APPENDIX D

FOURTH-GRADE

SUBJECT-SPECIFIC CHILD-LEVELTEACHER 

QUESTIONNAIRES (TQCs)

Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 

(ECLS-K:2011)

Spring Fourth-Grade National Data Collection

and Fifth-Grade Recruitment

OMB Clearance Package

#1850-0750 v.16
1

Spring 2015

Reading and Language Arts

Teacher Questionnaire

Child Level

Rockville, Maryland

Use a black or blue ball point pen to complete this questionnaire.

National Center for Education Statistics by:

Prepared for the U.S. Department of Education

Westat

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED

TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR

OR AN ECLS‐K:2011 STAFF MEMBER. DO NOT MAIL THIS

QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY

STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

S_ID T_ID

C_ID

T

C

According to the Paperwork Reduction Act of 1995, no persons are required 

to respond to a collection of information unless it displays a valid OMB 

control number. The valid OMB control number for this voluntary survey is 

1850‐XXXX. Approval expires XX/XX/XXXX. The time required to complete this 

survey is estimated to average 26 minutes per response, including the time to 

review instructions, search existing data resources, gather the data needed, 

and complete and review the survey. If you have any comments concerning 

the accuracy of the time estimate or suggestions for improving this survey, or 

any comments or concerns regarding the status of your individual submission 

of this survey, please write to: Early Childhood Longitudinal Study, National 

Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006‐

5574.

The collection of information in this survey is authorized by 20 U.S. 

Code, Section 9543. Participation is voluntary. You may skip questions 

you do not wish to answer; however, we hope that you will answer as 

many questions as you can. Your responses are protected from 

disclosure by federal statute ﴾20 U.S. Code, Section 9573﴿. 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. Data will be combined to produce statistical reports. 

No individual data that links your name, address, telephone number, 

or identification number with your responses will be included in the 

statistical reports. 

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Dear Teacher, 

This questionnaire is an important part of a major longitudinal study of children’s early educational 

experiences beginning with kindergarten and continuing through grade 5. You have received this 

questionnaire because you teach reading and language arts to one or more of the children who are 

participants in this study. 

The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011) is 

collecting information from teachers of children who are in the study to investigate the relationship 

between children’s academic progress and various school, classroom, teacher, and home characteristics. 

Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you 

do not want to answer. However, only you can provide this information. Although we realize you are very 

busy, we urge you to complete this questionnaire as completely and accurately as possible. The 

information you provide is being collected for research purposes only and will be protected from 

disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 

9573).  Information from multiple individuals will be combined to produce statistical reports; no information 

that identifies you will be included in any reports or provided to students, their parents, or other school 

staff. 

This questionnaire has two parts: 

 Part 1 should be completed for the child whose name is on the cover of this questionnaire. 

  Part 2 has questions about your reading and language arts class – you only need to fill out Part 2 

if there is a red dot next to the child’s name on the cover of the questionnaire. 

The instructions preceding each part of the questionnaire will guide you. 

Please record your answers directly on the questionnaire by marking the appropriate answer (as 

instructed on page 5) or by writing your responses in the space provided. Your best estimates are 

acceptable answers. 

DEFINITIONS 

For the purposes of this study, the following definitions apply: 

 Individualized Education Program (IEP): A written statement of the educational program 

designed to meet the individual needs of a school-aged child with a disability that is judged to 

affect the child’s educational performance.  Children who receive special education services 

under the Individuals with Disabilities Act (IDEA) are expected to have an IEP. 

 English language learner (ELL): A student whose native language is one other than English and 

whose skills in listening, speaking, reading, or writing English are such that he or she has 

difficulty understanding school instruction in English. 

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Programs that focus on developing students' literacy solely in English

Programs that focus on developing students' literacy in two languages

THANK YOU VERY MUCH FOR YOUR HELP.

Sheltered English instruction or content-based English as a Second Language (ESL) program: The goal of

these programs is to develop proficiency in English while learning content in an all-English setting.

Students from various linguistic and cultural backgrounds can be in the same class. Instruction is adapted 

to students' proficiency in English and is supported by visual aids and support in the students' home 

languages as available. Fully developed prototypes of this program include Sheltered Instruction

Observational Protocol (SIOP) and Specially Designed Academic Instruction in English (SDAIE).

Structured English Immersion (SEI): The goal of SEI is to develop fluency in English. This program usually

serves only English language learners. All instruction is in English, though the instruction is adjusted to the

English proficiency level of students so subject matter is comprehensible. Teachers may have some

receptive skills in the students' home language(s) and generally use sheltered instructional techniques.

Pull-out English as a Second Language (ESL) or English Language Development (ELD): The goal of

these programs is to develop fluency in English. ELL students leave their mainstream classroom for part

of the day to receive ESL instruction, which generally focuses on grammar, vocabulary, and

communication skills, not academic content. There typically is no support provided for students' home

languages.

Push-in English as a Second Language (ESL) program: The goal of push-in ESL is to develop fluency in

English. Students receive ESL instruction in a mainstream classroom, with instruction in English with some

native language support if needed. The ESL teacher or an instructional aide provides clarification,

translation if needed, and uses ESL strategies.

TYPES OF LANGUAGE INSTRUCTION EDUCATIONAL PROGRAMS (LIEPS)1

Heritage language program or indigenous language program: The goal of these programs is to develop

literacy in two languages. Content is taught in both languages by teachers fluent in both languages.

These programs typically target non-English speakers with weak literacy skills in their home language.

Transitional program, early exit bilingual program, or early exit transitional program: The goal of these

programs is to develop English proficiency skills as soon as possible, without delaying learning of

academic core content. Instruction begins in students' home language but rapidly moves to English.

Students typically are transitioned into mainstream classrooms with their English-speaking peers as soon

as possible.

Developmental bilingual program, late exit transitional program, or maintenance bilingual education

program: The goal of these programs is to develop some skills and proficiency in students' home language

and strong skills and proficiency in English. Content is taught in both languages by teachers fluent in both

languages. These programs may also be called dual language programs. Instruction at lower grades is in

the students' home language with a gradual transition to English. Students typically transition into

mainstream classrooms with their English-speaking peers. The programs can vary in the focus placed on

acquiring literacy in students' home language, but students generally do continue to receive some degree

of support in their home language after the transition to English classrooms.

Two-way immersion program (TWI) or two-way bilingual program: The goal of these programs is to

develop strong skills and proficiency in both students' home language and English. These programs may

also be called dual language programs. These programs include students whose native language is not

English (but who all speak the same non-English language) and students whose native language is English.

Instruction is provided in both languages, typically starting with a smaller proportion of instruction in

English, and gradually moving to half of the instruction in each language. Students typically stay in these

programs throughout elementary school.

National Clearinghouse for English Language Acquisition. (n.d.). Types of language instruction educational programs (LIEPs).

Retrieved [January 6, 2012] from http://www.ncela.gwu.edu/files/uploads/5/Language_Instruction_Educational_Programs.pdf.

1

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PART 1:

Please answer the questions in Part 1 about the child identified on the

cover of this questionnaire.

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SECTION A. SOCIAL SKILLS

k. Keeps belongings organized.

n. Shows eagerness to learn new things.

o. Works independently.

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Social Skills

Twenty-six items ask teachers to rate children in their classroom on social skills (including their ability to 

exercise self-control, interact with others, resolve conflict, and participate in group activities); problem 

behaviors (e.g., fighting, bullying, arguing, anger, depression, low self-esteem, impulsiveness, etc.); and 

learning dispositions or “approaches to learning” (e.g., curiosity, selfdirection, and inventiveness). The 

social skills items and the problem behavior items are not listed as they are copyright protected. The 

learning disposition items are not copyright protected and are listed below.

