D-1

Appendix D

Teacher Survey
Teacher Survey 

D-2

OMB#: XXXX-XXXX

Expiration Date: XX/XX/20XX

Implementation of Title I/II Program 

Initiatives

Draft Teacher Survey

Spring 2014

Paperwork Reduction Act of 1995 

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 30 

minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection of information. Your response 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, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email ICDocketMgr@ed.gov and 

reference the OMB Control Number XXXX-XXXX. Note: Please do not return the completed survey to this address.

Notice of Confidentiality 

Information collected for this study comes under the confidentiality and data protection requirements of the Institute of Education 

Sciences (The Education Sciences Reform Act of 2002, Title I, Part E, Section 183). Responses to this data collection will be used only 

for statistical purposes. The reports prepared for the study will summarize findings across the sample and will not associate 

responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside 

the study team, except as required by law.
Teacher Survey 

6/19/2013 D-3

Introduction

The Implementation of Title I/II Program Initiatives study will examine the implementation of policies promoted 

through Elementary and Secondary Education Act (ESEA) at the state, district and school levels, in four core 

areas: state content standards, aligned assessments, accountability and school turnaround, and educator 

workforce development. The study will serve as an update on implementation of the Title I and Title II provisions 

since the last national assessment that concluded in 2006. The study includes surveys of officials from all state 

education agencies and district officials, school principals, and teachers from nationally representative samples. 

The United States (U.S.) Department of Education, Institute of Education Sciences (IES) is sponsoring this study.

 Your responses are critical to drawing lessons about the implementation of ESEA

 All survey results will be presented as aggregate findings and no individual schools or teachers will be 

named or otherwise identified in any study reports or other communications that use survey data.

 We will survey a new sample of teachers from your school in spring 2015 so we can examine changes 

occurring in the school over time.

The study, including this survey, is being conducted by Westat and its partners, Mathematica Policy Research 

and edCount. 
Teacher Survey 

6/19/2013 D-4

DEFINITIONS FOR USE THROUGHOUT THIS SURVEY:

Summative assessments are state- or district-mandated tests that are intended to measure students' 

knowledge and skills at (or near) the end of a school year or course relative to grade-level content standards.

Diagnostic assessments are assessments that measure students’ knowledge and skills at interim points during 

the school year to provide timely feedback on their progress toward grade-level content standards so that 

instruction can be adjusted or other support can be provided.

Student achievement growth is the change in achievement for individual students between one year and 

the next. In some states and districts, the term value added is used instead of student achievement 

growth, to indicate a teacher’s or school’s contribution to students’ achievement growth.

For purposes of this survey, please consider “student achievement growth” and “value added” to be 

synonymous.

Standardized assessments are assessments consistently administered and scored for all students in the 

same grades and subjects, districtwide.

WEB PROGRAMMING NOTE: SOME TEXT IN THIS SURVEY WILL BE CUSTOMIZED AS FOLLOWS DEPENDING 

ON WHETHER THE TEACHER IS IN A SCHOOL IN A STATE THAT ADOPTED THE COMMON CORE STATE 

STANDARDS (CCSS) FOR ENGLISH LANGUAGE ARTS (ELA) AND MATH. 

IF THE TEACHER IS IN A SCHOOL IN A STATE THAT ADOPTED THE CCSS IN ELA AND MATH, DISPLAY 

“COMMON CORE STATE STANDARDS (CCSS) IN ELA OR MATH” OR “CCSS” WHERE NOTED.

IF THE TEACHER IS IN A SCHOOL THAT IS NOT IN A STATE THAT ADOPTED THE CCSS IN BOTH ELA AND 

MATH, DISPLAY “CURRENT STATE CONTENT STANDARDS IN ELA OR MATH” OR “CURRENT STATE CONTENT 

STANDARDS” WHERE NOTED.
Teacher Survey 

6/19/2013 D-5

Section 1. State Content Standards

Many states have recently adopted the Common Core State Standards (CCSS)—that is, content standards for English language arts 

(ELA) and Math that are shared across these states. Other states have substantially revised their own state content standards for 

ELA and Math in recent years. This section includes questions about materials, professional development, and resources you have 

used to revise curriculum and instructional materials to align with the [COMMON CORE STATE STANDARDS (CCSS) FOR ENGLISH 

LANGUAGE ARTS (ELA) OR MATH/ CURRENT STATE CONTENT STANDARDS FOR ENGLISH LANGUAGE ARTS (ELA) OR MATH].

1-1. During this school year (2013-14), are you teaching to the [COMMON CORE STATE STANDARDS (CCSS) FOR ENGLISH

LANGUAGE ARTS (ELA) OR MATH/ CURRENT STATE CONTENT STANDARDS FOR ELA OR MATH] fully, partially, or have you 

not incorporated the standards into your teaching yet?

SELECT ONE RESPONSE IN EACH ROW

NOT YET TEACHING 

TO THE 

[CCSS/CURRENT 

STATE CONTENT 

STANDARDS]

PARTIALLY 

TEACHING TO THE 

[CCSS/CURRENT 

STATE CONTENT 

STANDARDS] 

FULLY TEACHING TO 

THE [CCSS/CURRENT 

STATE CONTENT 

STANDARDS] 

a. English language arts (ELA) ......................... 1 2 3

b. Math............................................................ 1 2 3

WEB PROGRAMMING NOTE: DEPARTMENTALIZED MATH TEACHERS WILL 

NOT BE ASKED ABOUT ELA, AND DEPARTMENTALIZED ENGLISH/READING 

TEACHERS WILL NOT BE ASKED ABOUT MATH IN 1-1.
Teacher Survey 

6/19/2013 D-6

1-2. During this school year (2013-14), have you used any of the following materials to revise curriculum to align with the 

[COMMON CORE STATE STANDARDS (CCSS) FOR ELA OR MATH/ CURRENT STATE CONTENT STANDARDS FOR ELA OR 

MATH] and/or plan lessons based on these standards?

