.246/246OS What was the diagnosis? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ250a/b/c How old was {CHILD} when the first diagnosis of a problem related to {his/her}

{ability to communicate/hearing} was made?

ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.255a/b What was the month and year the problem with {CHILD}'s {ability to

communicate/hearing} was diagnosed? 

ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.256a {Since the fall of 2012 /Since last spring/Since the spring of 2012/Since the 

spring of 2011}, has {CHILD} worn a hearing aid?

ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.256b Has {CHILD} ever worn a hearing aid? ECLS-K:2011 (modified) Use of hearing aid PQ1, PQ2

CHQ.257a/b At what age was the recommendation that {CHILD} wear a hearing aid first

made?

ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.258 How often does {CHILD} use the hearing aid(s) in school? Would you say...

All of the time,

Most of the time,

Sometimes,

Rarely, or

Never?

ECLS-K:2011 Use of hearing aid PQ1, PQ2

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187

188

189

190

191

192

193

194

195

196

197

198

199

A B C D E F

CHQ.259 Please indicate whether the following statement describes {CHILD}'s hearing 

when wearing {his/her} hearing aid(s). {CHILD} can usually hear and 

understand what a person says without seeing his or her face if that person 

whispers to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

hearing aid

PQ1, PQ2

CHQ.260 [Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} hearing aid(s). ] {CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

talks in a normal voice to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

hearing aid

PQ1, PQ2

CHQ.261 [Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} hearing aid(s). ] {CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

shouts to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

hearing aid

PQ1, PQ2

CHQ.262 [Please indicate whether the following statement describes {CHILD}'s hearing 

when wearing {his/her} hearing aid(s).] {CHILD} can usually hear and 

understand what a person says without seeing his or her face if that person 

speaks loudly into {his/her} {better} ear.

ECLS-K:2011 Hearing ability: with 

hearing aid

PQ1, PQ2

CHQ.263 {Since last spring has/Has} a doctor or other health care professional {ever}

recommended that {CHILD} wear a hearing aid?

ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.264a/b At what age was the recommendation that {CHILD} wear a hearing aid first

made?

ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.270 Does {CHILD} have a cochlear implant? ECLS-K Use of cochlear implant PQ1, PQ2

CHQ.271 In what year was it implanted? ECLS-K Use of cochlear implant PQ1, PQ2

CHQ.272a/b How old was {CHILD} when it was implanted? ECLS-K:2011 Use of cochlear implant PQ1, PQ2

CHQ.273 In what years were they implanted? ECLS-K Use of cochlear implant PQ1, PQ2

CHQ.274 [In what years were they implanted?] ECLS-K Use of cochlear implant PQ1, PQ2

CHQ.275a/b {How old was {CHILD} when it was implanted in the left ear?}{How old was

{CHILD} when they were implanted?}

ECLS-K:2011 Use of cochlear implant PQ1, PQ2

CHQ.276a/b {How old was {CHILD} when it was implanted in the right ear?}{How old was

{CHILD} when they were implanted?}

ECLS-K:2011 Use of cochlear implant PQ1, PQ2

CHQ.277 Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} cochlear implant {s}. {CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

whispers to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

cochlear implant

PQ1, PQ2

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201

202

203

204

205

206

207

208

209

210

211

A B C D E F

CHQ.278 [Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} cochlear implant {s}.]{CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

talks in a normal voice to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

cochlear implant

PQ1, PQ2

CHQ.279 [Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} cochlear implant {s}.] {CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

shouts to {him/her} from across a quiet room.

ECLS-K:2011 Hearing ability: with 

cochlear implant

PQ1, PQ2

CHQ.280 [Please indicate whether the following statement describes {CHILD}'s hearing

when wearing {his/her} cochlear implant {s}.] {CHILD} can usually hear and

understand what a person says without seeing his or her face if that person

speaks loudly into {his/her} {better} ear.

ECLS-K:2011 Hearing ability: with 

cochlear implant

PQ1, PQ2

CHQ.285 Now I want to ask you about {CHILD}’s vision. Without the use of eyeglasses

or contact lenses, does {CHILD} have difficulty seeing objects in the distance or

letters on paper?

ECLS-K Vision ability PQ1, PQ2

CHQ.286 Is {CHILD}’s difficulty with seeing objects in the distance, things up close (like

letters on paper) or both?

ECLS-K:2011 Vision ability PQ1, PQ2

CHQ.290 {Since last spring has/Has} {CHILD}'s vision {ever} been evaluated by an eye

care professional?

ECLS-K (modified) Evaluated for vision ability PQ1, PQ2

CHQ.300 Did you obtain a diagnosis of a vision-related problem from an eye care

professional?

ECLS-K (modified) Diagnoses for visionrelated problems

PQ1, PQ2

CHQ.301/301OS What was the diagnosis? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.305a/b How old was {CHILD} when the first diagnosis of a problem was made? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.310a/b What was the month and year the diagnosis was made? ECLS-K:2011 Diagnoses of disabilities 

and health conditions

PQ1, PQ2

CHQ.311 Has {CHILD} been prescribed glasses or contact lenses to improve {his/her}

vision?

ECLS-K:2011 Use of glasses or contact 

lenses

PQ1, PQ2

CHQ.312 How often does {CHILD} wear glasses or contact lenses?

All of the time,

Most of the time,

Sometimes,

Rarely, or

Never?

ECLS-K:2011 Use of glasses or contact 

lenses

PQ1, PQ2

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214

215

216

217

218

219

220

221

222

A B C D E F

CHQ.313 Does {CHILD} have glasses or contact lenses? ECLS-K:2011 Use of glasses or contact 

lenses

PQ1, PQ2

CHQ.314 Do {CHILD}’s glasses or contacts help {him/her} see things up close, see things

in the distance, or both?

ECLS-K:2011 Use of glasses or contact 

lenses

PQ1, PQ2

CHQ.330 Would you say {CHILD}'s health is ...

Excellent,

Very good,

Good,

Fair, or

Poor?

ECLS-K Child's general health PQ1, PQ2

CHQ.340 During this school year, has {CHILD} received therapy services or taken part in

a program for children with disabilities?

ECLS-K Services for disabilities PQ1, PQ2

CHQ.420 During this school year, did {CHILD} participate in a special education

program? 

ECLS-K (modified) Services for disabilities PQ1, PQ2

CHQ.430 Overall, how satisfied are you with the progress {CHILD} has made in the 

special services or special education program this school year? Are you...

Completely satisfied,

Very satisfied,

Fairly satisfied,

Somewhat dissatisfied, or

Very dissatisfied?

ECLS-K:2011 Services for disabilities PQ1, PQ2

Peer Victimization

VIQ.010 Now, I have some questions about problems {CHILD} may have had with other 

children.

During this school year have other children ever teased, made fun of, or called 

{CHILD} names?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.020 How often has this happened? Would you say ...

Rarely,

Sometimes,

Often, or

Very often?:

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.030 During this school year have other children ever pushed, shoved, slapped, hit, 

or kicked {CHILD}?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.040 How often has this happened? Would you say ...

Rarely,

Sometimes,

Often, or

Very often?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.050 During this school year have other children ever intentionally excluded or left 

{CHILD} out from playing with

them?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

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225

226

227

228

229

230

231

232

233

234

235

236

A B C D E F

VIQ.060 How often has this happened? Would you say ...

Rarely,

Sometimes,

Often, or

Very often?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.070 During this school year, have other children ever told lies or untrue stories 

about {CHILD}?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

VIQ.080 How often has this happened? Would you say ...

Rarely,

Sometimes,

Often, or

Very often?

Espelage and Holt 

(2001) (modified)

Peer victimization PQ1

Parent's Psychological WellBeing and Health

PPQ.100 I'm going to read some statements that may relate to how you have felt about 

yourself and your life during the past week. For each statement I read, please 

indicate how often in the past week you felt or behaved this way. There are 

no right or wrong answers.