Source: Social Skills Rating System (SSRS). Copyright © 1990 NCS Pearson. Adapted with permission. All rights reserved.

Approaches to Learning Scale items

The teacher indicated how frequently the child exhibited the following behaviors. The response scale 

included four points ranging from “never” to “very often,” and there was also a “no opportunity to observe” 

option.

• Keeps belongings organized

• Shows eagerness to learn new things

• Works independently

• Easily adapts to changes in routine

• Follows classroom rules

• Persists in completing tasks

• Pays attention well
9

u. Easily adapts to changes in routine.

w. Persists in completing tasks.

x. Pays attention well.

y. Follows classroom rules.

Source: Social Skills Rating System (SSRS). Copyright © 1990, NCS Pearson. Adapted with permission. All rights reserved.

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SECTION A. SOCIAL SKILLS (continued)
10

A2. Please indicate how often each of these items applies to the child identified on the cover of this

questionnaire. MARK ONE RESPONSE ON EACH ROW.

d. Likes being in school

a. Likes to come to school

b. Dislikes school

c. Has fun at school

e. Seems unhappy in school

f. Enjoys most classroom activities

g. Groans or complains about suggested activities

Source: Teacher version of the School Liking and Avoidance Questionnaire ﴾SLAQ; Adapted from Ladd & Price, 1987; Ladd, 1990﴿

Doesn't apply

Seldom displays

this behavior

Sometimes applies

Occasionally displays

this behavior

Certainly applies

Often displays

this behavior

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Source: Adapted from the Temperament in Middle Childhood Questionnaire. © 2004 Jennifer Simonds and Mary K. Rothbart, University of

Oregon. Used with permission.

SECTION B. CLASSROOM BEHAVIORS

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Classroom Behaviors

Thirteen items adapted from the Temperament in Middle Childhood Questionnaire ask teachers to assess 

the attentional focusing and inhibitory control of the children in their classroom. The items are not listed as 

they are copyright protected.
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SECTION C. PEER RELATIONSHIPS

Please answer the following questions about the child identified on the cover of this questionnaire.

C1. For the items below, please think about the friends with whom the child identified on the cover of 

this questionnaire has associated the most during the past month or two. Please indicate how

true you think each of these items is for this group of children. If you cannot answer these items

because the child has not usually associated with a group of other children in the past month or

two, then mark "Not applicable." MARK ONE RESPONSE ON EACH ROW.

Source: Vandell, Deborah Lowe ﴾2001﴿. Relationships With Peers: Part D (Teacher). Unpublished scale, NICHD Study of Early Child Care and

Youth Development, Form FLV18G3.

a. This is a good group of kids

c. Some of these kids are a bad

influence

on this child

b. I worry when this child is with this

group

of kids

d. These kids must be closely supervised

by an adult

e. These kids get into trouble

f. These kids are excellent students

g. These kids are hard workers

i. Most of these kids are kind to other

children

h. This child has a fun time with this

group

of children

Almost

always

untrue

Almost

always

true

Usually

true

Not

applicable

Sometimes

true,

sometimes

untrue

Usually

untrue

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 Source: Adapted from the Child Behavior Scale © Gary W. Ladd. Used with permission.

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Peer Relationships

Nine items from the Child Behavior Scale that ask teachers to assess the child’s relationships to his or her 

peers. The items are not listed as they are copyright protected.
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C3. During this school year, how often have other students ... MARK ONE RESPONSE ON EACH ROW.

d. Intentionally excluded or left this

student out from playing with

them?

c. Pushed, shoved, slapped, hit, or

kicked this student?

a. Teased, made fun of, or called

this student names?

Never Rarely Sometimes Often Very often

b. Told lies or untrue stories about

this student?

C5. Thinking about the child identified on the cover of this questionnaire compared to a typical

child in his/her grade, please evaluate this child in the following areas. MARK ONE RESPONSE ON

EACH ROW.

Very

poor

Very

Average Good good

Somewhat

poor

a. Understands others' feelings

b. Accurately interprets what a peer is

trying to do

c. Generates good quality solutions to

interpersonal problems

d. Is aware of the effects of his/her

behavior on others

Source: Pierce, K. M., Hamm, J. V., & Vandell, D. L. ﴾1999﴿. Experiences in after‐school programs and children's adjustment in

first‐grade classrooms. Child Development, 70, 756‐767.

Source: Espelage, D. L. & Holt, M. ﴾2001﴿. Bullying and peer victimization during early adolescence: Peer influences and

psychosocial correlates. Journal of Emotional Abuse, 2, 123‐142. Adapted and used with permission.

C4. During this school year, how often has this student ... MARK ONE RESPONSE ON EACH ROW.

d. Intentionally excluded or left other

students out from playing with him

or her?

c. Pushed, shoved, slapped, hit, or

kicked other students?

a. Teased, made fun of, or called

other students names?

Never Rarely Sometimes Often Very often

b. Told lies or untrue stories about

other students?

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SECTION D. STUDENT INFORMATION

Please answer the following questions about the child identified on the cover of this questionnaire..

D1. Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON EACH

ROW.

a. Reading/language arts 

b. Mathematics

c. Science 

d. Social studies

D3. Please indicate the total number of times this child has been absent from your reading/language

arts class during the current school year. MARK ONE RESPONSE.

No absences

1 to 4 absences

5 to 7 absences

8 to 10 absences

11 to 19 absences

20 or more absences

Yes No

D4. 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? MARK YES OR NO ON EACH ROW.

a. Individual tutoring or remedial program in reading/language arts

b. Gifted and talented program in reading/language arts

c. Gifted and talented program with no specific content focus

Yes No

D2. How long has this child been in your reading/language arts class this school year until now? MARK

ONE RESPONSE.

Entire school year until now

More than one semester but less than the entire school year until now

More than one quarter but less than one semester

Less than one quarter of the school year

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D5. Is English this child's native language? MARK ONE RESPONSE.

Yes ﴾SKIP TO Q D11﴿

No

Don't know

D6. Does this child participate in an instructional program designed to teach English language skills

to children with limited English proficiency? MARK ONE RESPONSE.

Yes

No ﴾SKIP TO Q D11﴿

Programs that focus on developing students' literacy in two languages. For example:

Programs that focus on developing students' literacy solely in English. For example:

 Two‐way immersion program or two‐way bilingual program







Transitional program, early exit bilingual program, or early exit transitional program

Developmental bilingual program, late exit transitional program, or

maintenance bilingual education program

Heritage language program or indigenous language program

Sheltered English instruction or content‐based English as a Second

Language ﴾ESL﴿ program



No specialized language program is provided to this child. ﴾SKIP TO Q D10﴿

Other program﴾s﴿ (PLEASE SPECIFY)

 Structured English Immersion ﴾SEI﴿

 Pull‐out English as a Second Language ﴾ESL﴿ or English Language Development ﴾ELD﴿

 Push‐in ESL program

D7. Would you say the instruction this child receives is primarily... MARK ONE RESPONSE.

EXAMPLES OF THE PROGRAMS INCLUDED IN EACH CATEGORY ARE PROVIDED BELOW. 

SEE PAGE 4 FOR DEFINITIONS OF THESE EXAMPLES.

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D10. During this school year, how often is this child's reading instruction provided in his/her native 

language? MARK ONE RESPONSE.