(Select NA (not applicable), where available, if you do not teach any English learners or students with disabilities.)

SELECT ONE RESPONSE

IN EACH ROW

YES NO NA

Materials to help align curriculum and instruction with the content standards

a. Documents showing alignment between the previous state standards and the 

[CCSS/ CURRENT STATE CONTENT STANDARDS] ......................................................... 1 0

b. Documents showing the alignment between required state summative 

assessments and the [CCSS/ CURRENT STATE CONTENT STANDARDS].......................

c. Tools or guidance on providing instruction aligned with the [CCSS/ CURRENT 

STATE CONTENT STANDARDS] such as scope and sequence, curriculum maps, or 

frameworks.................................................................................................................. 1 0

d. A state-developed model curriculum for ELA or Math instruction for each grade 

or course ...................................................................................................................... 1 0

e. Sample lesson plans consistent with the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] ................................................................................................................ 1 0

f. Examples or videos of instruction consistent with the [CCSS/ CURRENT STATE 

CONTENT STANDARDS]................................................................................................ 1 0

g. Sample student work ................................................................................................... 1 0

h. Sample performance tasks for formative assessment purposes including rubrics 

or scoring guides.......................................................................................................... 1 0

i. Diagnostic assessment tests ........................................................................................ 1 0

j. Textbooks or other instructional materials aligned with the [CCSS/ CURRENT 

STATE CONTENT STANDARDS]..................................................................................... 1 0

Materials to facilitate instruction for special populations

k. Documents showing alignment between the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] and the state’s English Language Proficiency standards........................ 1 0 na

l. Materials for understanding how to adapt instruction to help English learners 

meet [CCSS/ CURRENT STATE CONTENT STANDARDS]................................................ 1 0 na

m. Materials for understanding how to adapt instruction to help students with 

disabilities meet the [CCSS/ CURRENT STATE CONTENT STANDARDS]........................ 1 0 na

Other materials

n. Walk-through or observation protocols to aid in monitoring alignment of your 

instruction to the [CCSS/ CURRENT STATE CONTENT STANDARDS].............................. 1 0

o. Student report cards aligned with the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] ................................................................................................................ 1 0

IF YES IS SELECTED FOR ANY ROW ABOVE, PROCEED TO QUESTION 1-3. 

OTHERWISE, SKIP TO QUESTION 1-4.
Teacher Survey 

6/19/2013 D-7

1-3. Indicate to what extent you found the materials described in the previous question (by category) useful to help revise 

curriculum to align with the [COMMON CORE STATE STANDARDS (CCSS) FOR ELA OR MATH/ CURRENT STATE CONTENT

STANDARDS FOR ELA OR MATH] and/or plan lessons based on these standards.

(Select NA if you did not use that type of material.)

SELECT ONE RESPONSE IN EACH ROW

NOT 

USEFUL 

AT ALL

SOMEWHAT 

USEFUL

MODERATELY 

USEFUL

VERY 

USEFUL NA

a. Materials to help align curriculum and 

instruction with the [CCSS/ CURRENT STATE 

CONTENT STANDARDS] .................................... 0 1 2 3 na

b. Materials to facilitate instruction for special 

populations....................................................... 0 1 2 3 na

c. Other materials................................................. 0 1 2 3 na
Teacher Survey 

6/19/2013 D-8

1-4. During this school year (2013-14) and including last summer (2013), which of the following topics related to the 

[COMMON CORE STATE STANDARDS (CCSS) IN ELA OR MATH/ CURRENT STATE CONTENT STANDARDS IN ELA OR MATH]

and through what mode, have been covered in professional development that you have received? 

(Select NA where available, if you do not teach any English learners or students with disabilities.)

SELECT ALL THAT APPLY IN EACH ROW

TOPIC NOT 

COVERED BY 

ANY 

PROFESSIONAL 

DEVELOPMENT

(PD) YOU 

RECEIVED

ATTENDED 

STATE 

CONFERENCE 

ON THESE 

TOPICS

ATTENDED 

WEBINAR OR 

PRESENTATION 

ON THESE 

TOPICS

PARTICIPATED 

IN REQUIRED 

IN-SERVICE PD

ON THESE 

TOPICS

INSTRUCTIONAL 

COACHES WORK 

WITH YOU ON 

THESE TOPICS

RECEIVED 

VIA SOME 

OTHER 

FORM OF 

PD NA

a. Information about the 

[CCSS / CURRENT STATE 

CONTENT STANDARDS], 

such as content covered 

at each grade level and 

instructional changes or 

shifts required................... 0 1 2 3 4 5

b. Instructional strategies 

consistent with the 

[CCSS / CURRENT STATE 

CONTENT STANDARDS], 

such as model lessons 

or designing student 

work.................................. 0 1 2 3 4 5

c. Adapting instruction to 

help English learners 

meet the [CCSS / 

CURRENT STATE 

CONTENT STANDARDS] .... 0 1 2 3 4 5 na

d. Adapting instruction to 

help students with 

disabilities meet the 

[CCSS / CURRENT STATE 

CONTENT STANDARDS] .... 0 1 2 3 4 5 na

e. Using student assessment 

data to improve 

instruction....................... 0 1 2 3 4 5

IF YES IS SELECTED FOR ANY ROW IN 1-4 PROCEED TO QUESTIONS 1-5 AND 1-6. 

OTHERWISE, SKIP TO QUESTION 1-7.
Teacher Survey 

6/19/2013 D-9

1-5. Indicate to what extent the professional development you received was useful to help plan lessons and use teaching 

strategies aligned with the [COMMON CORE STATE STANDARDS (CCSS) FOR ELA OR MATH/ CURRENT STATE CONTENT

STANDARDS FOR ELA OR MATH]. 

