# APP E N D IX D FOURTH - GRADE SUBJECT - SPECIFIC CHILD - LEVEL TEACHER QUESTIONNAIRES (TQCs)

Ear l y Ch il dho od Long it ud i n al St u d y , K i nd er g a rten Cl a ss o f 2 0 1 0 - 11 (E CL S - K : 2011) 

# Spring Fourth - Grade National Data Collection and Fifth - Grade Recruitment
O M B C le a ra n ce P acka g e #1850 - 0750 v.1 6

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# 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 

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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. Draft

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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, tea cher, 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. Althou gh 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 dotnext 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. Draft

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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

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# PART 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire. Draft

### 8 SECTION A . SOCIAL SKILLS

k. Keeps belongings organized.

n. Show s e agerness to learn new things. o. Works independently. Draft

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

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u. Easi ly adapts to changes in routine.
w. Persists in completing tasks.
x. Pays at tention well. y. Follow s classroom rules.

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

### SECTI ON A
. SOCIAL SKILLS (continued)

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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 Draft

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Sour ce: 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 Draf t

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.

### 12 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 Draft

### 13 Sourc e: Adapted from the Child Behavior Scale © Gary W. Ladd. Used with permission. Draft

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 good Good Average 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 ? Draft

### 15 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 Draft

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

﴾SKIP TO Q D11﴿ Yes 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. Draft

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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 a week Never Draft

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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 Draft

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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. ﴾SKIP TO Q D17﴿ I do not use instructional groups for reading Two Three Four Five or more Draft

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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. Draft

### 22 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 Draft

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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 Draft

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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 Draft

### 25 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 Draft

### 26 Number of children absent on an average day F5. How many children in this class are absent on an average day? W RITE 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. Draft

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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 11‐25% 26‐50% 51‐75% 76‐100% 1‐10% 0%

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. Draft

### 28 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 DraftDraft



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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 a n 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 da ys 1 da y 2 da ys 3 da ys 4 da ys 5 da ys ﴾SKI P TO Q G6﴿ h. DV D player, VCR, or video streaming device ﴾for example, Roku﴿ a. Des ktop 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 Neve r Not ava ilable Rarely Sometimes Often

j. Stud ent response system ﴾for example, clickers, responders, ActiVote, ActivExpression﴿ i. TV

k. Mi crophone or classroom audio sound system ﴾for example, TopCat, Redcat﴿Dra ft



### 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 year Never 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

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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

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H4. Date Questionnaire Completed:



# THANK YOU FOR YOUR COOPERATION! MONTH DAY YEAR



## 2015 Draft

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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. 

### ﴾SKIP TO PART 2, PAGE 9﴿ I do not use instructional groups for mathematics 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? W RITE 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 11‐25% 26‐50% 51‐75% 76‐100% 1‐10% 0%

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 DraftDra ft



### 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﴿Dra ft



### 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 year Never 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 ca n 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 Draft

### 7

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. Draft

### 8

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 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 Draft

### 11

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 Draft

### 12 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 Draft

### 13

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? W RITE 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. 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 11‐25% 26‐50% 51‐75% 76‐100% 1‐10% 0%

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 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 Draft

### 16

Dr aft

D4 . In an average week, how many days a week is science homework assigned in this class? Please co unt 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 de vices for instructional purposes in science? Please include any desktop, laptop, or other co mputer‐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 Ne ver Not available Ra rely So metimes Often

j. St udent response system ﴾for example, clickers, responders, ActiVote, ActivExpression﴿ i. TV

k. Microphone or classroom audio sound system ﴾for example, TopCat, Redcat﴿Dra ft



### 17

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 year Never 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 Draft

### 19 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 Draft

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E4. Date Questionnaire Completed:



# THANK YOU FOR YOUR COOPERATION! MONTH DAY YEAR



## 2015 Draft

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Draft