How often during the past week have you felt that you were bothered by 

things that don't usually bother you? Would you say never, some of the time, 

a moderate amount of the time, or most of the time?

ECLS-K Depression and subjective 

well-being

PQ1, PQ3

PPQ.110 How often during the past week have you felt that you did not feel like eating, 

that your appetite was poor?

ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.120 How often during the past week have you felt that you could not shake off the 

blues even with help from your family or friends?

ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.130 How often during the past week have you felt that you had trouble keeping 

your mind on what you were doing?

ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.140 How often during the past week have you felt depressed? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.150 How often during the past week have you felt that everything you did was an 

effort?

ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.160 How often during the past week have you felt fearful? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.170 How often during the past week have you felt your sleep was restless? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.180 How often during the past week have you felt that you talked less than usual? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.190 How often during the past week have you felt lonely? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.200 How often during the past week have you felt sad? ECLS-K Depression and subjective 

well-being PQ1, PQ3

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239

240

241

242

243

244

A B C D E F

PPQ.210 How often during the past week have you felt that you could not get going? ECLS-K Depression and subjective 

well-being PQ1, PQ3

PPQ.220 Now, I would like to ask you about your health. In general, would you say that 

your health is...

Excellent,

Very good,

Good,

Fair, or

Poor?

ECLS-K Parent health PQ1, PQ3, PQ5

Food Security

FDQ.130a/b/c These next questions are about whether your family is able to afford the 

food that you need. I am going to read you several statements that people 

have made about their food situation. For these statements, please tell me 

whether the statement was often true, sometimes true, or never true for 

{you/your household} in the last 12 months, that is, since last {CURRENT 

MONTH}, 2013.

a. {I/We} worried whether {my/our} food would run out before {I/we} got 

money to buy more. Was that often true, sometimes true, or never true for 

{you/your household} in the last 12 months?

b. The food that {I/we} bought just didn't last, and {I/we} didn't have 

money to get more. Was that often true, sometimes true, or never true for 

{you/your household} in the last 12 months?

c. {I/We} couldn't afford to eat balanced meals.

ECLS-K Family food security PQ1, PQ3

FDQ.140 In the last 12 months, did {you/you or other adults in your household} ever cut 

the size of your meals or skip meals because there wasn't enough money for 

food?

ECLS-K Family food security PQ1, PQ3

FDQ.150 How often did this happen? Would you say...

Almost every month

Some months, but not every month, or

In only 1 or 2 months?

ECLS-K Family food security PQ1, PQ3

FDQ.160 In the last 12 months, did you ever eat less than you felt you should because 

there wasn't enough money for food?

ECLS-K Adult food security PQ1, PQ3

FDQ.170 In the last 12 months, were you ever hungry but didn't eat because there 

wasn't enough money for food?

ECLS-K Adult food security PQ1, PQ3

FDQ.180 In the last 12 months, did you lose weight because there wasn't enough 

money for food?

ECLS-K Adult food security PQ1, PQ3

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247

248

249

250

251

252

A B C D E F

FDQ.190 In the last 12 months, did {you/you or other adults in your household} ever 

not eat for a whole day because there wasn't enough money for food?

ECLS-K Adult food security PQ1, PQ3

FDQ.191 How often did this happen? Would you say...

Almost every month

Some months, but not every month, or

In only 1 or 2 months?

ECLS-K Adult food security PQ1, PQ3

Parent's Education

PEQ.020 {Now I have a few questions about education and job training.} What is the 

highest grade or year of school that {you/{NAME}} {have/has} completed?

ECLS-K:2011 (modified) Parent education PQ1, PQ3

PEQ.021 {Do/Does} {you/{NAME}} have a high school diploma, or its equivalent, such as 

a GED, or neither?

ECLS-K Parent education PQ1, PQ3

Parent's Employment

EMQ.200 Which best describes {your/NAME'S} current employment situation? {Are

you/Is {NAME}}...

working part-time,

working full-time,

a stay-at-home parent or guardian, or

not working?

Westat Parent employment PQ1, PQ3

EMQ.210 Since {CHILD} was born, {have you/has {NAME}} served on active duty in the

U.S. Armed Forces, military Reserves, or National Guard? Active duty does not

include training for the Reserves or National Guard, but DOES include

activation, for example, for the war in Afghanistan.

United States Census 

Bureau (modified)

Active duty military 

service: since child was 

born

PQ1, PQ3

EMQ.215 {Are you/Is {NAME}} currently on active duty in the U.S. Armed Forces, military

Reserves, or National Guard?

United States Census 

Bureau (modified)

Active duty military 

service: current

PQ1, PQ3

Parent Income and Assets

PAQ.100 {In studies like this, households are sometimes grouped according to income.} 

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? Was it...

$25,000 or less, or

More than $25,000?

ECLS-K Annual family income PQ1, PQ3

Page 26 of 29
App C Spring 3rd Parent Intervi

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254

255

256

257

258

A B C D E F

PAQ.110 Was it...

$5,000 or less

$5,001 to $10,000

$10,001 to $15,000

$15,001 to $20,000

$20,001 to $25,000

$25,001 to $30,000

$30,001 to $35,000

$35,001 to $40,000

$40,001 to $45,000

$45,001 to $50,000

$50,001 to $55,000

$55,001 to $60,000

$60,001 to $65,000

$65,001 to $70,000

$70,001 to $75,000

$75,001 to $100,000

$100,001 to $200,000

$200,001 or more

ECLS-K Annual family income PQ1, PQ3

PAQ.120 What was your total household income last year, to the nearest thousand? ECLS-K Annual family income PQ1, PQ3

PAQ.140/140OS What is your current housing situation? Do you...

own your own house or condominium 

rent your house or apartment 

exchange services for housing 

not pay for housing 

live in temporary housing or a shelter, or 

have another type of arrangement (SPECIFY)?

ECLS-K Housing PQ1, PQ3

Mobility and Tracking Updates

CMQ.010 Have you moved since {DATE OF LAST INTERVIEW}? ECLS-K Child Mobility NA

CMQ.020/020OS Why did you move? ECLS-K Child Mobility NA

CMQ.060 Just to make sure I can reach you for the next interview, which will take place 

next school year, I'd like to ask a few questions about how to find you.

 Is there a second phone number, such as a work number, a friend or relative's 

number, or a beeper or cell phone number, where you can sometimes be 

reached?

ECLS-K Closing NA

Page 27 of 29
App C Spring 3rd Parent Intervi

259

260

261

262

263

264

265

266

267

268

269

270

271

272

273

A B C D E F

CMQ.100 Just to make sure I can reach you for the next interview, which will take place 

next school year, I'd like to ask a few questions about how to find you. I have 

recorded {PHONE NUMBER} as a second phone number where you can 

sometimes be reached. Is this the right number?

ECLS-K Closing NA

CMQ.140 What is that telephone number? ECLS-K Closing NA

CMQ.150/155 Where is that telephone located? ECLS-K Closing NA

CMQ.200 I have recorded that {NAME OF RELATIVE/FRIEND}

at {PHONE NUMBER}

on

{STREET ADDRESS, LINE 1}

{STREET ADDRESS, LINE 2}

{CITY}

{STATE}

{ZIP CODE}

will always know where you are if you move. Is this still true?

ECLS-K Closing NA

CMQ.205 Is there a relative or friend, who does not live in this household, who will 

always know where you are if you move?

ECLS-K Closing NA

CMQ.210/220/23

0/240/250/255/2

55OS/260/270

What is the name, address, and telephone number of that person? ECLS-K Closing NA

CMQ.280 What is the person's relationship to you? ECLS-K Closing NA

CMQ.382 I have also recorded that your e-mail address is {EMAIL ADDRESS}. Is that 

correct?