None of the time

Less than half of the time

Half of the time

More than half of the time

Almost all the time

D9. On the days when this child receives specialized language instruction, for how much time does he/she

receive instruction of the following program types? MARK ONE RESPONSE ON EACH ROW.

3 hours

or more

a. Program that focuses on

developing students'

literacy in two languages

b. Program that focuses on

developing students'

literacy solely in English

c. Other program

 Not

applicable/

never

2 1⁄2 to

less

than 3

hours

2 to less

than 2 1⁄2

hours

1 1⁄2 to

less

than 2

hours

1 to less

than 1 1⁄2

hours

1⁄2 hour

to less

than 1

hour

Less

than 1⁄2

hour

D8. How often does this child usually receive specialized language instruction of the following program

types? MARK ONE RESPONSE ON EACH ROW.

a. Program that focuses on

developing students' literacy in

two languages

b. Program that focuses on

developing students' literacy

solely in English

c. Other program

4 days

 a week

3 days

a week

2 days

a week

1 day

a week

5 days

a week

Less

than

once

Never a week

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D13. 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? MARK ONE RESPONSE ON EACH ROW.

b. Writing

a. Reading

c. Oral language

d. Social studies

Below

grade level

About on

grade level

Above

grade level

D12. Does this child receive instruction in any of the following types of programs in your school? MARK

YES OR NO ON EACH ROW.

a. Speech‐language therapy for children with speech or language

disorders/impairments

b. Special education services, not including speech therapy, whether 

provided in the classroom or in a pull‐out setting

Yes No

D14. How often does this child work to the best of her/his ability in READING AND LANGUAGE ARTS?

MARK ONE RESPONSE.

Never

Seldom

Usually

Always

D11. Does this child have an IEP on record with the school? MARK ONE RESPONSE.

Yes

No

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D16. In which reading instructional group is this child currently placed? USE "1" FOR THE HIGHEST 

INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL GROUP BELOW.

Instructional Group

D17. How involved at the school would you say this child's parents/guardians are? MARK ONE 

RESPONSE.

Not involved at all

Somewhat involved

Very involved

Don't know

If there is a red dot next to the child's name on the cover of this questionnaire, please continue

with Part 2.

If there is no red dot next to the child's name on the cover, skip to question H4 on page 33.

D15. How many instructional groups based on achievement or ability levels in READING do you currently

have in this child's class? MARK ONE RESPONSE.

I do not use instructional groups for reading ﴾SKIP TO Q D17﴿

Two

Three

Four

Five or more

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PART 2:

To be completed only if there is a red dot next to the child's name on the cover

of this questionnaire.

If there is no red dot next to the child's name on the cover, skip to question H4 on page 33.

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SECTION E. READING AND LANGUAGE ARTS INSTRUCTION

Please answer the following questions for the reading class in which the child identified on the cover of this

questionnaire receives reading and language arts instruction.

E1. From the first day of school until today, please indicate on how many days you have covered each of

the following READING AND LANGUAGE ARTS skills and concepts in this child's class. Please include

the time during which you provide direct instruction as well as the time you spend supervising

students as they work.

Please focus on the skill areas that are shown in bold text. ﴾The unbolded examples are only a sample

of things you may do or cover under this skill area.﴿ MARK ONE RESPONSE ON EACH ROW.

d.

e.

f. Integrating knowledge and ideas, for

example, interpreting how charts, graphs, or

timelines relate to the text; integrating information

from two texts on the same topic; etc.

Understanding craft and structure, for example,

describing the chronology of events in a text;

recognizing cause and effect; comparing different

accounts of the same event or topic; etc.

Understanding key ideas and details, for

example, identifying important details; drawing

inferences from details in the text; explaining

events, procedures or concepts in the text; etc.

Informational Text

On

41‐80

days

On

21‐40

days

On

11‐20

days

On

1‐10

days

On more

than 80

days

Not yet

taught

or not

taught

in this

grade

a.

b.

c. Integrating knowledge and ideas, for example,

making connections between text and a visual

or oral presentation of the text; comparing

treatment of similar themes in stories and

myths; etc.

Understanding craft and structure, for

example, explaining major differences between

poems, plays, and prose; comparing the point

of view from which different stories are

narrated; etc.

Understanding key ideas and details, for

example, identifying the main idea or theme;

summarizing; describing characters and

settings; etc.

Literature

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E1. ﴾continued﴿ From the first day of school until today, please indicate on how many days you have

covered each of the following READING AND LANGUAGE ARTS skills and concepts in this child's

class. Please include the time during which you provide direct instruction as well as the time you

spend supervising students as they work.

Please focus on the skill areas that are shown in bold text. ﴾The unbolded examples are only a sample

of things you may do or cover under this skill area.﴿ MARK ONE RESPONSE ON EACH ROW.

On

41‐80

days

On

21‐40

days

On

11‐20

days

On

1‐10

days

On more

than 80

days

Not yet

taught

or not

taught

in this

grade Writing and Language

g. Writing narratives, opinion pieces, and

informational text with facts and details

h.

i. Building vocabulary, for example, studying

words and their meanings in text; learning

about roots, prefixes, and suffixes; using context

clues to derive meaning; etc.

Developing and strengthening writing by

planning, drafting, revising, and editing

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E2. How often do the children in this class engage in the following reading and language arts activities?

MARK ONE RESPONSE ON EACH ROW.

a. Read silently

b. Read books they have chosen themselves

c. Talk with others about what they have read

d. Do a group activity or project about what they

have read

f. Look up vocabulary words and write

definitions

h. When given specific questions, write responses

that are at least 3 to 4 sentences long

i. Gather evidence from literary or informational

texts ﴾in books and/or digital sources﴿ to inform

their writing

j. Spend extended time writing and revising text

that they have written

e. Discuss different interpretations of what they

have read

g. Demonstrate understanding of words by relating

them to their opposites ﴾antonyms﴿ and to words

with similar meanings ﴾synonyms﴿

k. Edit their classmates' writing

Almost

every

day

Once or

twice a

week

Once or

twice a

month

Less than

once a

month or

never

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SECTION F. CLASSROOM AND STUDENT CHARACTERISTICS

Please answer the following questions for the reading class in which the child identified on the cover of

this questionnaire receives reading and language arts instruction.

F3. How many of the children in this class are repeating their grade this year? WRITE NUMBER IN BOX.

IF NONE, WRITE "0."

Number of children repeating their grade

F1. As of today's date, how many children ...

WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN IN A PARTICULAR CATEGORY, WRITE "0."

a. Are currently enrolled in this class?

c. Are girls?

b. Are boys?

Number of

children

F2. What grade levels are included in this class? MARK ALL THAT APPLY.

a. 2nd grade or lower

b. 3rd grade

c. 4th grade

d. 5th grade

e. 6th grade or higher

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Number of children absent on an average day

F5. How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

F4. How many children in this class ...

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

a. Are classified as Gifted and Talented?

b. Are participating in a Gifted and Talented program?

Number of

children

a. English reading skills?

b. Social studies?

I do not teach

this subject

About on

grade level

Above

grade level

F6. How many children in this class are below grade level, about on grade level, or above grade level

in their English reading skills and in social studies?

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

Below

grade level

F7. At this point in the school year, how would you rate the behavior of the children in this class?

MARK ONE RESPONSE.

Group misbehaves very frequently and is almost always difficult to handle.

Group misbehaves frequently and is often difficult to handle.

Group misbehaves occasionally.

Group behaves well.

Group behaves exceptionally well.

