Prepared by Mathematica Policy Research



# IMPACT EVALUATION OF SUPPORT

**FOR PRINCIPALS TEACHER SURVEY** 

[DATE] This questionnaire is part of the Im pact Evaluation of Support for Principals, a national evaluation being conducted for the U.S. Department of Education by Mathematica Policy Research The questionnaire asks about the professional development and supports you received in the 2015-2016 school year, your school ’s climate and culture, and your teaching background and experience
. **We want you to know that:** 1. This survey

is voluntary, but your response is critical for producing valid and reliable data. You may skip any questions you do not wish to answer; however, we hope that you answer as many questions as you can. Your answers to questions will not affect your job or any h iring decisions now or in the future and will only be shared with the Mathematica study team (they will not be shared with anyone from your school or district)
. Participation in the teacher survey will not im pose any risks to you as a respondent. If you have any questions about your rights as a research volunteer, contact XXX at New England IRB, toll free XXX-XXX-XXXX
. 2. The U.S. Department of Education is committed to protecting the privacy of individuals who participate in surveys. All information you provide will be kept strictly confidential and used for research purposes only. Your answers will be combined with other surveys, and no information identifyi ng individual teachers or their schools will be released. Thank you for your help with this survey! This evaluation is authorized by Title IX, Part F of the Elementary and Secondary Education Act, section 9601 as amended by the “No Child Left Behind Act of 2001” (20 USC 7941) as it relates to Title II, Part A of the Elementary and Secondary Education Act (ESEA), section 2121 -2123 as amended by No Child Left Behind (NCLB) (20 USC 6621 -6623). 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 information collection is **XXXX -**  **XXXX**
. The time required to complete this information collection is estimated to average 30 minutes per respondent, including the time to review i nstructions, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U .S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: U .S. Department of Education, I nstitute of Education Sciences, 555 New Jersey Avenue, NW,Washington, DC 20208.Prepared by Mathematica Policy Research 2 **SECTION A .**  **TEA CHER PROFESSIONA** **L DEVELOPMENT A ND**  **GOA LS**  This section includes questions on two types of support for your professional growth this year: (1) your participation in formal professional development , and (2) how your goals f or your growth as a teacher were supported
. In this section, we will ask you about your participation in **formal** professional development programs this year. By formal professional development programs, we mean coordinated groups of activities designed specifically for the purpose of teacher professional development, such as university courses, degree programs, workshops, conferences, seminars, or in-service training. In this section, please **do not** include experiences such as coaching or mentoring, participating in a network of educators, joint lesson planning, and observing or being observed by other teachers in your school , as we will ask you about those experiences later
. **A1. What is your best estimate of the**  **total number of hours of formal**  **professional development or**  **learning sessions in which**  **you participated**  **during the 2015 -** **2016 school year** **?** TOTAL NUMBER OF HOURS I did not participate in formal professional development this school year
............ 0 **GO TO A 4** 

**A 2**  **. Thinking about all**  **of the**  **formal professional development**  **in which you**  **participated during**  **the 2015** **- 2016**  **school year,**  **what is**  **your best**  **estimate of**  **the percentage**  **that was**  **personally delivered**  **or arranged**  **by your**  **principal ,**  **as opposed**  **to someone**  **else (such**  **as someone**  **from your**  **school ,**  **your district** **, or**  **an external**  **organization or**  **individu al**  **hired to**  **provide the professional development** **) ?**  PERCENTAGES SHOULD SUM TO 100 **a.** PERCENTAGE YOUR PRINCIPAL PERSONALLY DELIVERED **b.** PERCENTAGE YOUR PRINCIPAL PERSONALLY ARRANGED (BUT DID NOT PERSONALLY DELIVER)
**c.** PERCENTAGE SOMEONE OTHER THAN YOUR PRINCIPAL DELIVERED AND ARRANGEDPrepared by Mathematica Policy Research 3