SELECT ONE ONLY

Not useful at all.....................................................................................................................0

Somewhat useful ..................................................................................................................1

Moderately useful ................................................................................................................2

Very useful............................................................................................................................3

1-6. Thinking about the professional development topics listed in question 1-4, please indicate the total number of hours of 

professional development you received on these topics during this school year (2013-14) and including last summer

(2013). Include time spent on these topics during required in-service days, summer professional development days, or 

during other professional development opportunities.

(Your best estimate is fine.)

____________ TOTAL 2013-14 HOURS OF PROFESSIONAL DEVELOPMENT I RECEIVED RELATED TO STATE CONTENT 

STANDARDS
Teacher Survey 

6/19/2013 D-10

1-7. During this school year (2013-14), have you participated in any of the following activities related to the [COMMON CORE 

STATE STANDARDS (CCSS) FOR ELA OR MATH/ CURRENT STATE CONTENT STANDARDS FOR ELA OR MATH]? 

SELECT ONE RESPONSE

IN EACH ROW

YES NO

a. Discussed how to implement the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] at faculty, department, or grade-level meetings............................ 1 0

b. Worked with other teachers to articulate coverage of the [CCSS/ CURRENT 

STATE CONTENT STANDARDS] across grades or courses...................................... 1 0

c. Reviewed the alignment of curriculum and lesson plans to the [CCSS/ 

CURRENT STATE CONTENT STANDARDS] covering the subjects you teach.......... 1 0

d. Dropped material from lesson or unit plans that does not align with the 

[CCSS/ CURRENT STATE CONTENT STANDARDS] .................................................. 1 0

e. Set student learning goals or objectives using the [CCSS/ CURRENT STATE 

CONTENT STANDARDS]......................................................................................... 1 0

f. Developed assignments, projects, tests, or performance tasks aimed at 

assessing student progress toward meeting the [CCSS/ CURRENT STATE 

CONTENT STANDARDS]......................................................................................... 1 0

g. Provided feedback to students in terms of their progress toward the [CCSS/ 

CURRENT STATE CONTENT STANDARDS].............................................................. 1 0

h. Had central office staff or a school administrator visit your classroom to see 

how your instruction aligns with the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] ......................................................................................................... 1 0

i. Had a coach, mentor teacher, or other instructional leader visit your 

classroom to see how your instruction aligns with the [CCSS/ CURRENT 

STATE CONTENT STANDARDS].............................................................................. 1 0

j. Discussed the alignment of your teaching to the [CCSS/ CURRENT STATE 

CONTENT STANDARDS] with school administrators as part of your 

performance evaluation process .......................................................................... 1 0

k. Had alignment of your teaching with the [CCSS/ CURRENT STATE CONTENT 

STANDARDS] as part of your performance evaluation ......................................... 1 0

l. Include implementing the [CCSS/ CURRENT STATE CONTENT STANDARDS] as 

part of your professional development plan ........................................................ 1 0
Teacher Survey 

6/19/2013 D-11

1-8. During your class instruction this school year (2013-14), how often do you do the following activities? 

(If you teach more than one group of students during the day, please respond for your typical or average class.)

SELECT ONE RESPONSE IN EACH ROW

NEVER

ONCE 

PER 

MONTH 

OR LESS

TWO OR 

THREE 

TIMES PER 

MONTH

ONCE OR 

TWICE 

PER WEEK

THREE OR 

FOUR TIMES 

PER WEEK

EVERY 

DAY NA

a. Use non-fiction informational 

texts such as historical, 

scientific, or technical narratives

in your instruction ........................ 0 1 2 3 4 5 na

b. Use non-fiction literary texts 

such as essays, speeches, 

arguments, art reviews, or 

memoirs in your instruction ......... 0 1 2 3 4 5 na

c. Require students to include 

evidence from informational or 

literary texts in their writing......... 0 1 2 3 4 5 na

d. Create assignments that require 

students to use information 

from literary or informational 

texts to complete.......................... 0 1 2 3 4 5 na

e. In classroom discussions, require 

students to practice using 

evidence from both literary and 

informational texts....................... 0 1 2 3 4 5 na

f. Provide opportunities for 

students to apply Math concepts 

in real-world situations................. 0 1 2 3 4 5 na

g. Require students to 

demonstrate conceptual Math 

understanding through complex 

problem solving ............................ 0 1 2 3 4 5 na
Teacher Survey 

6/19/2013 D-12

1-9. To what extent would you describe the following as challenges to incorporating the [COMMON CORE STATE STANDARDS 

(CCSS) FOR ELA OR MATH/ CURRENT STATE CONTENT STANDARDS FOR ELA OR MATH] into your classroom instruction? 

SELECT ONE RESPONSE IN EACH ROW

NOT A 

CHALLENGE

MINOR 

CHALLENGE

MAJOR 

CHALLENGE

a. Insufficient time for professional development.................... 1 2 3

b. Professional development that is weak or poorly aligned 

with instructional needs ....................................................... 1 2 3

c. Insufficient information available about how to revise 

lessons and instructional materials to meet the [CCSS/ 

CURRENT STATE CONTENT STANDARDS].............................. 1 2 3

d. Lack of school staff who can mentor or serve as a 

resource to teachers about the [CCSS/ CURRENT STATE 

CONTENT STANDARDS]......................................................... 1 2 3

e. Lack of guidance or support from the district or school........ 1 2 3

f. Lack of instructional materials aligned with the [CCSS/ 

CURRENT STATE CONTENT STANDARDS].............................. 1 2 3

g. The additional work required to modify curriculum and 

lesson plans within tight timeframes.................................... 1 2 3

h. Community concerns or opposition to the [CCSS/ 

CURRENT STATE CONTENT STANDARDS].............................. 1 2 3

1-10. Overall, to what extent do you view incorporating the [COMMON CORE STATE STANDARDS (CCSS) FOR ELA OR MATH / 

CURRENT STATE CONTENT STANDARDS FOR ELA OR MATH] into your instruction as a challenge?