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F11. How many English language learners ﴾ELLs﴿ do you have in this class? WRITE NUMBER IN BOX. IF

NONE, WRITE "0."

Number of ELL children

F10. Do you have any children who are English language learners in this class? ﴾English language

learners are children whose native language is one other than English and whose skills in

listening, speaking, reading, or writing English are such that they have difficulty understanding

school instruction in English.﴿ MARK ONE RESPONSE.

Yes

No ﴾SKIP TO Q G1﴿

F9. How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

Number of children

a. Have difficulty paying attention in class

b.Lack self‐control ﴾disruptive behavior﴿

c. Are rejected by peers

d. Do not accept authority

0% 1‐10% 11‐25% 26‐50% 51‐75% 76‐100%

Source: Abry, T., Swanson, J., and Fabes, R. A. ﴾2012﴿. The Classroom Environment Student Difficulties Scale. Arizona State University,

Unpublished measure. Adapted with permission.

F8. Approximately what percentage of the students in this class demonstrate the following problems?

MARK ONE RESPONSE ON EACH ROW.

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SECTION G. CLASSROOM INSTRUCTION AND EVALUATION

Please answer the following questions for the reading class in which the child identified on the cover of

this questionnaire receives reading and language arts instruction.

G1. In a typical day, how much time do children in this reading and language arts class spend in the

following activities? MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS

BREAKS.

a. Working independently

b. Working on individual tasks under

teacher direction

c. Working with peers under teacher

direction

d. Working in small groups with

teacher

e. Teacher lecture with large group

and/or large group discussion led

by teacher

G2. Do any of the following staff members provide direct instruction to students in this reading and

language arts class who are struggling or at risk of failure in reading? INCLUDE STAFF OTHER

THAN YOURSELF WHO PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL‐OUT

SETTING. EXCLUDE PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.

a. A READING specialist/interventionist who has specialized 

training in reading instruction

b. A special education teacher

Yes No

No

time

1‐15

minutes

16‐30

minutes

31‐45

minutes

Longer

than 45

minutes

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29

G3. In this class, how frequently do you or your students use computers or the following electronic

devices for instructional purposes in reading and language arts? Please include any desktop,

laptop, or other computer‐type devices. MARK ONE RESPONSE ON EACH ROW.

G4. In an average week, how many days a week is reading and language arts homework assigned in

this class? Please count homework assigned over the weekend as one day. MARK ONE RESPONSE.

0 days

1 day

2 days

3 days

4 days

5 days

﴾SKIP TO Q G6﴿

h. DVD player, VCR, or video

streaming device ﴾for example,

Roku﴿

a. Desktop or laptop computer or

other computer‐type device ﴾for

example, iPad/other tablet,

eReader such as Kindle or Nook﴿

b.Cell phone/smartphone ﴾for

example, iPhone﴿

c. Interactive whiteboard ﴾for

example, SMART Board,

Activboard﴿

d. Document camera or document

projector ﴾for example, ELMO,

HoverCam﴿

e. LCD or DLP projector

f. Digital camera ﴾still or video﴿

g. CD player, MP3 player/iPod,

cassette/tape player

Never

Not

available Rarely Sometimes Often

j. Student response system ﴾for

example, clickers, responders,

ActiVote, ActivExpression﴿

i. TV

k. Microphone or classroom audio

sound system ﴾for example,

TopCat, Redcat﴿
Draft

30

1 to 10 minutes

11 to 20 minutes

21 to 30 minutes

More than 30 minutes

G5. On days when homework is assigned, how much time do you expect children in this class to spend

on homework in reading and language arts? MARK ONE RESPONSE.

G6. In this class, how often do you use a formal assessment in READING for the following purposes? 

MARK ONE RESPONSE ON EACH ROW.

3 to 4

times a

year

 2 times

a year

Once a

Never year

5 to 8

times a

year

1 to 2

times a

month

1 to 2

times a

week

b. To monitor each student's

progress on specific skills

over the school year

a. To evaluate how well each

student is responding to the

core curriculum provided in

the general education

classroom

c. To identify the deficits in

specific skills of struggling

students

d. To monitor the progress of

students who fall below

benchmark levels

e. To determine whether

students need placement in a

more or less intensive level of

instruction
31

Please answer the following question about the school's practices regarding reading and language arts.

G7. For each of the following statements about READING, indicate how strongly you agree or disagree.

MARK ONE RESPONSE ON EACH ROW.

a. This school has a set of clear,

predetermined, grade‐level

benchmarks ﴾that is, cut

scores, goals/targets, or

percentiles﴿ that are used to

determine which students are

struggling or at risk of failure in

reading in fourth grade.

b. This school has clear, 

predetermined criteria for 

determining the level of

intervention fourth‐grade

students will receive in reading.

c. This school has clear, 

predetermined criteria for 

determining when fourth‐

grade students no longer

need a reading intervention.

Don't

know

Strongly

disagree Disagree

Neither

agree nor

disagree Agree

Strongly

agree

Draft
32

SECTION H. STAFF ACTIVITIES

* Professional development may include continuing formal education; courses, conferences,

 workshops, or in‐service training; staff meetings that include staff development activities; and

 receiving coaching or mentoring.

H1. Did you participate in any professional development* within the last 12 months? MARK ONE

RESPONSE.

Yes

No ﴾SKIP TO Q H3﴿

H2. How often did you participate in professional development activities covering the following topics

in the last 12 months? MARK ONE RESPONSE ON EACH ROW.

a. How to use assessment data to identify

students who are struggling or at risk of

failure in READING

Never Once 2 times

3 to 4

times

More

than 4

times

b. How to use and apply assessment data

to guide READING instruction

c. How to implement the READING

curriculum

H3. Have you received support from any of the following staff members during the current academic

year? MARK ONE RESPONSE ON EACH ROW. IF THE RESOURCE IS NOT AVAILABLE TO YOU, MARK THE

LAST COLUMN.

Yes,

support

received

No, support

not received

but

available

Resource

not

available

a. A school or district staff member whose role is to

provide ongoing training and support to classroom

teachers in the delivery of effective READING

instruction

c. A school or district staff member who supports

teachers in collecting, organizing, and managing

assessment data

b. A school or district staff member who provides

ongoing training and support to classroom teachers

in the delivery of effective behavioral supports

d. A school or district staff member who supports

teachers in the interpretation and use of assessment

data to guide instruction

Draft
33

H4. Date Questionnaire Completed:

THANK YOU FOR YOUR COOPERATION!

MONTH DAY YEAR

2015

Draft
34

Draft
35

For Office Use Only

Comp

Ref

Draft
36

Draft
1

Rockville, Maryland

Use a black or blue ball point pen to complete this questionnaire.

National Center for Education Statistics by:

Prepared for the U.S. Department of Education

Westat

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED

TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR

OR AN ECLS‐K:2011 STAFF MEMBER. DO NOT MAIL THIS

QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY

STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

Spring 2015

Mathematics

Teacher Questionnaire

Child Level

S_ID T_ID

C_ID

T

C

According to the Paperwork Reduction Act of 1995, no persons are required 

to respond to a collection of information unless it displays a valid OMB 

control number. The valid OMB control number for this voluntary survey is 

1850‐XXXX. Approval expires XX/XX/XXXX. The time required to complete this 

survey is estimated to average 13 minutes per response, including the time to 

review instructions, search existing data resources, gather the data needed, 

and complete and review the survey. If you have any comments concerning 

the accuracy of the time estimate or suggestions for improving this survey, or 

any comments or concerns regarding the status of your individual submission 

of this survey, please write to: Early Childhood Longitudinal Study, National 

Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006‐

5574.

