APPENDIX A

TEACHER ASSIGNMENT DATA REQUEST
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A.3

Sheila Heaviside

Survey Director

1100 1st Street, NE, 12th Floor

Washington, DC 20002-4221

Telephone (202) 484-9220

Fax (202) 863-1763

www.mathematica-mpr.com

[DATE]

Dear [School Contact]:

We would like to thank your school for participating in the evaluation of data-driven 

instruction sponsored by the U.S. Department of Education and conducted by Mathematica Policy

Research and its partners. This study will provide valuable information on how data-driven 

instruction is implemented in schools and the impact of high quality data-driven instruction on 

student achievement and other outcomes. 

We are requesting data for fourth and fifth grade teachers in study schools in order to identify

a sample of teachers who will be asked to complete a study survey, and to examine movement of 

teachers between the start of the study in fall 2014 and when the survey will be administered in 

spring 2016.

The attached teacher enumeration form and instructions indicate which teachers should be 

included and information we would like for each teacher. You can return the data either by posting 

an electronic file to our secure website or by sending the hard copy lists via a prepaid Federal 

Express packet provided. 

The staff list you provide will be used only for sampling purposes for this study.

Thank you very much for your assistance with this data request. A member of our study team 

will contact you in the next week to determine if you have any questions about this request and to 

whom you have delegated the task of completing the form. You can reach me at 202-484-3096 or 

sheaviside@mathematica-mpr.com. We greatly appreciate your support for this important study.

Sincerely, 

Sheila Heaviside

Survey Director

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays 

a valid OMB control number. Public reporting burden for this collection of information is estimated to average 15 minutes per response. The 

obligation to respond to this collection is voluntary. Send comments regarding the burden estimate or any other aspect of this collection of 

information, including suggestions for reducing this burden, to the U.S. Department of Education, Washington, DC 20202. If you have comments or 

concerns regarding the content or the status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of 

Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208.

An Affirmative Action/Equal Opportunity Employer
A.

4

[SCHOOL NAME or ID]Line Teacher's Email Address Grades

Taught

Subjects

Taught

Teaching

Status at this

School

Prior Year

Please provide an email address that the schooluses to contact this teacher.

Enter thenumericcode thatcorrespondsto thegrade(s)taught bythis teacher.

Enter thenumeric codethatcorrespondsto thesubject(s)taught by thisteacher.

Enter thenumeric codethatcorrespondsto theteacher'sstatus at thisschool.

Did thisteacherteach at thisschoolduring thepriorschoolyear (2014- 2015)?

First Last Email Address

1 - 4th2 - 5th3 - Both

1 - Math2 - Reading3 - Both

1 - Full-time2 - Part-time

1 - Yes2 - No

1987654321

0

Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associateresponses with a specific district or individual. We will not provide information that identifies you, teachers, principals, or your district to anyone outside the study team, except asrequired by law.

OMB No. XXXX: Approval Expires XX/XX/20XX U.S. DEPARTMENT OF EDUCATION

Teacher's Name

Please list all of the teachers who teach 4th or 5thgrade at this school during this school year (2015- 2016).Please provide first and last name and an emailaddress.

Notice of Confidentiality
A.5

EVALUATION OF DATA-DRIVEN INSTRUCTION 

GUIDELINES FOR SENDING TEACHER DATA FILES 

Please use one of the two methods below to return the teacher assignment list to Mathematica. 

A. Upload Electronic Files to a Secure Website 

1. Go to https://www.xxx.org/upload using an Internet browser (for example, Microsoft 

Explorer). When prompted, use the following login information: 

Username: XXX 

Password: XXX 

Domain Name: XXX 

Note: Username and password are case sensitive. 

2. Click the BROWSE button and select the file you wish to transfer. 

3. Click the UPLOAD button to begin the transfer process. Once a file is uploaded, it cannot 

be downloaded or accessed by anyone other than an authorized member of the study team. 

4. If the file name is not unique, you will receive a message indicating that the “file already 

exists.” If this occurs, please rename your file and upload again. 

5. Close the browser once the upload is complete. 

6. If your file is password protected, please call [Name] at [phone] with the password. For 

security reasons, please do not send the password by email. 

B. Federal Express (Paper Lists, Diskettes CD-ROMs, DVDs) 

1. Use the enclosed prepaid labels and send your package via Federal Express to 

Mathematica. Please write your return address information and the type of packaging you 

are using on the Federal Express label. 

2. Affix the provided “DO NOT X-RAY; DO NOT BEND” label to the package. 

3. If you would like Mathematica to provide other packaging material appropriate for the type 

of data list you are sending, please call [Name] at [phone].

4. Keep a copy of the information you send for your records.

If you have additional questions about the request or any of the instructions above, please call 

(Name) at XXX-XXX-XXXX or email XXXX.
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