SELECT ONE ONLY

Not a challenge.....................................................................................................................1

Minor challenge....................................................................................................................2

Major challenge....................................................................................................................3
Teacher Survey 

6/19/2013 D-13

Section 2. Assessments

In this section of the survey, we will ask about materials or professional development that you have received to help with 

assessment activities, and how you use information from assessments.

2-1. During this school year (2013-14), have you done any of the following to prepare students for required state summative 

assessments in English Language Arts (ELA) and Math? 

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. Strengthened coursework in tested areas................................................................ 1 0

b. Taught test-taking skills to students......................................................................... 1 0

c. Provided students opportunities to take practice assessments on paper................ 1 0

d. Provided students opportunities to take practice assessments on-line................... 1 0

e. Identified students likely to score just below state proficiency levels for 

additional help .......................................................................................................... 1 0

Next we will ask about the use of a student-level data system. By student-level data system, we mean any technology-based tool 

that provides school leaders and teachers with data that can be used to monitor the achievement of individual students. The data 

system may be developed and maintained at either the state or the district level.

2-2. During this school year (2013-14), do you have direct access to a student-level data system that includes any of the 

following types of data for students in your classes?

□ Check box if you do not have direct access to a student-level data system and skip to 2-4

SELECT ONE RESPONSE 

IN EACH ROW

Data System Includes YES NO

a. Past achievement of each of your current students on required state summative 

assessments.................................................................................................................. 1 0

b. Past achievement of each of your current students on districtwide summative 

assessments.................................................................................................................. 1 0

c. Achievement of each of your current students on districtwide diagnostic 

assessments.................................................................................................................. 1 0

d. Achievement growth of each of your current students on state or districtwide 

summative assessments ............................................................................................... 1 0

e. Past course grades for each of your current students.................................................. 1 0

f. Behavior/discipline information of each of your current students............................... 1 0

g. Readiness of each of your current students for grade promotion or graduation (“on 

track” measures)........................................................................................................... 1 0
Teacher Survey 

6/19/2013 D-14

2-3. During this school year (2013-14), have you received any of the following related to the data system to help you analyze 

and use student data to inform instruction?

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. Web-based tools.............................................................................................. 1 0

b. Manuals or guidebooks.................................................................................... 1 0

c. Individual support from data experts who could address your questions ...... 1 0

2-4. During this school year (2013-14), have you used data on student achievement for any of the following purposes? Data 

on student achievement could come from state summative assessments, districtwide assessments, or assessments you 

developed for your classes.

(Select NA, where available, if you do not teach English learners or student with disabilities.)

SELECT ONE RESPONSE 

IN EACH ROW

YES NO NA

a. To set measurable learning objectives or goals for your classes..................... 1 0

b. To monitor student progress toward performance targets or learning goals. 1 0

c. To monitor the progress of English learners.................................................... 1 0 na

d. To monitor the progress of students with disabilities..................................... 1 0 na

e. To identify individual students who are struggling academically .................... 1 0

f. To monitor the progress of students who are struggling academically........... 1 0

g. To plan whole-class instruction ....................................................................... 1 0

h. To plan instruction for individual students...................................................... 1 0

i. To evaluate the effectiveness of a lesson or unit ............................................ 1 0

j. To evaluate the effectiveness of your instruction ........................................... 1 0
Teacher Survey 

6/19/2013 D-15

2-5. To what extent would you describe the following as challenges to using assessment data to inform your instruction? 

SELECT ONE RESPONSE IN EACH ROW

NOT A 

CHALLENGE

MINOR 

CHALLENGE

MAJOR 

CHALLENGE

a. Limited access to data from prior years on the students I 

teach this year .......................................................................... 1 2 3

b. Timeliness of the data on student achievement from prior 

years.......................................................................................... 1 2 3

c. Understanding how to analyze student data from diagnostic 

assessments.............................................................................. 1 2 3

d. Lack of district or school staff who can assist me with 

questions about analyzing student data................................... 1 2 3

e. Having regularly-scheduled time to meet with other teachers 

as a team to discuss student achievement data and 

instruction................................................................................. 1 2 3

f. Assessments are not well aligned with the curriculum ............ 1 2 3

g. Available assessment data do not accurately measure my 

students’ knowledge and skills................................................. 1 2 3
Teacher Survey 

6/19/2013 D-16

Section 3. Accountability

3-1. During this school year (2013-14), have school leaders provided any of the following information about your school? 

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. Your school’s performance category, based on your state or district school 

accountability system................................................................................................ 1 0

b. Why your school is in its current performance category .......................................... 1 0

c. This year’s school goals for student achievement..................................................... 1 0

d. Strategies your school is pursuing to meet its student achievement goals .............. 1 0

e. How you could contribute to meeting your school’s student achievement goals.... 1 0

f. Strategies to set specific student achievement goals for your classes or students... 1 0

g. Strategies for you to use in meeting student achievement goals for your classes 

or students................................................................................................................. 1 0

3-2. During this school year (2013-14) and including previous summer (2013), have you participated in any of the following 

activities to improve student achievement? 

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. Implemented an externally-developed school reform or instructional model in 

your classroom .......................................................................................................... 1 0

b. Worked a school schedule that provides additional time for student learning 

through an extended school day, week, or year....................................................... 1 0

c. Identified struggling students for school-sponsored individual or small-group 

tutoring outside of the school day ............................................................................ 1 0

d. Provided school-sponsored assistance to struggling students outside of the school 

day at least once a week ........................................................................................... 1 0

e. Implemented a new schoolwide safety or discipline program with your students .. 1 0

f. Participated in a new schoolwide program to address students’ social, emotional, 

or health needs.......................................................................................................... 1 0

g. Participated in a new schoolwide program to increase family and community 

engagement............................................................................................................... 1 0
Teacher Survey 

6/19/2013 D-17

3-3. To what extent would you describe the following as challenges to improving the achievement of students in your 

classes? 