The collection of information in this survey is authorized by 20 U.S. 

Code, Section 9543. Participation is voluntary. You may skip questions 

you do not wish to answer; however, we hope that you will answer as 

many questions as you can. Your responses are protected from 

disclosure by federal statute ﴾20 U.S. Code, Section 9573﴿. 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. Data will be combined to produce statistical reports. 

No individual data that links your name, address, telephone number, 

or identification number with your responses will be included in the 

statistical reports. 

Draft
2

Draft
3

Dear Teacher, 

This questionnaire is an important part of a major longitudinal study of children’s early educational 

experiences beginning with kindergarten and continuing through grade 5. You have received this 

questionnaire because you teach mathematics to one or more of the children who are participants in this 

study. 

The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K: 2011) is 

collecting information from teachers of children who are in the study to investigate the relationship 

between children’s academic progress and various school, classroom, teacher, and home characteristics.  

Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you 

do not want to answer. However, only you can provide this information. Although we realize you are very 

busy, we urge you to complete this questionnaire as completely and accurately as possible. The 

information you provide is being collected for research purposes only and will be protected from 

disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 

9573).  Information from multiple individuals will be combined to produce statistical reports; no information 

that identifies you will be included in any reports or provided to students, their parents, or other school 

staff. 

This questionnaire has two parts: 

 Part 1 should be completed for the child whose name is on the cover of this questionnaire. 

  Part 2 has questions about your mathematics class – you only need to fill out Part 2 if there is a 

red dot next to the child’s name on the cover of the questionnaire. 

The instructions preceding each part of the questionnaire will guide you. 

Please record your answers directly on the questionnaire by marking the appropriate answer (as 

instructed on page 4) or by writing your responses in the space provided. Your best estimates are 

acceptable answers. 

THANK YOU VERY MUCH FOR YOUR HELP.

Draft
4

Draft
5

PART 1:

Please answer the questions in Part 1 about the child identified on the

cover of this questionnaire.

Draft
6

A4. 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? MARK YES OR NO ON EACH ROW.

SECTION A. STUDENT INFORMATION

Please answer the following questions about the child identified on the cover of this questionnaire.

A3. Please indicate the total number of times this child has been absent from your math class during

the current school year. MARK ONE RESPONSE.

No absences

1 to 4 absences

5 to 7 absences

8 to 10 absences

11 to 19 absences

20 or more absences

A1. Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON EACH

ROW.

a. Reading/language arts 

b. Mathematics

c. Science 

d. Social studies

Yes No

Yes No

a. Individual tutoring or remedial program in mathematics

b. Gifted and talented program in mathematics

A2. How long has this child been in your math class this school year until now? MARK ONE RESPONSE.

Entire school year until now

More than one semester but less than the entire school year until now

More than one quarter but less than one semester

Less than one quarter of the school year

Draft
7

A7. Overall, how would you rate this child's academic skills in math, based on curriculum standards for

his/her current grade level? MARK ONE RESPONSE.

Below grade level

About on grade level

Above grade level

A9. How many instructional groups based on achievement or ability levels in MATHEMATICS do

you currently have in this child's class? MARK ONE RESPONSE.

I do not use instructional groups for mathematics ﴾SKIP TO PART 2, PAGE 9﴿

Two

Three

Four

Five or more

A6. During this school year, how often is this child's math instruction provided in his/her native

language? MARK ONE RESPONSE.

None of the time

Less than half of the time

Half of the time

More than half of the time

Almost all the time

A8. How often does this child work to the best of her/his ability in MATH? MARK ONE RESPONSE.

Never

Seldom

Usually

Always

A5. Is English this child's native language? MARK ONE RESPONSE.

Yes

No

Don't know

﴾SKIP TO Q A7﴿

Draft
8

A10. In which mathematics instructional group is this child currently placed? USE "1" FOR THE HIGHEST

INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL GROUP BELOW.

Instructional Group

If there is a red dot next to the child's name on the cover of this questionnaire, please

continue with Part 2.

If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

Draft
9

PART 2:

To be completed only if there is a red dot next to the child's name on the cover

of this questionnaire.

If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

Draft
10

Please answer the following questions for the math class in which the child on the cover of this questionnaire

receives math instruction.

Using operations to solve problems, for example,

solving problems by multiplying or dividing

two whole numbers; solving multiple‐step word

problems that use several different operations;

interpreting remainders; finding factor pairs; etc.

Using algebraic thinking, for example, solving word

problems by representing the problem as an

equation with a symbol for the unknown number; etc.

Understanding place value, for example, reading and

writing multi‐digit whole numbers; comparing two

numbers based on meanings of the digits in each place;

using understanding of place value to round whole

numbers to any place; etc.

Adding and subtracting multiple‐digit numbers using

strategies based on place value and properties of

operations

Understanding fractions, for example, comparing

fractions with different numerators or

denominators; adding and subtracting fractions;

multiplying fractions by whole numbers;

understanding the relationship between decimals and

fractions; etc.

Solving problems involving measurement, for example,

solving problems involving measures of distance,

time, volume, or money; understanding the relative size of

units of measurement; finding the area or perimeter of

rectangles; etc.

Representing and interpreting data, for example, making

line plots or other visuals to display fractions of a unit;

using addition and subtraction of fractions to answer

questions about a line plot; etc.

Drawing and identifying lines and angles, for example,

drawing points, lines, line segments, rays, angles, and

perpendicular and parallel lines; recognizing

right triangles; understanding lines of symmetry; etc.

B1. From the first day of school until today, please indicate on how many days you have covered each of

the following MATHEMATICS skills and concepts in this child's class. Please include the time during

which you provide direct instruction as well as the time you spend supervising students as they work.

Please focus on the skill areas that are shown in bold text. ﴾The unbolded examples are only a sample

of things you may do or cover under this skill area.﴿ MARK ONE RESPONSE ON EACH ROW.

a.

b.

c.

d.

e.

f.

g.

h.

On more

than 80

days

On

41‐80

days

On

21‐40

days

On

11‐20

days

On

1‐10

days

Not yet

taught

or not

taught

in this

grade

SECTION B. MATHEMATICS INSTRUCTION

Draft
11

B2. How often do the children in this class engage in the following mathematics activities? MARK ONE

RESPONSE ON EACH ROW.

a. Solve mathematics problems from textbooks or

worksheets

b. Solve mathematics problems from the

blackboard, whiteboard/SMART Board®, or

projector

c. Solve mathematics problems in small groups or

with a partner

d. Work with measuring instruments ﴾for example,

rulers, compasses, protractors﴿

h. Write a few sentences about how to solve a

mathematics problem

e. Work with manipulatives ﴾for example, geometric

shapes, fraction bars﴿

f. Use a calculator

g. Take mathematics tests/quizzes

i. Discuss solutions to mathematics problems with

other students

k. Use a computer for math ﴾beyond using a

computer's calculator﴿

j. Work on and discuss mathematics problems that

reflect real‐life situations

l. Create or interpret visual representations ﴾for

example, diagrams, graphs, tables, models﴿

Almost

every

day

Once or

twice a

week

Once or

twice a

month

Less than

once a

month or

never

Draft
12

SECTION C. CLASSROOM AND STUDENT CHARACTERISTICS

Please answer the following questions for the math class in which the child identified on the cover of this

questionnaire receives math instruction.

C1. As of today's date, how many children ...

WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN IN A PARTICULAR CATEGORY, WRITE "0."

a. Are currently enrolled in this class?

c. Are girls?

b. Are boys?