**A 3**  **. Thinking about all**  **the formal**  **professional development that**  **you received during the 2015 -**  **2016 school year, please indicate the extent to which you agree or disagree**  **with the following statements**  **. The**  **formal professional development**  **I received...**
IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a . was aligned with m y own improvement goals 1  2  3  4  b
. was aligned with school-wide goals or plans for im provement 1  2  3  4  c. was aligned with evidence from my performance evaluations , observations of my teaching, or m y students’ performance data 1  2  3  4  d
. deepened or built upon m y identified strengths 1  2  3  4  e . addressed the pressing issues in m y classroom(s) 1  2  3  4  f
. engaged me in setting specific goals to improve my teaching 1  2  3  4  g . sent a consistent message about specific actions I could take to im prove m y teaching 1  2  3  4  h
. led me to make specific changes to m y teaching practice 1  2  3  4 Prepared by Mathematica Policy Research 4

The next set of questions ask s about how your goals f or your growth as a teacher were supported this year. **A 4** **. During**  **the 2015 -** **2016 school year, how often did you have an interaction about your growth as a teacher with**  **your principal ?**  Select one only  Never
................................ ................................ ................................ .................... 1 **GO TO A 6**   Yearly
................................ ................................ ................................ .................... 2  Quarterly
................................ ................................ ................................ ............... 3  Monthly
................................ ................................ ................................ ................. 4  Weekly
................................ ................................ ................................ .................. 5 **A 5** **. How**  **useful did you find**  **these interactions with**  **yo ur principal**  **?** Select one only  Not Very Useful
................................ ................................ ................................ .... 1  Som ewhat Useful
................................ ................................ ................................ . 2  Moderately Useful
................................ ................................ ................................ . 3  Very Useful
................................ ................................ ................................ ........... 4

**A 6**  **. During**  **the 2015 -** **2016 school year, how often did you have an interaction about your growth as a teacher with**  **someone other than your principal**  **(such as another teacher, a coach or mentor, an instructional leader in your school, or your assistant principal or department**  **chair) ?**  Select one only  Never
................................ ................................ ................................ .................... 1 **GO TO A 8**   Yearly
................................ ................................ ................................ .................... 2  Quarterly
................................ ................................ ................................ ............... 3  Monthly
................................ ................................ ................................ ................. 4  Weekly
................................ ................................ ................................ .................. 5 **A 7**  **. How useful did you find these interactions with**  **individuals other than**  **your principal**  **?** Select one only  Not Very Useful
................................ ................................ ................................ .... 1  Som ewhat Useful
................................ ................................ ................................ . 2  Moderately Useful
................................ ................................ ................................ . 3  Very Useful
................................ ................................ ................................ ........... 4Prepared by Mathematica Policy Research 5

**A 8**  **. During the 2015** **- 2016 school year,**  **did you have an individualized plan that established**  **short -**  **or long -** **term plans or goals**  **for your growth as a teacher ?**   Yes
................................ ................................ ................................ ........................ 1  No
................................ ................................ ................................ ......................... 0 **GO TO B1** 
**A 9**  **. Please**  **indicate the**  **extent to**  **which you**  **agree or**  **disagree with**  **the following**  **statements about this**  **individualized plan**  **.** IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a . The plan was aligned with my own improvement goals 1  2  3  4  b
. The plan was aligned with school-wide goals or plans for improvement 1  2  3  4  c. The plan was aligned with evidence from m y performance evaluations , observations of m y teaching, or m y students’ performance data 1  2  3  4  d
. The plan identified ways for me to deepen or build upon m y identified strengths 1  2  3  4  e . The plan addressed the pressing issues in m y classroom(s) 1  2  3  4  f
. The plan included specific goals to help me improve my teaching 1  2  3  4  g . The plan included specific actions I could take to im prove m y teaching 1  2  3  4  h
. The plan led me to make specific changes to my teaching practice 1  2  3  4  i
. I received resources or interventions that supported my progress toward goals in m y plan 1  2  3  4 Prepared by Mathematica Policy Research 6 **SECTION B**  **. TEA** **CHER INSTRUCTIONA L SUPPORTS**  This section asks questions about various instructional supports that you received during the school year
. **B1 .**  **Please indicate the frequency**  **and usefulness of support s**  **that you may have**  **received in the following forms during the 2015** **- 2016 school year** **. In Column A** **: For each type of**  **instructional support , mark**  **how often each occurred**