ECLS-K Closing NA

CMQ.383 Is there an e-mail address where we could reach you? ECLS-K Closing NA

CMQ.384 What is your e-mail address? ECLS-K Closing NA

CMQ.680 WAS THIS INTERVIEW CONDUCTED BY TELEPHONE OR IN-PERSON? ECLS-K Closing NA

CMQ.690/690OS WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, A CHINESE 

LANGUAGE, VIETNAMESE, OR ANOTHER LANGUAGE?

ECLS-K Closing NA

CMQ.695 WHERE WAS THIS INTERVIEW CONDUCTED? ECLS-K Closing NA

CMQ.700 Thank you very much for your cooperation and for taking the time to 

participate in the Early Childhood Longitudinal Study.

ECLS-K Closing NA

CMQ.701 We would like to call the parent or guardian for {CHILD} at the household 

where {he/she} lives. Could you please give me the name and telephone 

number for the home that I should call?

ECLS-K Closing NA

Page 28 of 29
App C Spring 3rd Parent Intervi

274

275

276

A B C D E F

CMQ.702 We would like to call back when {this person/{CHILD}’s parent or guardian is 

available. Please tell me when we should call back. 

ECLS-K Closing NA

CMQ.703 Thank you. ECLS-K Closing NA

CMQ.720 PRESS 1 AND ENTER TO SAVE AND EXIT THIS CASE. ECLS-K Closing NA

Page 29 of 29
App D Spring 3rd TQA (Class)

1

2

3

4

5

6

7

8

9

10

11

A B C D E F

Section Item # Item Stem Source Construct

Research 

Question

Classroom and 

Student 

Characteristics A1

As of today’s date, how many children... Are

currently enrolled in your class? Have joined the

class since the beginning of the school year? Have

left the class since the beginning of the school year?

Are boys? Are girls? ECLS-K

Classroom characteristics: 

enrollment, gender distribution TQ1; TQ3

A2 What grade levels are included in your class? ECLS-K

Classroom characteristics: grade 

levels within class TQ1

A3

During this school year have you taught the 

following subjects to any or all of the students in 

your class? New

Classroom characteristics: subjects 

taught TQ3

A4

How many of the children in your class are repeating 

this grade this year? ECLS-K

Classroom characteristics: number 

of repeaters TQ2; TQ3

A5

How many children in your class...Are classified as 

Gifted and Talented? Are participating in a Gifted 

and Talented program? ECLS-K

Classroom characteristics: number 

of gifted and talented TQ3

A6

How many children in your class...Are tardy on an 

average day? Are absent on an average day? ECLS-K Students tardy or absent TQ2

A7

How many children in your class are below grade 

level, about on grade level, or above grade level in 

each of the following subjects? ECLS-K

Students above or below grade 

level in reading/math TQ3

A8

At this point in the school year, how would you rate

the behavior of the children in your class? ECLS-K Overall behavior of the class TQ1

A9

Items asking the percentage of the students in the

classroom who demonstrate behaviors or

characteristics that either disrupt or create a

challenging learning environment. Items not

included due to copyright restrictions (4 items total).

New. From Abry, 

Swanson, & Fabes 

(2012)

Classroom climate (student 

difficulties) TQ2

Spring Third-Grade General Classroom Teacher Classroom-Level Questionnaire, Appendix D

Page 1 of 5
App D Spring 3rd TQA (Class)

12

13

14

15

16

17

18

19

20

A B C D E F

A10

How many children in your class have a diagnosed 

disability? ECLS-K

Number of students with 

disabilities TQ3

A11

Do you have any children who are English language 

learners in your class? (English language learners are 

children whose native language is one other than 

English and whose skills in listening, speaking, 

reading, or writing English are such that they have 

difficulty understanding school instruction in 

English.) ECLS-K

Number of English language 

learners TQ3

A12

How many English language learners (ELLs) do you 

have in your class? ECLS-K

Number of English language 

learners TQ3

A13

Which languages are spoken by you or any other 

teacher or aide to the ELL children in your class for 

academic instruction, instructional support, or 

conversation? ECLS-K Languages used in the classroom TQ3

Class Organization 

and Resources B1

During a typical day, how much time per day would 

you estimate that you spend on classroom discipline 

and handling disruptive behavior? ECLS-K Time spent on discipline TQ1

B2

How often does the typical child in your class usually 

work on lessons or projects in the following general 

subject areas, whether as a whole class, in small 

groups, or in individualized arrangements? ECLS-K Use of class time, by subject area TQ1

B3

On the days children work in these areas, how much 

time does the typical child in your class usually work 

on lessons or projects in the following general 

subject areas? ECLS-K Use of class time, by subject area TQ1

B4

How often do the children in your class go to the 

school library or media center? ECLS-K

Visit library and borrow materials, 

frequency TQ1

B5 How many days a week do children have recess? ECLS-K

Class activities (outside of class)/ 

recess TQ1

Page 2 of 5
App D Spring 3rd TQA (Class)

21

22

23

24

25

26

27

28

29

30

A B C D E F

B6

On days when children have recess, between the 

school day starting time and the dismissal time, how 

many times a day do children have recess? ECLS-K

Class activities (outside of class)/ 

recess TQ1

B7

In a typical day, how much time do children in your 

class spend in the following activities? ECLS-K

Use of class time (outside of class)/ 

lunch, recess TQ1

B8

Do any of the following staff members provide direct 

instruction to students in your class who are 

struggling or at risk of failure in reading or math? 

Adapted from 

Reading First 

Impact Study--

Teacher Survey

Response to Intervention-related 

policies and practices TQ8

B9

How frequently do you or your students use 

computers or the following electronic devices for 

instructional purposes? Please include any desktop, 

laptop, or other computer-type

devices. ECLS-K

Availability, use, and adequacy of 

materials TQ1

B10

In an average week, how many days a week is 

homework assigned? Please count homework 

assigned over the weekend as one day. ECLS-K Use of homework TQ1

B11

On days when homework is assigned, how much 

time do you expect children to spend on homework 

in the following areas? ECLS-K Use of homework TQ1

Parent Involvement C1

How many regularly scheduled conferences do you 

have with a parent or guardian of each child in your 

class during the school year? ECLS-K Parent-teacher conferences TQ5

C2

What percentage of children in your class have 

parents who participate in the following activities? ECLS-K Parent involvement in school TQ5

Evaluation and 

Grading Practices D1

How important is each of the following in evaluating 

the children in your class for reporting to parents? ECLS-K

Methods of assessing children's 

progress TQ1

D2

How often do you use a formal assessment in 

READING for the following purposes?

ECLS-K:2011 

Grade 1

Response to Intervention-related 

policies and practices TQ8

Page 3 of 5
App D Spring 3rd TQA (Class)

31

32

33

34

35

36

37

38

39

40

41

42

43

A B C D E F

D3

How often do you use a formal assessment in MATH 

for the following purposes?

ECLS-K:2011 

Grade 1

Response to Intervention-related 

policies and practices TQ8

School and Staff 

Activities E1

Did you participate in any professional 

development* within the last 12 months

ECLS-K:2011 

Grade 1

Professional development 

activities TQ4

E2

How often did you participate in professional 

development activities covering the following topics 

in the last 12 months?

Adapted from 

Reading First 

Impact Study--

Teacher Survey

Response to Intervention-related 

policies and practices TQ8

E3

Have you received support from any of the following 

staff members during the current academic year? ECLS-K:11 Grade 1

Response to Intervention-related 

policies and practices TQ8

Views on School 

Climate and School 

Environment F1

Please indicate the extent to which you agree or 

disagree with each of the following statements 

about your school. ECLS-K School climate TQ4

F2

To what extent do you agree or disagree with the 

following statements? ECLS-K

Teacher’s sense of efficacy; Job 

satisfaction TQ4

F3

To what extent do you agree or disagree with the 

following statements? ECLS-K

Teacher’s sense of efficacy; Job 

satisfaction TQ4

F4

For each of the following statements about 

READING, indicate how strongly you agree or 

disagree.