Number of

children

C2. What grade levels are included in this class? MARK ALL THAT APPLY.

a. 2nd grade or lower

b. 3rd grade

c. 4th grade

d. 5th grade

e. 6th grade or higher

C3. How many of the children in this class are repeating their grade this year? WRITE NUMBER IN BOX.

IF NONE, WRITE "0."

Number of children repeating their grade

Draft
13

C6. How many children in this class are below grade level, about on grade level, or above grade level

in mathematics skills?

C4. How many children in this class ...

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

a. Are classified as Gifted and Talented?

b. Are participating in a Gifted and Talented program?

Number of

children

Number of children absent on an average day

C5. How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

Number of children below grade level

Number of children about on grade level

Number of children above grade level

C7. At this point in the school year, how would you rate the behavior of the children in this class?

MARK ONE RESPONSE.

Group misbehaves very frequently and is almost always difficult to handle.

Group misbehaves frequently and is often difficult to handle.

Group misbehaves occasionally.

Group behaves well.

Group behaves exceptionally well.

Draft
14

C11. How many English language learners ﴾ELLs﴿ do you have in this class? WRITE NUMBER IN BOX. IF

NONE, WRITE "0."

Number of ELL children

C10. Do you have any children who are English language learners in this class? ﴾English language

learners are children whose native language is one other than English and whose skills in

listening, speaking, reading, or writing English are such that they have difficulty understanding

school instruction in English.﴿ MARK ONE RESPONSE.

Yes

No ﴾SKIP TO Q D1﴿

C9. How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

Number of children

C8. Approximately what percentage of the students in this class demonstrate the following problems?

MARK ONE RESPONSE ON EACH ROW.

a. Have difficulty paying attention in class

b.Lack self‐control ﴾disruptive behavior﴿

c. Are rejected by peers

d. Do not accept authority

0% 1‐10% 11‐25% 26‐50% 51‐75% 76‐100%

Source: Abry, T., Swanson, J., and Fabes, R. A. ﴾2012﴿. The Classroom Environment Student Difficulties Scale. Arizona State University,

Unpublished measure. Adapted with permission.

Draft
15

a. Working independently

b. Working on individual tasks under

teacher direction

c. Working with peers under teacher

direction

d. Working in small groups with

teacher

e. Teacher lecture with large group

and/or large group discussion led

by teacher

No

time

1‐15

minutes

16‐30

minutes

31‐45

minutes

Longer

than 45

minutes

Please answer the following questions for the math class in which the child identified on the cover of this

questionnaire receives math instruction.

D1. In a typical day, how much time do children in this math class spend in the following activities?

MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.

D2. Do any of the following staff members provide direct instruction to students in this math class

who are struggling or at risk of failure in math? INCLUDE STAFF OTHER THAN YOURSELF WHO 

PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL‐OUT SETTING. EXCLUDE

PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.

SECTION D. CLASSROOM INSTRUCTION AND EVALUATION

a. A math specialist/interventionist who has specialized 

training in MATH instruction

b. A special education teacher

Yes No

Draft
Draft

16

D3. In this class, how frequently do you or your students use computers or the following electronic

devices for instructional purposes in math? Please include any desktop, laptop, or other 

computer‐type devices. MARK ONE RESPONSE ON EACH ROW.

D4. In an average week, how many days a week is math homework assigned in this math class? Please 

count homework assigned over the weekend as one day. MARK ONE RESPONSE.

0 days

1 day

2 days

3 days

4 days

5 days

﴾SKIP TO Q D6﴿

h. DVD player, VCR, or video

streaming device ﴾for example,

Roku﴿

a. Desktop or laptop computer or

other computer‐type device ﴾for

example, iPad/other tablet,

eReader such as Kindle or Nook﴿

b.Cell phone/smartphone ﴾for

example, iPhone﴿

c. Interactive whiteboard ﴾for

example, SMART Board,

Activboard﴿

d. Document camera or document

projector ﴾for example, ELMO,

HoverCam﴿

e. LCD or DLP projector

f. Digital camera ﴾still or video﴿

g. CD player, MP3 player/iPod,

cassette/tape player

Never

Not

available Rarely Sometimes Often

j. Student response system ﴾for

example, clickers, responders,

ActiVote, ActivExpression﴿

i. TV

k. Microphone or classroom audio

sound system ﴾for example,

TopCat, Redcat﴿
Draft

17

1 to 10 minutes

11 to 20 minutes

21 to 30 minutes

More than 30 minutes

D5. On days when homework is assigned, how much time do you expect children in this class to spend

on homework in math? MARK ONE RESPONSE.

D6. In this class, how often do you use a formal assessment in MATH for the following purposes? 

MARK ONE RESPONSE ON EACH ROW.

3 to 4

times a

year

 2 times

a year

Once a

Never year

5 to 8

times a

year

1 to 2

times a

month

1 to 2

times a

week

b. To monitor each student's

progress on specific skills

over the school year

a. To evaluate how well each

student is responding to the

core curriculum provided in

the general education

classroom

c. To identify the deficits in

specific skills of struggling

students

d. To monitor the progress of

students who fall below

benchmark levels

e. To determine whether

students need placement in a

more or less intensive level of

instruction
18

Please answer the following question about the school's practices regarding math.

D7. For each of the following statements about MATH indicate how strongly you agree or disagree.

MARK ONE RESPONSE ON EACH ROW.

a. This school has a set of clear,

predetermined, grade‐level

benchmarks ﴾that is, cut

scores, goals/targets, or

percentiles﴿ that are used to

determine which students are

struggling or at risk of failure in

math in fourth grade.

b. This school has clear, 

predetermined criteria for 

determining the level of

intervention fourth‐grade

students will receive in math.

c. This school has clear, 

predetermined criteria for 

determining when fourth‐

grade students no longer

need a math intervention.

Don't

know

Strongly

disagree Disagree

Neither

agree nor

disagree Agree

Strongly

agree

Draft
19

b.

SECTION E. STAFF ACTIVITIES

* Professional development may include continuing formal education; courses, conferences,

 workshops, or in‐service training; staff meetings that include staff development activities; and

 receiving coaching or mentoring.

E1. Did you participate in any professional development* within the last 12 months? MARK ONE

RESPONSE.

Yes

No ﴾SKIP TO Q E3﴿

E2. How often did you participate in professional development activities covering the following topics

in the last 12 months? MARK ONE RESPONSE ON EACH ROW.

a. How to use assessment data to identify 

students who are struggling or at risk of 

failure in MATH

Never Once 2 times

3 to 4

times

More

than 4

times

b. How to use and apply assessment data

to guide MATH instruction

c. How to implement the MATH

curriculum

E3. Have you received support from any of the following staff members during the current academic

year? MARK ONE RESPONSE ON EACH ROW. IF THE RESOURCE IS NOT AVAILABLE TO YOU, MARK THE

LAST COLUMN.

Yes,

support

received

No, support

not received

but

available

Resource

not

available

a. A school or district staff member whose role is to 

provide ongoing training and support to classroom 

teachers in the delivery of effective MATH

instruction

c. A school or district staff member who supports

teachers in collecting, organizing, and managing

assessment data

data

b. A school or district staff member who provides 

ongoing training and support to classroom teachers 

in the delivery of effective behavioral supports

d. A school or district staff member who supports

teachers in the interpretation and use of assessment

data to guide instruction

Draft
20

E4. Date Questionnaire Completed:

THANK YOU FOR YOUR COOPERATION!