**during the 2015 -** **2016 school year .**  **In Column B: For each type of instructional support, mark**  **how useful**  **you found the**

**support. If**  **you did not receive the**  **support, mark “N/A .”** 

IN EACH ROW

, MARK ONE BOX ONLY IN BOTH A AND B A. How often did each of the following supports occur? B. How useful were each of the following supports? Never Yearly Quarterly Monthly Weekly Not Very Useful Somewhat

Useful Moderately

Useful Very

Useful N/A a. My principal coached or mentored me on my instructional practice 1  2  3  4  5  1  2  3  4  n  b. Someone other than my principal coached or mentored me on my instructional practice 1  2  3  4  5  1  2  3  4  n 
c. I coached or mentored another teacher 1  2  3  4  5  1  2  3  4  n  d. Another teacher(s) and I jointly planned lessons 1  2  3  4  5  1  2  3  4  n  e. I observed another teacher teaching, or another teacher observed me teaching 1  2  3  4  5  1  2  3  4  n  f
. Someone helped me locate formal professional development opportunities to support my goals 1  2  3  4  5  1  2  3  4  n  g. Someone at my school arranged an informal learning opportunity to support teacher growth 1  2  3  4  5  1  2  3  4  n  h. I had the opportunity to take a leadership role related to one of my identified areas of strength 1  2  3  4  5  1  2  3  4  n  i. A content expert worked with me 1  2  3  4  5  1  2  3  4  n  j I participated in a network of teachers formed specifically for the professional development of teachers 1  2  3  4  5  1  2  3  4  n Prepared by Mathematica Policy Research 7

**B2 .**  **P lease**  **indicate the f requency and usefulness of**  **the following types of instructional**  **support s**  **that you**  **may have received**  **specifically from your principal during the 2015** **- 2016**  **school year .**  **In Column A :**  **For each type of instructional support, mark**  **how often your**  **principal**

**provided you**  **the support. In Column B:**  **For each type of instructional support** **, mark how useful**  **you found the**

**support. If**  **you did not receive**  **the support**  **from your principal , mark “N/A** **.”**
IN EACH ROW

, MARK ONE BOX ONLY IN BOTH A AND B A. How often did **my principal**
... ? B. How useful were each of the following supports? Never Yearly Quarterly Monthly Weekly Not Very Useful Somewhat

Useful Moderately

Useful Very

Useful N/A **Instructional evaluation & feedback** a. observe my classroom instruction as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  b
. observe my classroom instruction not as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  c. give me specific feedback on the quality of my teaching as part of a state- or districtmandated evaluation 1  2  3  4  5  1  2  3  4  n  d
. give me specific feedback on the quality of my teaching not as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  e. work with me to develop specific instructional practice goals 1  2  3  4  5  1  2  3  4  n  f
. work with me to identify the evidence that would be used to assess whether my instructional practice goals were met 1  2  3  4  5  1  2  3  4  n  g . examine data to determine whether my instructional practice goals were met 1  2  3  4  5  1  2  3  4  n  **Support for data use** 1  2  3  4  5  1  2  3  4  n  f. discuss grade- or school-level student achievement data, teacher effectiveness data, or classroom observation data with me (either individually or as part of a group) 1  2  3  4  5  1  2  3  4  n  g. made data (student achievement data, teacher effectiveness data, or classroom observation data) or reports available to me 1  2  3  4  5  1  2  3  4  n  h
. suggest specific teaching actions to me, based on student achievement data, teacher effectiveness data, or classroom observation data 1  2  3  4  5  1  2  3  4  n Prepared by Mathematica Policy Research 8

IN EACH ROW

, MARK ONE BOX ONLY IN BOTH A AND B A. How often did **my principal** ...? B. How useful were each of the following supports? Never Yearly Quarterly Monthly Weekly Not Very Useful Somewhat