Adapted from WA 

(RTI) and HB 

2136: Spring 2010

Response to Intervention-related 

policies and practices TQ8

F5

For each of the following statements about MATH, 

indicate how strongly you agree or disagree.

Adapted from WA 

(RTI) and HB 

2136: Spring 2010

Response to Intervention-related 

policies and practices TQ8

Teacher 

Background G1 What is your gender? ECLS-K Teacher demographic information TQ4

G2 In what year were you born? ECLS-K Teacher demographic information TQ4

G3 Are you Hispanic or Latino? ECLS-K Teacher demographic information TQ4

G4 Which best describes your race? ECLS-K Teacher demographic information TQ4

Page 4 of 5
App D Spring 3rd TQA (Class)

44

45

46

47

48

49

50

51

52

A B C D E F

G5

What is the highest level of education you have 

completed? ECLS-K Teacher's education TQ4

G6

Counting this school year, how many years have you 

taught each of the following grades and programs, 

including years in which you taught part time? ECLS-K

Teaching experience, by school and 

grade TQ4

G7

Counting this school year, how many years have you 

been a school teacher, including years in which you 

taught part-time? ECLS-K

Teaching experience, by school and 

grade TQ4

G8

Is this school year the first year you have taught in 

this school? New

Number of years teaching in 

current school TQ4

G9

If you have an associate's or bachelor's degree, 

indicate your undergraduate major field of study. ECLS-K

Teacher's education: major field of 

study TQ4

G10

If you have a graduate degree, indicate the major 

field of study of your highest level graduate degree. ECLS-K

Teacher's education: major field of 

study TQ4

G11

Have you ever taken a college course that addressed 

issues related to the following?

ECLS-K:2011 

Grade 1 Teacher's education: coursework TQ4

G12

Which of the following describes the teaching 

certificate you currently hold in THIS state? ECLS-K Type of teaching certification held TQ4

G13 Date questionnaire completed

Page 5 of 5
Section Item # Item Stem Source Construct

Research 

Question

Reading and Language Arts 

Instruction A1

From the first day of school until today, please indicate how 

many days each of the following READING skills and concepts 

has been covered in your class. Please include the time during 

which you provide direct instruction as well as the time you 

spend supervising students as they work.

ECLS-K, updated to reflect 

"Common Core State 

Standards," 

corestandards.org

Time spent on specific 

activities and skills in 

reading/language arts TQ1

Mathematics Instruction B1

From the first day of school until today, please indicate how 

many days each of the following MATH skills and concepts has 

been covered in your class. Please include the time during 

which you provide direct instruction as well as the time you 

spend supervising students as they work.

ECLS-K, updated to reflect 

"Common Core State 

Standards," 

corestandards.org

Time spent on specific 

activities and skills in 

mathematics TQ1

Science Instruction C1

From the first day of school until today, please indicate how 

often each of the following SCIENCE skills and concepts has 

been covered in your class. Please include the time during 

which you provide direct instruction as well as the time you 

spend supervising students as they work. ECLS-K Skills taught in science TQ1

C2

For this school year as a whole, please indicate if each of the 

following SCIENCE topics or skills is taught in your class either in 

your class in its own unit or lesson or as part of a unit/lesson on 

a different topic.

ECLS-K, updated to reflect 

"Next Generation Science 

Standards," NSTA.org Topics taught in science TQ1

Social Studies Instruction D1

For this school year as a whole, please indicate if each of the 

following SOCIAL STUDIES topics or skills is taught in your class 

either in your class in its own unit or lesson or as part of a 

unit/lesson on a different topic. ECLS-K Topics taught in social studies TQ1

Spring Third-Grade General Classroom Teacher Subject-Level Questionnaire, Appendix D
App D Spring 3rd TQC (Child)

1

2

3

4

5

6

7

8

9

10

11

12

A B C D E F

Section Item # Item Stem Source Construct Research 

Question

Social Skills A1-A26 Items not included due to copyright restrictions (26 items total) SSRS 

Elementary 

Scale A; ECLS-K

Social skills and approaches to learning TQ7

Classroom 

Behaviors 

Questionnaire

B1-B13 Items not included due to copyright restrictions (13 items total) TMCQ Social skills and approaches to learning TQ7

Student-Teacher 

Interactions

C1-C15 Items not included due to copyright restrictions (15 items total) STRS Level of closeness between child and 

teacher; level of conflict between child 

and teacher

TQ6; TQ7

Peer Relationships D1-D9 Items asking how often certain statements related to the child's 

relationships with peers apply to the child. Items not included due 

to copyright restrictions (9 items total)

New. The Child 

Behavior Scale. 

Gary W. Ladd 

(2010)

Peer acceptance/exclusion TQ7

D10 a/b/c/d During this school year, how often have other students...

a. Teased, made fun of, or called this student names?

b. Pushed, shoved, slapped, hit, or kicked this student?

c. Told lies or untrue stories about this student?

d. Intentionally excluded or left this student out from playing with 

them?

Source: Adapted 

from Espelage 

and Holt (2001).

Target of victimization by other students TQ7

D11 a/b/c/d During this school year, how often has this student...

a. Teased, made fun of, or called other students names?

b. Pushed, shoved, slapped, hit, or kicked other students?

c. Told lies or untrue stories about other students?

d. Intentionally excluded or left other students out from playing 

with them?

Source: Adapted 

from Espelage 

and Holt (2001).

Victimization of other students by this 

student

TQ7

Student Information E1 How long has this child been in your classroom this school year? ECLS-K Family mobility TQ3

E2 Please indicate the total number of absences for this child for the 

current school year. 

ECLS-K Attendance TQ3; TQ7

E3 Does this child receive (or has he/she received during this school 

year) instruction in any of the following types of programs in your 

school? 

ECLS-K Receipt of remedial or gifted services TQ3; TQ7

E4 Is English this child's native language? ECLS-K Native language other than English TQ3; TQ7

Spring Third-Grade General Classroom Teacher Child-Level Questionnaire, Appendix D

Page 1 of 3
App D Spring 3rd TQC (Child)

13

14

15

16

17

18

19

20

21

22

23

A B C D E F

E5 Does this child participate in an instructional program designed to 

teach English language skills to children with limited English 

proficiency? 

ECLS-K Receipt of instruction for English 

language learners

TQ3; TQ7

E6 Would you say the instruction this child receives is primarily ... Adapted from 

the "Types of 

language 

instruction 

educational 

programs," 

provided by the 

National 

Clearinghouse 

for English 

Language 

Acquisition.

Receipt of instruction for English 

language learners

TQ3; TQ7

E7 How often does this child usually receive specialized language 

instruction of the following program types?

ECLS-K Receipt of instruction for English 

language learners

TQ3; TQ7

E8 On the days when this child receives specialized language 

instruction, for how much time does he/she receive instruction of 

the following program types?

ECLS-K Receipt of instruction for English 

language learners

TQ3; TQ7

E9 During this school year, how often is this child's academic 

instruction provided in his/her native language?

ECLS-K Receipt of instruction for English 

language learners

TQ3; TQ7

E10 Does this child have an IEP on record with the school? ECLS-K IEP status TQ3; TQ7

E11 Does this child receive instruction in any of the following types of 

programs in your school?

ECLS-K Receipt of special education services TQ3; TQ7

E12 During structured play time, how does this child compare with 

other children in the class in terms of physical activity? 

ECLS-K Comparison to peers: physical activity TQ7

E13 During unstructured play time, how does this child compare with 

other children in the class in terms of physical activity? 