MONTH DAY YEAR

2015

Draft
21

Draft
22

Draft
23

For Office Use Only

Comp

Ref

Draft
24

Draft
1

Rockville, Maryland

Use a black or blue ball point pen to complete this questionnaire.

National Center for Education Statistics by:

Prepared for the U.S. Department of Education

Westat

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED

TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR

OR AN ECLS‐K:2011 STAFF MEMBER. DO NOT MAIL THIS

QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY

STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

Spring 2015

Science

Teacher Questionnaire

Child Level

S_ID T_ID

C_ID

T

C

According to the Paperwork Reduction Act of 1995, no persons are required 

to respond to a collection of information unless it displays a valid OMB 

control number. The valid OMB control number for this voluntary survey is 

1850‐XXXX. Approval expires XX/XX/XXXX. The time required to complete this 

survey is estimated to average 12 minutes per response, including the time to 

review instructions, search existing data resources, gather the data needed, 

and complete and review the survey. If you have any comments concerning 

the accuracy of the time estimate or suggestions for improving this survey, or 

any comments or concerns regarding the status of your individual submission 

of this survey, please write to: Early Childhood Longitudinal Study, National 

Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 20006‐

5574.

The collection of information in this survey is authorized by 20 U.S. 

Code, Section 9543. Participation is voluntary. You may skip questions 

you do not wish to answer; however, we hope that you will answer as 

many questions as you can. Your responses are protected from 

disclosure by federal statute ﴾20 U.S. Code, Section 9573﴿. 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. Data will be combined to produce statistical reports. 

No individual data that links your name, address, telephone number, 

or identification number with your responses will be included in the 

statistical reports. 

Draft
2

Draft
3

Dear Teacher, 

This questionnaire is an important part of a major longitudinal study of children’s early educational 

experiences beginning with kindergarten and continuing through grade 5. You have received this 

questionnaire because you teach science to one or more of the children who are participants in this 

study. 

The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K: 2011) is 

collecting information from teachers of children who are in the study to investigate the relationship 

between children’s academic progress and various school, classroom, teacher, and home characteristics.  

Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you 

do not want to answer. However, only you can provide this information. Although we realize you are very 

busy, we urge you to complete this questionnaire as completely and accurately as possible. The 

information you provide is being collected for research purposes only and will be protected from 

disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. § 

9573).  Information from multiple individuals will be combined to produce statistical reports; no information 

that identifies you will be included in any reports or provided to students, their parents, or other school 

staff. 

This questionnaire has two parts: 

 Part 1 should be completed for the child whose name is on the cover of this questionnaire. 

  Part 2 has questions about your science class – you only need to fill out Part 2 if there is a red 

dot next to the child’s name on the cover of the questionnaire. 

The instructions preceding each part of the questionnaire will guide you. 

Please record your answers directly on the questionnaire by marking the appropriate answer (as 

instructed on page 4) or by writing your responses in the space provided. Your best estimates are 

acceptable answers. 

THANK YOU VERY MUCH FOR YOUR HELP.

Draft
4

Draft
5

PART 1:

Please answer the questions in Part 1 about the child identified on the

cover of this questionnaire.

Draft
6

SECTION A. STUDENT INFORMATION

Please answer the following questions about the child identified on the cover of this questionnaire.

A4. Is English this child's native language? MARK ONE RESPONSE.

Yes

No

Don't know

﴾SKIP TO Q A6﴿

A2. How long has this child been in your science class this school year until now? MARK ONE RESPONSE.

Entire school year until now

More than one semester but less than the entire school year until now

More than one quarter but less than one semester

Less than one quarter of the school year

A3. Please indicate the total number of times this child has been absent from your science class during

the current school year. MARK ONE RESPONSE.

No absences

1 to 4 absences

5 to 7 absences

8 to 10 absences

11 to 19 absences

20 or more absences

A1. Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON EACH

ROW.

a. Reading/language arts 

b. Mathematics

c. Science 

d. Social studies

Yes No

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A7. How often does this child work to the best of her/his ability in SCIENCE? MARK ONE RESPONSE.

Never

Seldom

Usually

Always

A5. During this school year, how often is this child's science instruction provided in his/her native

language? MARK ONE RESPONSE.

None of the time

Less than half of the time

Half of the time

More than half of the time

Almost all the time

A6. Overall, how would you rate this child's academic skills in SCIENCE, based on curriculum standards

for his/her current grade level? MARK ONE RESPONSE.

Below grade level

About on grade level

Above grade level

If there is a red dot next to the child's name on the cover of this questionnaire, please

continue with Part 2.

If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

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PART 2:

To be completed only if there is a red dot next to the child's name on the cover

of this questionnaire.

If there is no red dot next to the child's name on the cover, skip to question E4 on page 20.

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Please answer the following questions for the science class in which the child identified on the cover of this

questionnaire receives science instruction.

SECTION B. SCIENCE INSTRUCTION

B1. From the first day of school until today, please indicate on how many days you have covered each of

the following SCIENCE skills and concepts in this child's class. Please include the time during which

you provide direct instruction as well as the time you spend supervising students as they work.

Please focus on the skill areas that are shown in bold text. ﴾The unbolded examples are only a sample

of things you may do or cover under this skill area.﴿ MARK ONE RESPONSE ON EACH ROW.

Science, Engineering and Technology

Interdependence of science, technology and

engineering, for example, exploring how

scientific discoveries lead to the development

of new technologies, new technologies lead to

new scientific discoveries, etc.

Engineering concepts, for example, identifying

a simple design problem that can be solved

through the development of an object, tool,

process, or system; etc.

g.

h.

Observations and hypotheses, for example,

understanding the difference between

observations and inferences, formulating

predictions that can be tested, etc.

Scientific testing, for example, planning and

conducting investigations, measuring using

appropriate tools, demonstrating safe behavior, etc.

Analysis and conclusions, for example,

analyzing the results of a scientific

investigation and determining whether the

results support the initial prediction, etc.

d.

e.

f.

Scientific Method

Physical science, for example, understanding

electricity, magnetism, energy, waves, chemistry,

etc.

Life science, for example, learning about

organisms, life cycles, food chains,

ecosystems, etc.

Earth science, for example, learning about

rocks and minerals, weather, erosion, water,

volcanoes, earthquakes, etc.

a.

b.

c.

Fields of Science

On

41‐80

days

On

21‐40

days

On

11‐20

days

On

1‐10

days

On more

than 80

days

Not yet

taught

or not

taught

in this

grade

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B2. How often do the children in this class engage in the following science activities? MARK ONE

RESPONSE ON EACH ROW.

a. Read a science textbook

Almost

every

day

Once or

twice a

week

Once or

twice a

month

Less than

once a

month or

never

b. Discuss science in the news

d. Work with other children on a science activity or 

project

e. Use science equipment ﴾e.g., magnifying glass, 

scales, thermometers﴿

g. Engage in hands‐on activities or investigations 

in science

i. Take a science test or quiz

j. Use library resources for science

k. Use computers for science

c. Generate and test hypotheses

f. Prepare a written science report

h. Talk about measurements and results from 

children’s hands‐on activities

l. Use the Internet for science

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SECTION C. CLASSROOM AND STUDENT CHARACTERISTICS

Please answer the following questions for the science class in which the child identified on the cover of

this questionnaire receives science instruction.

C1. As of today's date, how many children ...

WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN IN A PARTICULAR CATEGORY, WRITE "0."

a. Are currently enrolled in this class?

c. Are girls?

b. Are boys?