Useful Moderately

Useful Very

Useful N/A **Other instructional support** 1  2  3  4  5  1  2  3  4  n  i
. review my teaching plans to ensure that they were aligned with curriculum standards 1  2  3  4  5  1  2  3  4  n  j
. suggest specific strategies to improve student engagement 1  2  3  4  5  1  2  3  4  n  k
. share instructional materials or curricula to support my instructional goals 1  2  3  4  5  1  2  3  4  n  l
. help me establish classroom systems or routines to support high expectations for students 1  2  3  4  5  1  2  3  4  n Prepared by Mathematica Policy Research 9

**B3 .**  **P lease**  **indicate the frequency and usefulness of the following types of instructional**  **support s**  **that you**  **may have received**  **from someone other than your principal**  **( such as**  **another teacher, a coach /** **mentor, an assistant principal, a**  **department chair , or a distri** **ct administrator** **) during the 2015** **- 2016 school year** **. In Column A** **: For each type of instructional support,**  **mark how often someone other than** 

**your principal provided**  **you the support.**  **In Column B: For each type of instructional support, mark**  **how useful you found the** 

**support. If**  **you did not receive the**  **support from someone other than your**  **principal , mark “N/A** **.”**
IN EACH ROW

, MARK ONE BOX ONLY IN BOTH A AND B A. How often did **someone other**  **than my principal** ...? B. How useful were each of the following supports? Never Yearly Quarterly Monthly Weekly Not Very Useful Somewhat

Useful Moderately

Useful Very

Useful N/A **Instructional evaluation & feedback** a. observe my classroom instruction as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  b. observe my classroom instruction not as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  c. give me specific feedback on the quality of my teaching as part of a state- or districtmandated evaluation 1  2  3  4  5  1  2  3  4  n  d. give me specific feedback on the quality of my teaching not as part of a state- or district-mandated evaluation 1  2  3  4  5  1  2  3  4  n  e. work with me to develop specific instructional practice goals 1  2  3  4  5  1  2  3  4  n  f
. work with me to identify the evidence that would be used to assess whether my instructional practice goals were met 1  2  3  4  5  1  2  3  4  n  g . examine data to determine whether my instructional practice goals were met 1  2  3  4  5  1  2  3  4  n  **Support for data use** 1  2  3  4  5  1  2  3  4  n  f. discuss student grade- or school-level achievement data, teacher effectiveness data, or classroom observation data with me (either individually or as part of a group) 1  2  3  4  5  1  2  3  4  n  g. made data (student achievement data, teacher effectiveness data, or classroom observation data) or reports available to me 1  2  3  4  5  1  2  3  4  n  h
. suggest specific teaching actions to me, based on student achievement data, teacher effectiveness data, or classroom observation data 1  2  3  4  5  1  2  3  4  n Prepared by Mathematica Policy Research 10

IN EACH ROW

, MARK ONE BOX ONLY IN BOTH A AND B A. How often did **someone other**  **than my principal** ...? B. How useful were each of the following supports? Never Yearly Quarterly Monthly Weekly Not Very Useful Somewhat

Useful Moderately

Useful Very

Useful N/A **Other instructional support** 1  2  3  4  5  1  2  3  4  n  i
. review my teaching plans to ensure that they were aligned with curriculum standards 1  2  3  4  5  1  2  3  4  n  j
. suggest specific strategies to improve student engagement 1  2  3  4  5  1  2  3  4  n  k
. share instructional materials or curricula to support instructional goals 1  2  3  4  5  1  2  3  4  n  l
. help me establish classroom systems or routines to support high expectations 1  2  3  4  5  1  2  3  4  n Prepared by Mathematica Policy Research 11