ECLS-K Comparison to peers: physical activity TQ7

E14 Overall, how would you rate this child’s academic skills in each of 

the following areas, based on curriculum standards for his/her 

current grade level? 

ECLS-K Comparison to peers: academic skills for 

current grade level

TQ7

E15 a/b/c/d Items asking how often the child has had problems with four 

behaviors related to working memory over the past 6 months. 

Items not included due to copyright restrictions (4 items total). 

New. BRIEFBehavior Rating 

Inventory of 

Executive 

Function

Working memory (an aspect of executive 

function)

TQ7

Page 2 of 3
App D Spring 3rd TQC (Child)

24

25

26

27

28

29

30

31

A B C D E F

E16 How often does this child work to the best of his/her ability? ECLS-K Working to the best of one's ability TQ7

E17 How many instructional groups based on achievement or ability 

levels in READING do you currently have in this child's class? 

ECLS-K Use of achievement grouping: Reading TQ1; TQ3

E18 In which reading instructional group is this child currently placed? ECLS-K Placement in achievement grouping: 

Reading

TQ7

E19 How many instructional groups based on achievement or ability 

levels in MATHEMATICS do you currently have in this child's class? 

ECLS-K Use of achievement grouping: Math TQ1; TQ3

E20 In which mathematics instructional group is this child currently 

placed? 

ECLS-K Placement in achievement grouping: 

Math

TQ7

E21 How involved at the school would you say this child’s 

parents/guardians are? 

ECLS-K Parent involvement in school activities TQ5

E22 Are you this child's primary teacher in the following subject areas? ECLS-K N/A N/A

E23 Date questionnaire completed

Page 3 of 3
App E Spring 3rd SpEd SPA

1

2

3

4

5

6

7

8

9

10

11

12

13

A B C D E

Item # Item Stem Source Construct

Research 

Question

1 What is your gender? ECLS-K Teacher demographic information SEQ4

2 In what year were you born? ECLS-K Teacher demographic information SEQ4

3 Are you Hispanic or Latino? ECLS-K Teacher demographic information SEQ4

4 Which best describes your race? ECLS-K Teacher demographic information SEQ4

5 What is the highest level of education you have completed? ECLS-K Teacher’s education SEQ4

6 Is this school year the first year you have taught at this school? New

Number of years teaching in 

current school TQ4

7

Counting this school year, how many total years have you been 

working with children receiving special education or related 

services, including years in which you worked part time? ECLS-K

Teaching experience in special 

education SEQ4

8

Counting this school year, how many total years have you been 

working with children in any school, including years in which 

you worked part time? This would include other

assignments such as teaching in a regular classroom or 

otherwise providing services to children. ECLS-K Total years teaching experience SEQ4

9

Which of the following credentials, licenses, or certificates do 

you have for working with children with disabilities? ECLS-K

Teaching certification, credentials, 

and licenses SEQ4

10

Have you taken the exam for National Board for Professional 

Teaching Standards certification? ECLS-K

Teaching certification, credentials, 

and licenses SEQ4

11 Have you ever taken a college course in the following areas? ECLS-K Teacher’s education SEQ4

Spring Third-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix E

Page 1 of 2
App E Spring 3rd SpEd SPA

14

15

16

17

18

19

20

A B C D E

12

Have you ever taken a college course that addressed issues 

related to the following?

ECLSK:2011 

Grade 1 Teacher’s education SEQ4

13

Which of the following best describes your current position in 

this school? ECLS-K Teaching position and assignment SEQ4

14

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? ECLS-K Teaching position and assignment SEQ4

15

During this school year, where have you worked with children 

with IEPs? ECLS-K

Locations in which teacher delivers 

services

SEQ1, SEQ3, 

SEQ5

16

Please indicate the extent to which you agree or disagree with 

each of the following statements. ECLS-K

Teacher’s sense of efficacy; Job 

satisfaction SEQ4

17

During the school year, how many children with IEPs have you 

worked with or provided services for, on average, each week? 

(Include children you work with directly, as well as children for 

whom you consult with the general education teacher and/or 

another special education teacher service provider? ECLS-K Teaching student caseload SEQ4, SEQ5

18 Date Questionnaire Completed

Page 2 of 2
AppE Spring 3rd SpEd SPB (ch

1

2

3

4

5

6

7

8

9

10

11

12

13

14

A B C D E

Item # Item Stem Source Construct

Research 

Question

1

Is this child currently receiving gifted/talented services through 

an IEP, or has the child received such services during this school 

year? ECLS-K

Child's receipt of services: 

gifted/talented SEQ1

2

Is this child currently receiving special education services through 

an IEP due to a disability or has the child received such services 

during this school year? ECLS-K

Child's receipt of services: special 

education SEQ1

3

In what capacity or capacities do you teach or provide services to 

this child? ECLS-K Type of special education services SEQ1

4

When was this child first determined eligible for special 

education or related services? ECLS-K Length of diagnosis and services SEQ7

5

Is this the first school year that the child has been receiving 

special education services? ECLS-K

Age/Grade of first IEP and services for 

child SEQ7

6

When did this child first start receiving special education or 

related services? ECLS-K

Age/Grade of first IEP and services for 

child SEQ7

7

To what extent were you involved in planning the transition from 

last year's special education program to this year's special 

education program for this child? ECLS-K Transition activities SEQ7

8

To what extent did you communicate with the person(s) who 

provided special education for this child last year? ECLS-K Transition activities SEQ1

9

Have you reviewed this child’s records related to special 

education services provided before this school year? ECLS-K Transition activities SEQ1

10

What is this child’s primary disability as identified on the child’s 

IEP? ECLS-K Child’s disability SEQ2

11

During this school year, for which of the following disabilities has 

this child received special education or related services, whether 

for the child’s primary disability or another of his/her disabilities? ECLS-K Child’s disability SEQ2

12

During this school year, has this child received any special 

education or related services because of a diagnosed Attention 

Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder 

(ADHD)? ECLS-K Child's disability SEQ2

Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E

Page 1 of 4
AppE Spring 3rd SpEd SPB (ch

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A B C D E

Item # Item Stem Source Construct

Research 

Question

Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E

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During this school year, which of the following describe(s) the IEP 

goals for this child? ECLS-K IEP goals SEQ5

14

During this school year, which of the following related services 

have been provided through the school to this child? ECLS-K Type of special education services SEQ1, SEQ2

15

During this school year, has this child received any of the 

following? ECLS-K Type of special education services SEQ1, SEQ2

16

During this school year, has this child’s primary placement been a 

general education classroom? ECLS-K Child’s classroom placement SEQ3, SEQ5

17

During this school year, approximately how many hours per 

week of direct special education and related services (that is, 

service provided directly to the child, from a teacher or another 

adult) has this child received? ECLS-K Frequency of special education services SEQ1

18

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? ECLS-K

Frequency of special education services: 

outside general education classroom SEQ1

19

During this school year, what teaching practices and methods 

have you and/or other special education service providers used 

with this child? ECLS-K Teaching methods and materials SEQ1, SEQ2

20

During this school year, which of the following best describes the 

curriculum materials used with this child in the general education 

classroom? ECLS-K Teaching methods and materials SEQ1, SEQ2

21

During this school year, which of the following best describes the 

curriculum materials used with this child in the special education 

classroom/program? ECLS-K Teaching methods and materials SEQ1, SEQ2

22

During this school year, which of the following assistive 

technologies and devices has this child used? ECLS-K

Teaching methods and materials: 

assistive technology SEQ1, SEQ2

Page 2 of 4
AppE Spring 3rd SpEd SPB (ch

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A B C D E

Item # Item Stem Source Construct

Research 

Question

Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E

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26

27

28

29

30

31

32

33

23

Does this child have a computer, laptop, or word processing 

device assigned to him/her for use full time this school year? ECLS-K

Teaching methods and materials: 

assistive technology SEQ2, SEQ5

24

During this school year, on average, how often have you met 

with general education teacher(s) to discuss this child’s program 

or progress? ECLS-K Staff communication SEQ5, SEQ7

25

On average, how long were the meetings with the general 

education teacher(s) to discuss this child’s program or progress? ECLS-K Staff communication SEQ5, SEQ7