SELECT ONE RESPONSE IN EACH ROW

NOT A 

CHALLENGE

MINOR 

CHALLENGE

MAJOR 

CHALLENGE

a. Insufficient instructional time................................................................ 1 2 3

b. Lack of staff who can mentor or serve as a resource to teachers 

about instructional strategies for struggling students................................ 1 2 3

c. Lack of guidance or support from the district or school ................................1 2 3

d. Teacher concerns or opposition to implementing school 

interventions................................................................................................ 1 2 3

e. Concerns or opposition from teacher unions/associations to 

implementing school interventions................................................................1 2 3

f. Community concerns or opposition to implementing school 

interventions................................................................................................ 1 2 3

g. Curricula not aligned with the required state summative 

assessments................................................................................................ 1 2 3

h. Insufficient classroom resources................................................................ 1 2 3

i. Lack of effective methods/interventions to improve student 

achievement................................................................................................ 1 2 3
Teacher Survey 

6/19/2013 D-18

Section 4. Teachers and Leaders

Evaluation

4-1. During this school year (2013-14), is your school participating in a pilot or test of a new teacher evaluation system? 

Yes ........................................................................................................................................1

No .........................................................................................................................................0

DON’T KNOW........................................................................................................................d

4-2. During this school year (2013-14), does your performance evaluation include any of the following sources of information 

on performance? 

SELECT ONE RESPONSE IN EACH ROW

USED IN MY 

EVALUATION

NOT USED IN 

MY 

EVALUATION

DON’T 

KNOW

a. Classroom observations using a teacher professional practice rubric, 

conducted by the principal or other school administrator ................................ 1 0 d

b. Classroom observations using a teacher professional practice rubric, 

conducted by someone other than a school administrator (such as a 

peer or mentor teacher, instructional coach, central office staff 

member, or an observer from outside the school or district)................................1 0 d

c. Your self-assessment................................................................................................1 0 d

d. Portfolios or other artifacts of your teaching practice................................ 1 0 d

e. Assessments by a peer or mentor teacher not based on a teacher 

professional practice rubric........................................................................................ 1 0 d

f. Student work samples................................................................................................ 1 0 d

g. Student surveys or other feedback ................................................................ 1 0 d

h. Parent surveys or other feedback ................................................................ 1 0 d
Teacher Survey 

6/19/2013 D-19

4-3. During this school year (2013-14), will any of the following be evaluated as part of your performance evaluation?

(Select NA (not applicable), where available, if you do not have any English learners or students with disabilities in your 

classes.)

SELECT ONE RESPONSE IN EACH ROW

Extent to which you: YES NO

DON’T 

KNOW NA

a. Use assessment data to plan instruction .................................................... 1 0 d

b. Align lessons with the [CCSS/CURRENT STATE CONTENT STANDARDS]

in English language arts (ELA) or Math ....................................................... 1 0 d

c. Use instructional strategies aligned with the [CCSS/CURRENT STATE 

CONTENT STANDARDS] in ELA or Math ...................................................... 1 0 d

d. Differentiate instruction for English learners.............................................. 1 0 d na

e. Differentiate instruction for students with disabilities............................... 1 0 d na

f. Collaborate with other school staff............................................................. 1 0 d

4-4. So far this school year (2013-14), how many times have you been formally observed by a school administrator, coach, 

mentor or peer for the purpose of evaluating your performance?

(Please consider only instances of formal observations conducted in your classroom. Formal observations are 

standardized using an instrument, rubric or checklist.)

SELECT ONE ONLY

Never ....................................................................................................................................0 Skip to 4-8

Once......................................................................................................................................1

Twice.....................................................................................................................................2

3 times..................................................................................................................................3

4 or more times....................................................................................................................4
Teacher Survey 

6/19/2013 D-20

4-5. Indicate to what extent you agree or disagree with each of the following statements about the formal observations of 

your teaching.

SELECT ONE RESPONSE IN EACH ROW

DISAGREE 

STRONGLY

DISAGREE 

SOMEWHAT

AGREE 

SOMEWHAT

AGREE 

STRONGLY

a. I had a clear sense of what kinds of things the 

observers were looking for when they 

observed my teaching............................................ 1 2 3 4

b. The people who observed my teaching are 

well qualified to evaluate it.................................... 1 2 3 4

4-6. So far this school year (2013-14), how many times have you received the following based on the formal observation(s)?

SELECT ONE RESPONSE IN EACH ROW

NEVER ONCE TWICE 3 TIMES

4 OR MORE 

TIMES

a. You received oral feedback....................................................... 0 1 2 3 4

b. You received written feedback ................................................. 0 1 2 3 4

c. You received specific suggestions or coaching on how to 

improve your teaching .............................................................. 0 1 2 3 4

d. You received recommendations for resources (e.g., 

professional development, materials, lesson examples) to 

use to improve your teaching ................................................... 0 1 2 3 4

4-7. Indicate to what extent you agree or disagree with each of the following statements about the feedback you received 

based on the formal observation(s) of your teaching.

SELECT ONE RESPONSE IN EACH ROW

DISAGREE 

STRONGLY

DISAGREE 

SOMEWHAT

AGREE 

SOMEWHAT

AGREE 

STRONGLY

a. The feedback was based on the teacher professional 

practice rubric used to assess my teaching...................... 1 2 3 4

b. The feedback pointed out specific examples of 

strengths or weaknesses that were observed ................. 1 2 3 4

c. The feedback provided specific ideas about how I 

could improve my instruction .......................................... 1 2 3 4

d. The feedback was a fair assessment of my teaching ....... 1 2 3 4
Teacher Survey 

6/19/2013 D-21

4-8. During this school year (2013-14), will your performance evaluation include measures of student achievement growth or 

“value added” on standardized student assessments?