**B4 .**  **Thinking about**  **all the**  **instructional supports**  **you received**  **during the**  **2015 -** **2016 school**  **year, please**  **indicate the**  **extent to**  **which you**  **agree or**  **disagree with**  **the following**  **statements .**  **The instructional supports that I received...** IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a . were aligned with m y own improvement goals 1  2  3  4  b
. were aligned with school-wide goals or plans for im provement 1  2  3  4  c. were aligned with evidence from my performance evaluations, observations of my teaching, or m y students’ performance data 1  2  3  4  d
. deepened or built upon m y identified strengths 1  2  3  4  e . addressed the pressing issues in m y classroom(s) 1  2  3  4  f
. engaged me in setting specific goals to improve my teaching 1  2  3  4  g . sent a consistent message about specific actions I could take to im prove m y teaching 1  2  3  4  h
. led m e to make specific changes to my teaching practice 1  2  3  4 
**B5 .**  **Thinking about all the times during the 2015 -** **2016 school year someone came to**  **your classroom to observe your teaching**  **, what is**  **your best estimate of the total number of**  **observations that took place in your classroom ?**  TOTAL NUMBER OF OBSERVATION S My classroom was never observed
................................ ................................ ...... 0 **GO TO B7**  **B6 .**  **Thinking about all the times during the 2015 -** **2016 school year someone came to**  **your classroom to observe your teaching**  **, what is your best estimate of the duration ( in mi**  **nutes )**  **of each of the following? a.**  A TYPICAL OBSERVATION THAT YOU EXPERIENCED NUMBER OF MINUTES **b.** THE SHORTEST OBSERVATION THAT YOU EXPERIENCED NUMBER OF MINUTES **c.** THE LONGEST OBSERVATION THAT YOU EXPERIENCED NUMBER OF MINUTESPrepared by Mathematica Policy Research 12

**B7 .**  **Please i**  **ndicate the**  **extent to**  **which you**  **agree or**  **disagree with**  **the following**  **statements about the**  **instructional feedback you received during the 2015** **- 2016 school year** **. I received feedback on my instruction**  **that ...**  IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a. addressed the pressing issues in m y classroom(s) 1  2  3  4  b. included questions soliciting m y own reflection on teaching practices 1  2  3  4  c. involved me talking more than the evaluator 1  2  3  4  d. was depersonalized, with a focus on my performance rather than my personality or me as an individual 1  2  3  4 
e. used evidence as a starting point for reflection 1  2  3  4  f. provided me with actionable steps for im provement 1  2  3  4  g. focused on improving aspects of my teaching practice that are realistic for me to change 1  2  3  4  h. identified trends in m y instructional practice, based on analysis of evidence, such as changes over time or patterns across different populations of students 1  2  3  4  i. was related to feedback I received earlier in the year on the same issue or area for improvement 1  2  3  4  j. provided descriptions of specific things that m y students and I did or said during a classroom observation 1  2  3  4  k
. included recognition of my accomplishments or helped me identify m y areas of strength 1  2  3  4  l
. helped me identify my areas of instructional practice that need im provement 1  2  3  4 Prepared by Mathematica Policy Research 13 **SECTION C**  **. SCHOOL CULTURE A** **ND IMPROVEMENT** The next section includes questions about improvement plans in your school , your principal’

s practices during the school year

, and your school’s climate and culture
. **C1 .**  **D uring the 2015** **- 2016 school year** **, how often did your principal do each of the following?**  **My principal...**  IN EACH ROW

, MARK ONE BOX ONLY Never Yearly Quarterly Monthly Weekly a. communicated a clear vision for our school ’s instructional quality through his/her regular communications 0  1  2  3  4  b. discussed his/her goals for im proving our school’s instructional quality with teachers 0  1  2  3  4  c. communicated progress toward goals for im proving our school’s instructional quality to teachers 0  1  2  3  4 

**C 2**  **. Please**  **i ndicate**  **the extent**  **to which**  **you agree**  **or disagree**  **with the**  **following statements**  **about plans for**  **improvement in your school during the 2015 -** **2016 school year .**  IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree Don’t

Know a . Teachers collaborated with the administration to shape plans 0  1  2  3  n  b
. Plans detailed the measures that would be tracked to measure progress toward goals 0  1  2  3  n  c. Plans were consistent with teachers’ own goals for their individual growth 1  2  3  4  n  d
. Plans clearly outlined specific steps that teachers could take to improve their teaching 0  1  2  3  n Prepared by Mathematica Policy Research 14