26

During this school year, approximately how often have you 

communicated with this child’s parents about this child’s 

program or progress (by phone, in person, or in writing, including 

e-mail)? ECLS-K Parent communication SEQ6

27

During this school year, has this child received formal individual 

evaluations in any of the following areas for purposes of 

developing IEP goals? ECLS-K IEP goal development TQ3, SEQ7

28

To what extent is this child expected to achieve the same general 

education goals as other children at his/her grade level? ECLS-K

Expectation for achievement of general 

education goals TQ3, SEQ5

29

What percentage of this child’s current IEP goals have been met 

or nearly met at this point in the school year? ECLS-K IEP goal achievement SEQ1

30

Which of the following best expresses the likelihood that this 

child will continue to receive some level of special education 

services (through an IEP) in the next school year? ECLS-K IEP goal achievement TQ3, SEQ7

31

During this school year, to what extent has this child participated 

in any grade-level assessment administered as part of the 

school’s testing program? ECLS-K Participation in assessment TQ3, SEQ5

Page 3 of 4
AppE Spring 3rd SpEd SPB (ch

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2

A B C D E

Item # Item Stem Source Construct

Research 

Question

Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E

34

35

36

32

Did this child receive special accommodations to participate in 

the school's regular testing or

assessment program this school year? ECLS-K

Participation in assessment: special 

accommodations TQ3, SEQ5

33 In which grade is this child enrolled? ECLS-K Current grade level N/A

34 Date Questionnaire Completed

Page 4 of 4
App F Spring 3rd School Adm A

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ABCDEF

Section

Item # Item Stem Source ConstructResearch 

Question

School 

Characteristics A1

How many instructional days will this school 

provide during this academic year? ECLS-K Length of school year SAQ1

A2

School enrollment. WRITE IN THE APPROXIMATE 

NUMBER OF CHILDREN FOR EACH OF THE 

FOLLOWING. ECLS-K

Enrollment and 

attendance SAQ2

A3

Approximately, what is the Average Daily 

Attendance for your school this year? ECLS-K

Enrollment and 

attendance SAQ7

A4 Mark all grade levels included in your school. ECLS-K

School type 

(public/private/affiliation

; grades; magnet; etc) SAQ2

A5

Which of the following characterizes your 

school? ECLS-K

School type 

(public/private/affiliation

; grades; magnet; etc) SAQ2

A6

In what year did this school start providing 

instruction as a public CHARTER school? ECLS-K

School type 

(public/private/affiliation

; grades; magnet; etc) SAQ2

A7

Which of the following characterizes your 

public CHARTER school? ECLS-K

School type 

(public/private/affiliation

; grades; magnet; etc) SAQ2

A8

Approximately how many or what percentage of 

the children in your school belongs to each of 

the following racial/ethnic groups? ECLS-K

Student demographic 

information: 

race/ethnicity 

distribution SAQ2

A9

If your school is a private, magnet, or charter 

school, please check here and SKIP TO Q A12.

ECLSK:2011 

Grade 1

School type 

(public/private/affiliation

; grades; magnet; etc) SAQ2

A10

About what percentage of the children enrolled 

in this school attend from outside of this 

school’s assigned attendance area because.... ECLS-K

Student demographic 

information: transfers 

from outside attendance 

area SAQ2

A11

About what percentage of the children enrolled

in this school are eligible for free or reducedprice lunch? ECLS-K 

Student demographic 

information: indicator of 

poverty SAQ2

School 

Facilities and 

Resources B1

In general, how adequate are each of the 

following school facilities for meeting the needs 

of the children in your school? ECLS-K

Adequacy of facilities 

and resources SAQ2

School-FamilyCommunity 

Connections C10

Are any of the following programs or services 

for parents and families available at your school 

site? Please include programs run by the school 

and those run by outside groups. ECLS-K

School-based programs 

or services for parents 

and families SAQ3, SAQ4

C2

Please indicate how often each of the following 

activities is provided by your school. ECLS-K

School-based programs 

or services for parents 

and families SAQ3, SAQ4

C3

Indicate how much you agree or disagree with 

the following statements about the school’s 

community and parents. ECLS-K Parent involvement SAQ3

C4

How much of a problem are the following in the 

neighborhood where this school is located? ECLS-K Neighborhood problems SAQ6

C5

To the best of your knowledge how often do 

the following types of problems occur at your 

school? ECLS-K School safety SAQ7

C6

Does your school take either of the following 

measures to ensure the safety of children? ECLS-K

Measures taken to 

ensure school safety SAQ7

C7

To what extent is each of the following matters 

a problem in this school? Indicate whether each 

is a SERIOUS problem, a MODERATE problem, a 

MINOR problem, or NOT a problem in this 

school. ECLS-K

Enrollment and 

attendance; School 

climate; Teacher mobility SAQ7

C8

During the past year, to what extent did any of 

the following changes occur at your school? ECLS-K

Recent changes at the 

school SAQ2

C9

During the past year, did any of the following 

changes occur at your school? ECLS-K

Recent changes at the 

school SAQ2

School Policies 

and Practices D1

How many second-grade children were retained 

at their current grade level last school year? ECLS-K

Retention policies and 

practices SAQ2

D2

How many third-grade children were retained at 

their current grade level last school year? ECLS-K

Retention policies and 

practices SAQ2

D3

Is a school-wide positive behavioral 

intervention and support program (for example, 

Positive Behavioral Support, Positive Behavioral 

Intervention System) implemented at your 

school?

from FRSS 

99 

Dropout 

Prevention 

Services 

and 

Programs 

survey

Response to 

Intervention-related 

policies and practices SAQ9

D4

For each of the following statements about 

READING and MATH, indicate how strongly you 

agree or disagree.

from WA 

(RTI) and 

HB 2136: 

Spring 

2010

Response to 

Intervention-related 

policies and practices SAQ9

D5

Is Response to Intervention (RtI) currently used 

at your school in third grade, either partially or 

fully implemented?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA)

Response to 

Intervention-related 

policies and practices SAQ9

D6

Is RtI currently implemented at your school in 

third grade in the following areas?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA)

Response to 

Intervention-related 

policies and practices SAQ9

D7

Approximately how many years ago did your 

school begin implemementing RtI in third grade 

in any subject?

ECLSK:2011 

Grade 1

Response to 

Intervention-related 

policies and practices SAQ9

D8

For the 2013-2014 school year, how has your 

school made information available to 

parents/guardians to help them understand 

how RtI is being implemented in your school?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA)

Response to 

Intervention-related 

policies and practices SAQ9

School 

Programs for 

Particular 

Students E1

Do any of the children in this school come from a home where a language other than English is

spoken? ECLS-K

Student demographic 

information: language 

other than English SAQ2

E2

What percentage of children in this school and 

in third grade are English language learners 

(ELL)? ECLS-K

Delivery of instruction to 

English Language 

Learners (ELL) and 

services for language 

minority (LM) families SAQ2

E3

Please indicate what type(s) of specialized 

language instruction is provided to third-grade 

English language learners in your school.