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. Achievement growth or value added on standardized assessments for your own 

students is included in your performance evaluation........................................................ 1 0

b. Achievement growth or value added on standardized assessments for all tested 

students served by your teacher team or grade level is included in your 

performance evaluation..................................................................................................... 1 0

c. Achievement growth or value added on standardized assessments for tested 

students schoolwide is included in your performance evaluation .................................... 1 0

4-9. During this school year (2013-14), will your evaluation include whether your students meet student learning objectives or 

learning goals that you set at the beginning of the school year (perhaps in consultation with your principal)?

Yes ........................................................................................................................................1

No .........................................................................................................................................0

DON’T KNOW........................................................................................................................d

4-10. Please indicate to what extent you agree or disagree with each of the following statements about your performance 

evaluation for this school year (2013-14).

(Select NA, where available, if student achievement growth is not used in your performance evaluation.)

SELECT ONE RESPONSE IN EACH ROW

DISAGREE 

STRONGLY

DISAGREE 

SOMEWHAT

AGREE 

SOMEWHAT

AGREE 

STRONGLY NA

a. Student achievement growth for my students 

(or value added) is a fair way to assess my 

contribution to student achievement ..................... 1 2 3 4 na

b. My overall evaluation covers all important 

aspects of my performance as a teacher................. 1 2 3 4

c. In the long run, students will benefit from 

including measures of student achievement 

growth in the evaluations of teachers..................... 1 2 3 4 na
Teacher Survey 

6/19/2013 D-22

4-11. Will your evaluation results for this school year (2013-14) be used to guide any of the following decisions? 

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

Evaluation results will be used to guide decisions about:

a. Feedback provided on your professional practice............................................. 1 0

b. Planning your professional development.......................................................... 1 0

c. Development of a performance improvement plan.......................................... 1 0

d. Setting goals for student achievement growth for next school year ................ 1 0

e. Determining whether you should receive coaching, mentoring, or peer 

assistance........................................................................................................... 1 0

f. Determining your annual salary increase .......................................................... 1 0

g. Determining whether you receive a bonus or performance-based 

compensation other than a salary increase....................................................... 1 0

4-12. Could your evaluation results for this school year (2013-14) be used to guide any of the following decisions?

(Select NA, where available, if tenure is not offered in your district or school.)

SELECT ONE RESPONSE IN EACH ROW

Evaluation results could be used to guide decisions: YES NO

DON’T 

KNOW NA

a. Recognizing you as a highly effective teacher................................................... 1 0 d

b. Career advancement opportunities, such as teacher leadership roles............. 1 0 d

c. Granting tenure or similar job protection ......................................................... 1 0 d na

d. Determining whether you are eligible to transfer to other schools.................. 1 0 d

e. Loss of tenure or similar job protection ............................................................ 1 0 d na

f. How potential layoffs in your district could affect you ..................................... 1 0 d

g. Dismissal or terminating employment for cause............................................... 1 0 d
Teacher Survey 

6/19/2013 D-23

4-13. During this school year (2013-14) and including last summer (2013), did you receive professional development on any of 

the following topics? 

SELECT ONE RESPONSE IN 

EACH ROW

YES NO

DON’T 

KNOW

a. The components of the teacher evaluation system used in your school ............................ 1 0 d

b. The teacher professional practice rubric, including specific examples of performance at 

various rating levels for each item in the rubric .................................................................. 1 0 d

c. Creating student learning objectives and/or measures of student achievement growth... 1 0 d

d. How a teacher’s contribution to student achievement growth (or value added) is defined 

and measured....................................................................................................................... 1 0 d

4-14. During this school year (2013-14) and including last summer (2013), about how many hours of professional development 

on the teacher evaluation system did you participate in? 

(If you did not participate in any professional development on the teacher evaluation system during this period, please 

enter “0” below. Your best estimate is fine.)

_________ HOURS

4-15. During this school year (2013-14), have you received or had access to any of the following materials or events to help you 

understand the system for evaluating your performance?

SELECT ONE RESPONSE 

IN EACH ROW

YES NO

a. A website or page dedicated to providing information on the evaluation 

system....................................................................................................................... 1 0

b. An information session at your school or in your district......................................... 1 0

c. A hot line, email address, or web form for questions about the evaluation 

process...................................................................................................................... 1 0

d. Regular reports on the progress of planning or implementing the system.............. 1 0

e. A manual or handbook describing how the evaluation system is intended to 

operate...................................................................................................................... 1 0

f. Examples of what different levels of performance as defined by the system 

look like in practice ................................................................................................... 1 0
Teacher Survey 

6/19/2013 D-24

4-16. Indicate to what extent you agree or disagree with each of the following statements about your understanding of the 

system that will be used to evaluate your performance this school year (2013-14).

Professional Development

4-17. During this school year (2013-14), have you had access to professional development that is specifically linked to areas for 

improvement identified either by formal observations of your practice this year or by your performance evaluation last 

school year?

(Select NA if you have not had a formal observation of your practice this year or a completed performance evaluation for 

last school year.)

SELECT ONE RESPONSE IN 

EACH ROW

YES NO NA

a. An on-line resource that identifies district professional development 

opportunities linked to my specific areas for improvement..................................... 1 0 na

b. The principal or another school leader identifies professional development 

opportunities offered by my district linked to my specific areas for 

improvement ............................................................................................................ 1 0 na

c. A video library that illustrates teaching practices consistent with higher 

ratings on specific items on the teacher professional practice rubric ...................... 1 0 na

d. Self-paced, internet-based professional development modules that relate to 

my specific areas for improvement .......................................................................... 1 0 na

SELECT ONE RESPONSE IN EACH ROW

DISAGREE 

STRONGLY

DISAGREE 

SOMEWHAT

AGREE 

SOMEWHAT

AGREE 

STRONGLY

a. I have a good understanding of the procedures 

involved in the evaluation system.......................... 1 2 3 4

b. I have a good understanding of how the 

performance levels are defined .............................. 1 2 3 4

c. It is clear to me what I need to do to get the 

performance rating I want....................................... 1 2 3 4

d. Overall, I have a good understanding of the 

evaluation system.................................................... 1 2 3 4
Teacher Survey 

6/19/2013 D-25

4-18. During this school year (2013-14), does your school have an instructional coach available to help you improve your 

teaching? 