**C 3**  **. Please**  **indicate the**  **extent to**  **which you**  **agree or**  **disagree with**  **the following**  **statements about your**  **principal during the 2015** **- 2016 school year** **. My** **principal...** IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a. knows what effective teaching looks like 1  2  3  4  b
. m ade teachers feel comfortable to try new things in the classroom 1  2  3  4  c. com mu nicated clear standards for student learning 1  2  3  4  d
. was transparent about performance expectations for teachers 1  2  3  4  e . expected teachers to continually learn and grow 1  2  3  4  f. encouraged teachers to implement what they learned in professional development 1  2  3  4  g. informed teachers about resources they could use to improve their instruction 1  2  3  4  h. encouraged teachers to share ideas and work together to improve their teaching 1  2  3  4  i. praised or encouraged teachers for their efforts to im prove their teaching 1  2  3  4  j. worked directly with teachers to help them im prove their instruction 1  2  3  4  k. knew what was going on in classrooms 1  2  3  4  l
. changed instructional assignments to match teachers’ expertise with student needs 1  2  3  4 Prepared by Mathematica Policy Research 15

**C 4** **. Please**  **indicate the**  **extent to**  **which you**  **agree or**  **disagree with**  **the following**  **statements about your school**  **.** IN EACH ROW

, MARK ONE BOX ONLY Strongly Disagree Disagree Agree Strongly Agree a. Teachers at my

school help and support each other 1  2  3  4  b. Teachers at my

school feel comfortable raising issues and concerns that are important to them 1  2  3  4  c. Teachers at my

school trust each other 1  2  3  4  d
. In m y school, teachers are encouraged to experiment in their classrooms 1  2  3  4  e . In m y school, teachers are expected to continually learn and seek out new ideas for teaching 1  2  3  4  f
. Academic achievement is recognized and acknowledged in my school 1  2  3  4  g . The learning environment is orderly and engaged 1  2  3  4  h
. Students respect others who get good grades 1  2  3  4  i
. Teachers at my

school encourage students to keep trying even when the work is challenging 1  2  3  4  j
. Teachers at my

school set high expectations for academic work 1  2  3  4 Prepared by Mathematica Policy Research 16 **SECTION D**  **. TEA CHER BA** **CKGROUND A ND EXPERIENCE**  You ’re almost done! In this last section, please tell us about your background and teaching experience. **D 1**  **. What is the highest degree you have earned?**  Select one only  Associate’s degree
................................ ................................ ............................... 1  Bachelor’s degree (B.A., B.S., etc.)
................................ ................................ ...... 2  Master’s degree (M.A., M.A.T., M.B.A., 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.)
................................ ................................ ................................ .................. 5  Do not have a degree
................................ ................................ ........................... 6 **D 2**  **. Whi** **ch of the following describes the teaching certificate you held in June**  **201 5**  **(i.e., the beginning of the summer prior to this past school year) 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 in this state
................................ ..... 5 **D3 .**  **How many years have you worked as a teacher in any school**  **( please**  **round up to the nearest whole number and include the current school year)?**  TOTAL YEARS
**D4 .**  **How many years have you worked as a teacher at this**  **school ( please**  **round up to the nearest whole number and include the current school year)?**  TOTAL YEARS **D5 .**  **Are you of Hispanic or Latino origin?**   Yes
................................ ................................ ................................ ........................ 1  No
................................ ................................ ................................ ......................... 0Prepared by Mathematica Policy Research 17

**D6 .**  **What is your race?** Select all that apply  Am erican Indian or Alaska Native
................................ ................................ ........ 1  Native Hawaiian or other Pacific Islander
................................ ............................. 2  Asian
................................ ................................ ................................ ..................... 3  Black or African American
................................ ................................ .................... 4  Wh ite
................................ ................................ ................................ ..................... 5 **D7 .**  **Are you male or female?**   Male
................................ ................................ ................................ ...................... 1  Female
................................ ................................ ................................ .................. 2 **D8 .**  **In what year were you born?** YEAR

YYYY 19