Adapted 

from the 

"Types of 

language 

instruction 

educationa

l 

programs," 

provided 

by the 

Delivery of instruction to 

English Language 

Learners (ELL) and 

services for language 

minority (LM) families SAQ4

E4

Are any of the following services provided to 

families of children from households where a 

language other than English is spoken? ECLS-K

Delivery of instruction to 

English Language 

Learners (ELL) and 

services for language 

minority (LM) families SAQ5

E5

Since the beginning of this school year (2013-

2014), how many students have been NEWLY 

evaluated at your school to determine if they 

are eligible for an IEP?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA) Evaluation for IEP SAQ9

E6

Of those students who have been NEWLY 

evaluated at your school this school year (2013-

2014), how many were found eligible for an IEP, 

including those who may have an IEP for speech 

only?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA)

Special education 

eligibility SAQ9

E7

What method(s) are used in your school to 

determine special education ELIGIBILITY for 

students with learning disabilities?

Adapted 

from IDEA 

national 

Assessmen

t 

Implement

ation Study 

(LEA)

Special education 

eligibility SAQ9

E8

Approximately what percentage of your thirdgraders are in each of the following 

instructional programs? ECLS-K

Delivery of special 

education and related 

services to children with 

disabilities SAQ4

E9

Where are children with Individualized 

Education Programs (IEPs) typically served in 

this school? ECLS-K

Delivery of special 

education and related 

services to children with 

disabilities SAQ4

Federal 

Programs: Title 

I, Adequate 

Yearly 

Progress, and 

Title III F1

Did your school receive Federal Title I funds for 

this school year? ECLS-K

Services and programs: 

Title I SAQ2

F2

Is your school operating a Title I targeted 

assistance or schoolwide program? ECLS-K

Services and programs: 

Title I SAQ4

F3

This school year, did your school use Title I 

funds for any of the following purposes? ECLS-K

Services and programs: 

Title I SAQ2

F4

Did your school receive Federal Title III funds for 

this school year? (Title III is “Language 

Instruction for Limited English Proficient and 

Immigrant Students.”) ECLS-K

Services and programs: 

Title III SAQ2

F5

This school year, did your school use Title III 

funds for any of the following purposes? ECLS-K

Services and programs: 

Title III SAQ4

F6

At the end of the LAST school year (2012-

2013), did this school make Adequate Yearly 

Progress (AYP)? (Adequate Yearly Progress is 

your state’s measure of yearly progress toward 

achieving state academic standards.)

ECLSK:2011 

Grade K, 

from NCLB 

regulations

School status relative to 

Adequate Yearly Progress 

(AYP) SAQ2

F7

At the end of the LAST school year (2013-

2012), was this school identified for 

improvement due to Adequate Yearly Progress 

(AYP) requirements? (A school is identified for 

improvement if it does not make Adequate 

Yearly Progress for two consecutive years or 

more in the same

content area.)

ECLSK:2011 

Grade K, 

from NCLB 

regulations

School status relative to 

Adequate Yearly Progress 

(AYP) SAQ2

F8

Please indicate in PART 1 whether any of the 

following actions have taken place in your 

school in the past three years. For each action 

that you mark as having taken place, please 

indicate in PART 2 whether the action took 

place at your school in response to being 

identified for improvement due to AYP 

requirements.

ECLSK:2011 

Grade K, 

from NCLB 

regulations

School status relative to 

Adequate Yearly Progress 

(AYP) SAQ2

F9 Does this school have grade 3 students? ECLS-K State assessment data SAQ2

F10

Based on recent state assessments, what 

percentage of the grade 3 students in your 

school in the prior school year (2012-2013) 

scored “proficient” or above in the subjects in 

this table? Please also indicate the percentage 

of students scoring proficient or above that 

was needed to meet your AYP (Adequate Yearly 

Progress) goals for that school year. ECLS-K State assessment data SAQ2

Staffing and 

Teacher 

Characteristics G1

Approximately how many staff members does 

your school currently have in the following 

categories? ECLS-K

Total number of full- and 

part-time teachers, 

specialists, nurses, and 

paraprofessionals

SAQ2

G2

Does your school currently have any staff 

members (full- or part-time) in the following 

categories? ECLS-K

Numbers of full- and 

part-time teachers, 

specialists, nurses, and 

paraprofessionals SAQ2

G3

Does your school currently have any staff 

members who do the following as their primary 

role or one of their primary roles?

ECLSK:2011, 

Grade 1

Response to 

Intervention-related 

policies and practices SAQ9

G4

Please indicate the number of regular classroom 

teachers who have joined or left your school 

since October 1, 2013. ECLS-K Teacher mobility SAQ2

G5

Are monetary incentives such as cash bonuses, 

salary increases, or different steps on the salary 

schedule used in your school to reward 

teachers for... a) Improved student 

performance on state tests? b) Reaching target 

goals on state tests? ECLS-K Teacher Incentives SAQ2

G6

If a person other than the school administrator 

has completed the previous sections, please 

write in the name and title of the person who 

completed the majority of the sections. ECLS-K N/A

G7

How long has the individual listed above been 

employed at this school? ECLS-K N/A 

School 

Administrator 

Characteristics H1 What is your gender? ECLS-K

School administrator 

demographic 

information SAQ8

H2 In what year were you born? ECLS-K

School administrator 

demographic 

information SAQ8

H3 Are you Hispanic or Latino? ECLS-K

School administrator 

demographic 

information SAQ8

H4 Which best describes your race? ECLS-K

School administrator 

demographic 

information SAQ8

H5

How many years of experience do you have in 

each of the following positions, including years 

in which you worked part time? ECLS-K

School administrator's 

experience SAQ8

H6

Through which, if any, of the types of training 

programs below did you receive preparation for 

fulfilling your role as a school administrator?

ECLSK:2011, 

Grade K

School administrator's 

formal education and 

training SAQ8

Spring Third-Grade School Administrator Questionnaire, Appendix F

Page 1 of 2
App F Spring 3rd School Adm A

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70

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A B C D E F

H7

What is the highest level of education you have 

completed? ECLS-K

School administrator's 

formal education and 

training SAQ8

H8

What was your major field(s) of study in the 

highest degree you completed? ECLS-K

School administrator's 

formal education and 

training SAQ8

H9

What is your best estimate of the percentage of 

children in your school you know by name? ECLS-K

School administrator’s 

familiarity with students SAQ8

H10

During school hours, do you speak a language 

other than English with students at your school 

whose native language is not English? ECLS-K

School administrator’s 

use of a non-English 

language SAQ8

H11

Do you speak a language other than English 

with students’ families whose native language is 

not English? ECLS-K

School administrator’s 

use of a non-English 

language SAQ8

H12

If you do not speak a language other than 

English with EITHER students OR students’ 

families whose native language is not English, 

mark here and SKIP TO Q H15. ECLS-K

School administrator’s 

use of a non-English 

language SAQ8

H13

What language(s) other than English do you 

speak with students at your school or with their 

families? ECLS-K

School administrator’s 

use of a non-English 

language SAQ8

H14

Date questionnaire completed/Questionnaire 

completed by

Page 2 of 2
App F Spring 3rd School Adm B

1

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5

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7

8

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10

11

12

13

A B C D E F

Section Item # Item Stem Source Construct

Research 

Question

School Characteristics A1

How many instructional days will this school 

provide during this academic year? ECLS-K Length of school year SAQ1

A2

School enrollment. WRITE IN THE APPROXIMATE 

NUMBER OF CHILDREN FOR EACH OF THE 

FOLLOWING. ECLS-K Enrollment and attendance SAQ2

A3

Approximately what is the Average Daily 

Attendance for your school this year? ECLS-K Enrollment and attendance SAQ7

A4

About what percentage of the children enrolled in

this school are eligible for free or reduced-price

lunch? ECLS-K 

Student demographic 

information: indicator of 

poverty SAQ2

School-Family-Community 

Connections B1

Please indicate how often each of the following 

activities is provided by your school. ECLS-K

School-based programs or 

services for parents and 

families SAQ3

B2

Indicate how much you agree or disagree with 

the following statements about the school’s 

community and parents. ECLS-K Parent involvement SAQ3

B3

To the best of your knowledge how often do the 

following types of problems occur at your school? ECLS-K School safety SAQ7

B4

Does your school take any of the following 

measures to ensure the safety of children?