(An instructional coach provides intensive, on-site support to teachers to help them improve instructional practice. For 

this survey, instructional coaches do not include mentors exclusively assigned to help new teachers, or to assist struggling 

teachers placed in a peer assistance program.)

Yes ........................................................................................................................................1

No .........................................................................................................................................0 Skip to 4-20

DON’T KNOW........................................................................................................................d Skip to 4-20

4-19. During this school year (2013-14), how many times have you worked one-on-one with an instructional coach on any of 

the following topics:

(Select NA, where available, if you do not have any English learners or students with disabilities in your classes.)

SELECT ONE RESPONSE IN EACH ROW

NEVER ONCE TWICE

3-4 

TIMES

5 OR 

MORE 

TIMES NA

a. Implementing the [CCSS/CURRENT STATE 

CONTENT STANDARDS] in ELA or Math................ 0 1 2 3 4

b. Adapting instruction to the needs of English 

learners................................................................. 0 1 2 3 4 na

c. Adapting instruction to the needs of students 

with disabilities..................................................... 0 1 2 3 4 na

d. Using assessment results to plan instruction ....... 0 1 2 3 4

e. Understanding how the state or district 

measures student achievement growth............... 0 1 2 3 4

f. Improving your content knowledge...................... 0 1 2 3 4

g. Improving classroom management or 

relationships with students .................................. 0 1 2 3 4

4-20. During this school year (2013-14), do you and other teachers have common planning time to meet in teams? 

Yes ........................................................................................................................................1

No .........................................................................................................................................0 Skip to 4-23
Teacher Survey 

6/19/2013 D-26

4-21. How often do you have common planning time with other teachers in your school? 

SELECT ONE ONLY

Daily ......................................................................................................................................1

Several times per week.........................................................................................................2

Once per week......................................................................................................................3

Several times per month ......................................................................................................4

Several times per year..........................................................................................................5

4-22. Does your school require that you participate in common planning time? 

Yes ........................................................................................................................................1

No .........................................................................................................................................0

4-23. During this school year (2013-14), about how often have you engaged in any of the following with other teachers? 

SELECT ONE RESPONSE IN EACH ROW

NEVER

SEVERAL 

TIMES 

PER YEAR

SEVERAL 

TIMES PER 

MONTH

ONCE 

PER 

WEEK

SEVERAL 

TIMES PER 

WEEK DAILY

a. Received feedback on your teaching 

practice from other teachers................................

0 1 2 3 4 5

b. Planned lessons or courses with teachers of 

the same grade or subject...................................... 0 1 2 3 4 5

c. Developed materials or activities for 

particular classes or lessons with teachers 

of the same grade or subject ................................

0 1 2 3 4 5

d. Discussed learning needs of individual 

students with colleagues........................................

0 1 2 3 4 5

e. Discussed student assessment results with 

colleagues ..............................................................

0 1 2 3 4 5

f. Exchanged feedback with colleagues based 

on observing in each other’s classrooms...............

0 1 2 3 4 5

g. Learned from highly effective or highly 

rated teachers in your school or district................

0 1 2 3 4 5
Teacher Survey 

6/19/2013 D-27

School Climate

4-24. Indicate to what extent you agree or disagree with each of the following statements about your school’s climate. 

SELECT ONE RESPONSE IN EACH ROW

DISAGREE 

STRONGLY

DISAGREE 

SOMEWHAT

AGREE 

SOMEWHAT

AGREE 

STRONGLY

a. There is an atmosphere of trust and mutual respect in 

my school............................................................................. 1 2 3 4

b. Teachers at my school support each other in their 

efforts to improve teaching ................................................. 1 2 3 4

c. The principal has confidence in the expertise of 

teachers at my school .......................................................... 1 2 3 4

d. The method of teacher performance evaluation 

encourages teachers to cooperate rather than 

compete............................................................................... 1 2 3 4

e. My principal is responsive to teachers’ input...................... 1 2 3 4

f. Teachers can make up for most of the deficits and 

limitations that students bring with them to school ........... 1 2 3 4
Teacher Survey 

6/19/2013 D-28

Section 5: Arts Education

5-1. During the last school year (2012-13), how many minutes per week did a typical student in your grade or class spend in 

arts education? 

(Enter the number. Your best estimate is fine.)

__________ MINUTES PER WEEK

DON’T KNOW.................................................................................................................... d

5-2. During the 2012-13 school year, how often did a typical student in your school receive instruction designated specifically 

as arts education? 

SELECT ONE ONLY

Every day .......................................................................................................................... 1

3 or 4 times a week........................................................................................................... 2

Once or twice a week ....................................................................................................... 3

Less than once per week .................................................................................................. 4

Not at all ........................................................................................................................... 0 Skip to 5-4

DON’T KNOW.................................................................................................................... d Skip to 5-4

IF YOU DO NOT TEACH STUDENTS IN ELEMENTARY GRADES, SKIP TO QUESTION 6-1.

IF YOU DID NOT TEACH AT THIS SCHOOL DURING THE 2012-13 SCHOOL YEAR, SKIP TO QUESTION 5-4.

OTHERWISE, PROCEED TO QUESTION 5-1.

DEFINITIONS FOR USE THROUGHOUT THIS SECTION:

Arts Education is defined as visual arts, music, dance, and drama theatre.
Teacher Survey 

6/19/2013 D-29

5-3. During the 2012-13 school year, for what part of the school year does the arts education class for a typical student last

(i.e., does a typical student receive arts instruction throughout the full school year or only for some portion of the year)? 

SELECT ONE ONLY

The entire school year...................................................................................................... 1

Half of the school year...................................................................................................... 2

One-quarter of the school year........................................................................................ 3

Less than one quarter of the school year......................................................................... 4

Other ................................................................................................................................ 5

DON’T KNOW.................................................................................................................... d

5-4. During this school year (2013-14), how many minutes per week does a typical student in your school spend in arts 

education? 

