Explanation

1 2 3 4 5 6 7 8 9 10 11 12 13 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.

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## 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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3 4
5 6 7 8 9 10

11 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 2010-2011on {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**

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22 23 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
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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 youexpect{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 anybehaviorproblems {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 withschool 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 adultsin 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

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36

37 38 39

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 shestilllives in this household. Does {NAME}stilllive in this household? ECLS-K Household roster: current PQ1, PQ3

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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

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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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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 Howold {was/were}{you/{NAME}}when {you/{he/she}}first movedto{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 howmanybooksdoes{CHILD}have inyourhome now, includinglibrary books? Please only include books that are for children. ECLS-K Literacy materials in the home PQ4 HEQ.210 In thepast 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 29App C Spring 3rd Parent Intervi

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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 otherthan 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 pastyear, 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 pastyear, 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 pastyear, 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 pastyear, 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 pastyear, has {CHILD} participated in:] Drama

classes? ECLS-K Child activities outside of school hours PQ4 HEQ350 [Outside of school hours in the pastyear, 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 pastyear, 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 pastyear, has {CHILD} participated in:]

Religious activities or instruction? ECLS-K Child activities outside of school hours PQ4 Page 9 of 29App C Spring 3rd Parent Intervi

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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 aregular basisfrom 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}nowreceiving care from a relative on aregular 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 differentregularcare arrangements do youcurrentlyhave 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 scheduledat least onceeachweek? ECLS-K Time child spends in care arrangements PQ6 CCQ.085 How manydayseachweekdoes {CHILD} receive care from {{his/her}

{RELATIVE}/that relative}? ECLS-K Time child spends in care arrangements PQ6 CCQ.090 How manyhourseachweekdoes {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 forby{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}nowreceiving care in a private home on aregular basisfrom 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 differentregularcare arrangements do youcurrentlyhave with

nonrelatives? NHES ECPP and ECLS-B Participation in nonrelative care PQ6 CCQ.170 {Let'stalkaboutthe nonrelativewho providesthe mostcarefor{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 carethat{CHILD} receivesfrom that person regularlyscheduled at least

onceeachweek? ECLS-K Time child spends in care arrangements PQ6 CCQ.185 How manydayseachweekdoes {CHILD} receive care from that person? ECLS-K Time child spends in care arrangements PQ6 CCQ.190 How manyhourseachweekdoes {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 liketo askyou aboutanycare{CHILD}receivesfrom daycarecenters

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 manydifferentdaycarecenters orbefore-orafter-school care programs

does {CHILD}currentlygo to on aregular 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

eachweek? ECLS-K Time child spends in care arrangements PQ6 CCQ.350 How manydayseachweekdoes {CHILD} go to that program? ECLS-K Time child spends in care arrangements PQ6
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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 Otherthan regularschool hours, how many hours each weekdoes {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 hourseachweekdoes {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 aregular basisbefore or after school? ECLS-K Time child spends in selfcare PQ6 CCQ.377 How manyhoursperweekdoes {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 Non Resident 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 Page 12 of 29App C Spring 3rd Parent Intervi

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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

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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}’stelevision viewing. We

want you to include television shows, videos, or DVDs watched on a TV, computer, or handheld device like an iPad or cellphone; butnotgames 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
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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 considerall 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 heartbeatfor20continuous 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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149

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}

comparestootherchildrenofthesameage. {CHILD}isindependentandtakes 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 toadults...

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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157 158 159

160

161 162 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, somethingelseorwas 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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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 Forthe next question, please base your answer on how {CHILD} compares to

otherchildren ofthesameage. Does{CHILD}pronouncewords,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 hearingaid orotherassistive 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 personwhispersto {him/her} from across a quiet room. ECLS-K Hearing ability PQ1, PQ2

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

If{CHILD} has a hearingaid orotherassistive 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 persontalks in a normal voiceto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability PQ1, PQ2

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

If{CHILD} has a hearingaid orotherassistive device, please consider{his/her} hearing withoutthe hearing aid or assistive device.] {CHILD} can usually hear and understand what a person says without seeing his or her face if that personshoutsto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability PQ1, PQ2

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

If{CHILD} has a hearingaid orotherassistive 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 personspeaks loudlyinto {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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177 178 179 180 181 182 183 184