Number of

children

C2. What grade levels are included in this class? MARK ALL THAT APPLY.

a. 2nd grade or lower

b. 3rd grade

c. 4th grade

d. 5th grade

e. 6th grade or higher

C3. How many of the children in this class are repeating their grade this year? WRITE NUMBER IN BOX.

IF NONE, WRITE "0."

Number of children repeating their grade

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C4. How many children in this class ...

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

a. Are classified as Gifted and Talented?

b. Are participating in a Gifted and Talented program?

Number of

children

Number of children absent on an average day

C5. How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

C6. How many children in this class are below grade level, about on grade level, or above grade level

in science?

WRITE NUMBER IN BOX. IF NONE, WRITE "0."

Number of children below grade level

Number of children about on grade level

Number of children above grade level

C7. At this point in the school year, how would you rate the behavior of the children in this class?

MARK ONE RESPONSE.

Group misbehaves very frequently and is almost always difficult to handle.

Group misbehaves frequently and is often difficult to handle.

Group misbehaves occasionally.

Group behaves well.

Group behaves exceptionally well.

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C11. How many English language learners ﴾ELLs﴿ do you have in this class? WRITE NUMBER IN BOX. IF

NONE, WRITE "0."

Number of ELL children

C10. Do you have any children who are English language learners in this class? ﴾English language

learners are children whose native language is one other than English and whose skills in

listening, speaking, reading, or writing English are such that they have difficulty understanding

school instruction in English.﴿ MARK ONE RESPONSE.

Yes

No ﴾SKIP TO Q D1﴿

C9. How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF NONE,

WRITE "0."

Number of children

C8. Approximately what percentage of the students in this class demonstrate the following problems?

MARK ONE RESPONSE ON EACH ROW.

a. Have difficulty paying attention in class

b.Lack self‐control ﴾disruptive behavior﴿

c. Are rejected by peers

d. Do not accept authority

0% 1‐10% 11‐25% 26‐50% 51‐75% 76‐100%

Source: Abry, T., Swanson, J., and Fabes, R. A. ﴾2012﴿. The Classroom Environment Student Difficulties Scale. Arizona State University,

Unpublished measure. Adapted with permission.

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SECTION D. CLASSROOM INSTRUCTION AND EVALUATION

Please answer the following questions for the science class in which the child identified on the cover of this

questionnaire receives science instruction.

D2. Do any of the following staff members provide direct instruction to students in this science class

who are struggling or at risk of failure in science? INCLUDE STAFF OTHER THAN YOURSELF WHO

PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL‐OUT SETTING. EXCLUDE

PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.

a. A SCIENCE specialist/interventionist who has specialized 

training in science instruction

b. A special education teacher

Yes No

D1. In a typical day, how much time do children in this science class spend in the following activities?

MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.

a. Working independently

b. Working on individual tasks under

teacher direction

c. Working with peers under teacher

direction

d. Working in small groups with

teacher

e. Teacher lecture with large group

and/or large group discussion led

by teacher

No

time

1‐15

minutes

16‐30

minutes

31‐45

minutes

Longer

than 45

minutes

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D4. In an average week, how many days a week is science homework assigned in this class? Please

count homework assigned over the weekend as one day. MARK ONE RESPONSE.

0 days

1 day

2 days

3 days

4 days

5 days

﴾SKIP TO Q D6﴿

D3. In this class, how frequently do you or your students use computers or the following electronic

devices for instructional purposes in science? Please include any desktop, laptop, or other 

computer‐type devices. MARK ONE RESPONSE ON EACH ROW.

h. DVD player, VCR, or video

streaming device ﴾for example,

Roku﴿

a. Desktop or laptop computer or

other computer‐type device ﴾for

example, iPad/other tablet,

eReader such as Kindle or Nook﴿

b.Cell phone/smartphone ﴾for

example, iPhone﴿

c. Interactive whiteboard ﴾for

example, SMART Board,

Activboard﴿

d. Document camera or document

projector ﴾for example, ELMO,

HoverCam﴿

e. LCD or DLP projector

f. Digital camera ﴾still or video﴿

g. CD player, MP3 player/iPod,

cassette/tape player

Never

Not

available Rarely Sometimes Often

j. Student response system ﴾for

example, clickers, responders,

ActiVote, ActivExpression﴿

i. TV

k. Microphone or classroom audio

sound system ﴾for example,

TopCat, Redcat﴿
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D6. In this class, how often do you use a formal assessment in SCIENCE for the following purposes? 

MARK ONE RESPONSE ON EACH ROW.

3 to 4

times a

year

 2 times

a year

Once a

Never year

5 to 8

times a

year

1 to 2

times a

month

1 to 2

times a

week

b. To monitor each student's

progress on specific skills

over the school year

a. To evaluate how well each

student is responding to the

core curriculum provided in

the general education

classroom

c. To identify the deficits in

specific skills of struggling

students

d. To monitor the progress of

students who fall below

benchmark levels

e. To determine whether

students need placement in a

more or less intensive level of

instruction

1 to 10 minutes

11 to 20 minutes

21 to 30 minutes

More than 30 minutes

D5. On days when homework is assigned, how much time do you expect children in this class to spend

on homework in science? MARK ONE RESPONSE.
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Please answer the following question about the school's practices regarding science.

D7. For each of the following statements about SCIENCE indicate how strongly you agree or disagree.

MARK ONE RESPONSE ON EACH ROW.

a. This school has a set of clear,

predetermined, grade‐level

benchmarks ﴾that is, cut

scores, goals/targets, or

percentiles﴿ that are used to

determine which students are

struggling or at risk of failure in

science in fourth grade.

b. This school has clear, 

predetermined criteria for 

determining the level of

intervention fourth‐grade

students will receive in science.

c. This school has clear, 

predetermined criteria for 

determining when fourth‐

grade students no longer

need a science intervention.

Don't

know

Strongly

disagree Disagree

Neither

agree nor

disagree Agree

Strongly

agree

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SECTION E. STAFF ACTIVITIES

* Professional development may include continuing formal education; courses, conferences,

 workshops, or in‐service training; staff meetings that include staff development activities; and

 receiving coaching or mentoring.

E1. Did you participate in any professional development* within the last 12 months? MARK ONE

RESPONSE.

Yes

No ﴾SKIP TO Q E3﴿

E2. How often did you participate in professional development activities covering the following topics

in the last 12 months? MARK ONE RESPONSE ON EACH ROW.

a. How to use assessment data to identify 

students who are struggling or at risk of 

failure in SCIENCE

Never Once 2 times

3 to 4

times

More

than 4

times

b. How to use and apply assessment data

to guide SCIENCE instruction

c. How to implement the SCIENCE

curriculum

E3. Have you received support from any of the following staff members during the current academic

year? MARK ONE RESPONSE ON EACH ROW. IF THE RESOURCE IS NOT AVAILABLE TO YOU, MARK THE

LAST COLUMN.

Yes,

support

received

No, support

not received

but

available

Resource

not

available

a. A school or district staff member whose role is to 

provide ongoing training and support to classroom 

teachers in the delivery of effective SCIENCE 

instruction

c. A school or district staff member who supports

teachers in collecting, organizing, and managing

assessment data

b. A school or district staff member who provides 

ongoing training and support to classroom teachers 

in the delivery of effective behavioral supports

d. A school or district staff member who supports

teachers in the interpretation and use of assessment

data to guide instruction

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E4. Date Questionnaire Completed:

THANK YOU FOR YOUR COOPERATION!

MONTH DAY YEAR

2015

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