Measures taken to ensure 

school safety SAQ7

B5

To what extent is each of the following matters a 

problem in this school? Indicate whether each is a 

SERIOUS problem, a MODERATE problem, a 

MINOR problem or NOT a problem in this school. ECLS-K

Enrollment and 

attendance; School 

climate; Teacher mobility SAQ7

B6

During the past year, to what extent did any of 

the following changes occur at your school? ECLS-K

Recent changes at the 

school SAQ2

B7

During the past year, did any of the following 

changes occur at your school? ECLS-K

Recent changes at the 

school SAQ2

Spring Third-Grade School Administrator Questionnaire For Continuing Schools, Appendix F

Page 1 of 6
App F Spring 3rd School Adm B

14

15

16

17

18

19

A B C D E F

School Policies and Practices C1

How many second-grade children were retained 

at their current grade level last school year? ECLS-K

Retention policies and 

practices SAQ2

C2

How many third-grade children were retained at 

their current grade level last school year? ECLS-K

Retention policies and 

practices SAQ2

C3

Is a school-wide positive behavioral intervention 

and support program (for example, Positive 

Behavioral Support, Positive Behavioral 

Intervention System) implemented at your 

school?

Adapted from 

FRSS 99 

Dropout 

Prevention 

Services and 

Programs 

survey

Response to Interventionrelated policies and 

practices SAQ9

C4

For each of the following statements about 

READING and MATH, indicate how strongly you 

agree or disagree.

Adapted from 

WA (RTI) and 

HB 2136: 

Spring 2010

Response to Interventionrelated policies and 

practices SAQ9

C5

Is Response to Intervention (RtI) currently used at 

your school in third grade, either partially or fully 

implemented?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA)

Response to Interventionrelated policies and 

practices SAQ9

C6

Is RtI currently implemented at your school in 

third grade in the following areas?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA)

Response to Interventionrelated policies and 

practices SAQ9

Page 2 of 6
App F Spring 3rd School Adm B

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21

22

23

24

25

A B C D E F

C7

Approximately how many years ago did your 

school begin implemementing RtI in third grade in 

any subject? New

Response to Interventionrelated policies and 

practices SAQ9

C8

For the 2013-2014 school year, how has your 

school made information available to 

parents/guardians to help them understand how 

RtI is being implemented in your school?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA)

Response to Interventionrelated policies and 

practices SAQ9

School Programs for 

Particular Populations D1

Do any of the children in this school come from a

home where a language other than English is

spoken? ECLS-K

Student demographic 

information: language 

other than English SAQ2

D2

What percentage of children in this school and in 

third grade are English language learners (ELL)? ECLS-K

Delivery of instruction to 

English Language Learners 

(ELL) and services for 

language minority (LM) 

families SAQ2

Children with Special Needs D3

Since the beginning of this school year (2013-

2014), how many students have been NEWLY 

evaluated at your school to determine if they are 

eligible for an IEP?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA) Evaluation for IEP SAQ9

D4

Of those students who have been NEWLY 

evaluated at your school this school year (2013-

2014), how many were found eligible for an IEP, 

including those who may have an IEP for speech 

only?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA) Special education eligibility SAQ9

Page 3 of 6
App F Spring 3rd School Adm B

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27

28

29

30

31

32

33

34

A B C D E F

D5

What method(s) are used in your school to 

determine special education ELIGIBILITY for 

students with learning disabilities?

Adapted from 

IDEA national 

Assessment 

Implementati

on Study 

(LEA) Special education eligibility SAQ9

D6

Approximately what percentage of your thirdgraders are in each of the following instructional 

programs? ECLS-K

Delivery of special 

education and related 

services to children with 

disabilities SAQ4

Federal Programs: Title I, 

Adequate Yearly Progress, 

and Title III E1

Did your school receive Federal Title I funds for 

this school year? ECLS-K

Services and programs: 

Title I SAQ2

E2

Is your school operating a Title I targeted 

assistance or schoolwide program? ECLS-K

Services and programs: 

Title I SAQ4

Title III Funding and 

Programs E3

Did your school receive Federal Title III funds for 

this school year? (Title III is “Language Instruction 

for Limited English Proficient and Immigrant 

Students.”) ECLS-K

Services and programs: 

Title III SAQ2

Staffing and Teacher 

Characteristics F1

Approximately how many staff members does 

your school currently have in the following 

categories? ECLS-K

Total number of full- and 

part-time teachers, 

specialists, nurses, and 

paraprofessionals SAQ2

F2

Does your school currently have any staff 

members (full- or part-time) in the following 

categories?

Numbers of full- and parttime teachers, specialists, 

nurses, and 

paraprofessionals SAQ2

F3

Does your school currently have any staff 

members who do the following as their primary 

role or one of their primary roles? New

Response to Interventionrelated policies and 

practices SAQ9

F4

Please indicate the number of regular classroom 

teachers who have joined or left your school since 

October 1, 2013. ECLS-K Teacher mobility SAQ2

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App F Spring 3rd School Adm B

35

36

37

38

39

40

41

42

43

A B C D E F

F5

Are monetary incentives such as cash bonuses, 

salary increases, or different steps on the salary 

schedule used in your school to reward teachers 

for... a) Improved student performance on state 

tests? b) Reaching target goals on state tests? ECLS-K Teacher Incentives SAQ2

F6

If a person other than the school administrator 

has completed the previous sections, please write 

in the name and title of the person who 

completed the majority of the sections. ECLS-K N/A (respondent’s name)

F7

How long has the individual listed above been 

employed at this school? ECLS-K N/A 

School Administrator 

Characteristics G1 What is your gender? ECLS-K

School administrator 

demographic information SAQ8

G2 In what year were you born? ECLS-K

School administrator 

demographic information SAQ8

G3 Are you Hispanic or Latino? ECLS-K

School administrator 

demographic information SAQ8

G4 Which best describes your race? ECLS-K

School administrator 

demographic information SAQ8

G5

How many years of experience do you have in 

each of the following positions, including years in 

which you worked part-time)? ECLS-K

School administrator's 

experience SAQ8

G6

Through which, if any, of the types of training 

programs below did you receive preparation for 

fulfilling your role as a school administrator?

ECLS-K:2011, 

Grade K

School administrator's 

formal education and 

training SAQ8

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App F Spring 3rd School Adm B

44

45

46

47

48

49

50

51

A B C D E F

G7

What is the highest level of education you have 

completed? ECLS-K

School administrator's 

formal education and 

training SAQ8

G8

What was your major field(s) of study in the 

highest degree you completed? ECLS-K

School administrator's 

formal education and 

training SAQ8

G9

What is your best estimate of the number of 

children in your school you know by name? ECLS-K

School administrator’s 

familiarity with students SAQ8

G10

During school hours, do you speak a language 

other than English with students at your school 

whose native language is not English? ECLS-K

School administrator’s use 

of a non-English language SAQ8

G11

Do you speak a language other than English with 

students’ families whose native language is not 

English? ECLS-K

School administrator’s use 

of a non-English language SAQ8

G12

If you do not speak a language other than English 

with EITHER students OR students’ families whose 

native language is not English, mark here and 

SKIP TO Q G15. ECLS-K

School administrator’s use 

of a non-English language SAQ8

G13

What language(s) other than English do you 

speak with students at your school or with their 

families? ECLS-K

School administrator’s use 

of a non-English language SAQ8

G14

Date questionnaire completed/Questionnaire 

completed by

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