185 A B C D E F CHQ.222 Which best describes {CHILD}'s hearing in {his/her}worseear? 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 of2012 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 Howoldwas{CHILD}whenthefirstdiagnosisofa problem relatedto{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 usuallyhear and understandwhat a person says without seeing his or her face if that person whispersto {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 ifthat person talks in a normal voiceto {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 ifthat person shoutsto {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 usuallyhear and understandwhat a person says without seeing his or her face if that person speaks loudlyinto {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 ifthat person whispersto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2

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200

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 ifthat person talks in a normal voiceto {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 ifthat person shoutsto {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 ifthat person speaks loudlyinto {his/her} {better} ear. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2
CHQ.285 Now I wantto askyou about {CHILD}’s vision. Without the use ofeyeglasses

orcontact lenses, does{CHILD}havedifficultyseeingobjects inthedistanceor 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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212 213

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 orcontacts help{him/her}seethings upclose, seethings

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 Duringthis school year, has {CHILD} received therapyservices ortaken 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 programthis 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 Well Being 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 Page 24 of 29App C Spring 3rd Parent Intervi

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238

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 thatoftentrue,sometimestrue, ornever 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 thatoftentrue,sometimestrue, ornever 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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246 247 248

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, militaryReserves,orNational Guard? Activedutydoes 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 {Areyou/Is{NAME}}currentlyon activedutyinthe 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

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253 254

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

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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

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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 leftthe classsincethe beginningofthe 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 Atthis point in the school year, howwould 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 childrenwhose native language is one other than Englishand 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 Howoftendoes 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 failurein 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 haveother 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 hasthis 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 Howoftendoes 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'sacademic instructionprovided 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 Duringstructured 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 Duringunstructured 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 manytotalyears 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 manytotalyears 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, eachweek? (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’sprimarydisability 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

1 2 A B C D E **Item # Item Stem**  **Source Construct**  **Research Question**  **Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E**
15 16 17 18
19

20 21 22 23 24 13 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 manyhours per weekof 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 followingbestdescribes the curriculum materials used with this child in thegeneral education classroom? ECLS-K Teaching methods and materials SEQ1, SEQ2 21 During this school year, which of the followingbestdescribes the curriculum materials used with this child in thespecial 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

1 2 A B C D E **Item # Item Stem**  **Source Construct**  **Research Question**  **Spring Third-Grade Special Education Teacher Child-Level Questionnaire, Appendix E**

25 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

1 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 4App F Spring 3rd School Adm A

1 2 3 4 5
6
7
8
9
10
11
12 13 14

15
16 17 18 19 20

21 22 23 24 25

26

27

28

29 30

31
32

33

34

35

36

37

38
39
40

41 42 43
44 45

46

47

48 49

50

51
52 53 54

55

56 57 58 59 60 61
62
63 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 theAverage 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 fromoutsideof this school’s assigned attendance area because.... ECLS-K Student demographic information:transfers from outside attendance area SAQ2 A11 About whatpercentage ofthe 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-Family Community**  **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 yourschool? ECLS-K Recent changes at the school SAQ2 C9 During the past year, did any of the following changes occur at yourschool? ECLS-K Recent changes at the school SAQ2 **School Policies and Practices**  D1 How manysecond-grade childrenwere retained at their current grade level last school year? ECLS-K Retention policies and practices SAQ2 D2 How manythird-grade childrenwere 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 inthird 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 inthird 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 inthird gradeare 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 tothird-grade English language learnersin 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 beenNEWLY 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 yourthirdgradersare 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 schoolin 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 2App F Spring 3rd School Adm A

64 65 66
67 68
69 70 71 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 andSKIP 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

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### App F Spring 3rd School Adm B

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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 theAverage Daily Attendancefor your school this year? ECLS-K Enrollment and attendance SAQ7 A4 Aboutwhatpercentageofthechildren 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 yourschool? ECLS-K Recent changes at the school SAQ2 B7 During the past year, did any of the following changes occur at yourschool? ECLS-K Recent changes at the school SAQ2 **Spring Third-Grade School Administrator Questionnaire For Continuing Schools, Appendix F**

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### App F Spring 3rd School Adm B

14 15

16

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19 A B C D E F **School Policies and Practices** C1 How manysecond-grade childrenwere retained at their current grade level last school year? ECLS-K Retention policies and practices SAQ2 C2 How manythird-grade childrenwere 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 inthird 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 gradein 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 inthird gradein 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 anyofthe children in this school comefrom 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 gradeare 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 yourthirdgradersare 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 Page 4 of 6

### App F Spring 3rd School Adm B

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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 Page 5 of 6

### App F Spring 3rd School Adm B

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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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