(Enter the number. Your best estimate is fine.)

__________ MINUTES PER WEEK

DON’T KNOW.................................................................................................................... d

5-5. During this school year (2013-14), how often does a typical student in your school receive instruction designated 

specifically as arts education? 

SELECT ONE ONLY

Every day .......................................................................................................................... 1

3 or 4 times a week........................................................................................................... 2

Once or twice a week ....................................................................................................... 3

Less than once per week .................................................................................................. 4

Not at all ........................................................................................................................... 0 Skip to 6-1

DON’T KNOW.................................................................................................................... d Skip to 6-1

5-6. During this school year (2013-14), for what part of the school year does the arts education class for a typical student last 

(i.e., does a typical student receive arts instruction throughout the full school year or only for some portion of the year)?

SELECT ONE ONLY

The entire school year...................................................................................................... 1

Half of the school year...................................................................................................... 2

One-quarter of the school year........................................................................................ 3

Less than one quarter of the school year......................................................................... 4

Other ................................................................................................................................ 5

DON’T KNOW.................................................................................................................... d
Teacher Survey 

6/19/2013 D-30

Section 6. Background

6-1. Including the current school year, how many years of teaching experience do you have in each of the following settings?

(Count part of a year as one year; do not give fractions or months)

YEARS

a. Total number of years teaching........................................................ ____

b. Total number of years teaching in your current district................... ____

c. Total number of years teaching in your current school ................... ____

6-2. Which of the following best describes your primary role as a teacher this school year? 

SELECT ONE ONLY

Kindergarten teacher........................................................................................................ 1

Teach core subjects, music, the arts, language, electives, or physical education to 

general education students in any grades 1 through 12 .................................................. 2

Special education teacher ................................................................................................ 3

English as a second language teacher .............................................................................. 4

Library media specialist .................................................................................................... 5

Lead teacher, instructional coach, instructional facilitator, resource teacher, or 

professional development teacher................................................................................... 6

Other(specify)................................................................................................................... 7

______________________________________________________________________
Teacher Survey 

6/19/2013 D-31

6-3. How would you classify your main teaching assignment at this school, that is, the activity at which you spend most of 

your time during the current school year (2013-14)? 

SELECT ONE ONLY

Full-time teacher working only at this school................................................................... 1

Part-time teacher working only at this school.................................................................. 2

Itinerant teacher (e.g., your assignment requires that you provide instruction at 

more than one school) ..................................................................................................... 3

Long-term substitute (e.g., your assignment requires that you fill the role of a regular

teacher on a long-term basis, but you are still considered a substitute) ......................... 4

Other (specify).................................................................................................................. 5

______________________________________________________________________

6-4. Of the students you are teaching this school year, what percent are English learners? 

SELECT ONE ONLY

None ................................................................................................................................. 0

1 to 24 percent ................................................................................................................. 1

25 to 49 percent ............................................................................................................... 2

50 to 99 percent ............................................................................................................... 3

100 percent....................................................................................................................... 4

DON’T KNOW.................................................................................................................... d

6-5. Of the students you are teaching this school year, what percent are students with disabilities? 

SELECT ONE ONLY

None ................................................................................................................................. 0 Skip to 6-7

1 to 9 percent ................................................................................................................... 1

10 to 24 percent ............................................................................................................... 2

25 to 39 percent ............................................................................................................... 3

40 to 99 percent ............................................................................................................... 4

100 percent....................................................................................................................... 5

DON’T KNOW.................................................................................................................... d

6-6. Do you teach students with disabilities in a self-contained classroom or an inclusion classroom? 

SELECT ONE ONLY

Self-contained classroom ................................................................................................. 1

Inclusion classroom .......................................................................................................... 2

Both .................................................................................................................................. 3
Teacher Survey 

6/19/2013 D-32

6-7. What is the highest degree you have earned? 

SELECT ONE ONLY

Do not have a degree ....................................................................................................... 0

Associate degree............................................................................................................... 1

Bachelor's degree (B.A., B.S., etc.).................................................................................... 2

Master's degree (M.A., M.A.T., M.Ed., M.S., etc.)............................................................ 3

Educational specialist or professional diploma (at least one year beyond master’s 

level) ................................................................................................................................. 4

Doctorate or first professional degree (Ph.D., Ed.D., M.D., L.L.B., J.D., D.D.S., M.B.A.)... 5

6-8. Which of the following describes the teaching certificate you currently hold in this state? 

SELECT ONE ONLY

Regular or standard state certificate or advanced professional certificate ..................... 1

Certificate issued after satisfying all requirements except the completion of a 

probationary period ......................................................................................................... 2

Certificate that requires some additional coursework, student teaching, or passage of 

a test before regular certification can be obtained.......................................................... 3

Certificate issued to persons who must complete a certification program in order to 

continue teaching ............................................................................................................. 4

I do not have any of the above certifications for this state.............................................. 0

6-9. Are you male or female?

Male.................................................................................................................................. 1

Female .............................................................................................................................. 2

6-10. Are you of Hispanic or Latino origin? 

Yes .................................................................................................................................... 1

No ..................................................................................................................................... 0
Teacher Survey 

6/19/2013 D-33

6-12. What is your race?

SELECT ALL THAT APPLY

American Indian or Alaska Native..................................................................................... 1

Asian ................................................................................................................................. 2

Black or African American ................................................................................................ 3

Native Hawaiian or Other Pacific Islander........................................................................ 4

White ................................................................................................................................ 5

6-13. Do you speak any language other than English, either in the classroom or outside the classroom, such as at home? 

SELECT ALL THAT APPLY

Yes, Spanish ...................................................................................................................... 1

Yes, some other language................................................................................................. 2

No ..................................................................................................................................... 0

Thank you for completing this survey.