Evaluation of the DC Opportunity 

Scholarship Program

Elementary School (Grades 4-5)

Student Questionnaire

Spring 2013

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. The valid OMB control 

number for this information collection is xxxx-xxxx. Public reporting burden for this collection is 

estimated to average 15 minutes per response, including the time to review instructions, search existing 

data resources, gather the data needed, and complete and review the information collection. Completion 

of this survey is mandatory. SOAR Act Sec. 3009(a)(3)(C). .

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 

Avenue, S.W., LBJ, Room 2E117, Washington, DC 20210-4537 or send electronically through the 

Federal eRulemaking Portal at http://www.regulations.gov by selecting the Docket ID number.

OMB #: 

Expiration Date: 
Elementary School Student Questionnaire - Spring 2013 1

Please answer all the questions.

Part 1: About You

This first section asks questions about you.

Q1. Are you a .... (Previous DC Choice Study survey)

( Check one)

Boy or ...............................................

1

Girl?...................................................

2

Q2. How often do you read books that are not assigned by your teacher? 

( Check one) (Previous DC Choice Study survey)

Every day ..........................................

1

Most days..........................................

2

Some days ........................................

3

Never.................................................

4

Q3. How far do you expect to go in school?

( Check one) (Question is from Previous DC Choice Study 

survey; response categories are from HSLS, 2009: First Follow-up)

Less than high school completion.................................................................................

1

Complete a high school diploma, GED or alternative high school credential ...............

2

Complete a certificate or diploma from a school that provides occupational training ..

3

Complete an Associate’s degree ..................................................................................

4

Complete a Bachelor’s degree......................................................................................

5

Complete a Master’s degree.........................................................................................

6

Complete a Ph.D., M.D., law degree, or other high level professional degree.............

7

Q4. During this year, have you done any of the following?

( Check yes or no on each row)

(Previous DC Choice Study survey)

Yes No

a. Participated in groups or activities at your church 

(like choir or youth group).............................. 

1 2

b. Participated in a team or club (like little league or 

girl scouts/boy scouts) in your community..... 

1 2

c. Participated in a team or club (like sports, music, 

or dance) at your school........................... 

1 2

d. Participated in a community service activity or 

volunteer work at your school or in your 

community ..................................................... 

1 2

e. Gone to religious services ............................. 

1 2
Elementary School Student Questionnaire - Spring 2013 2

Q5. On a regular school day, how long are you at home after school with no adult there?

( Check one) (Previous DC Choice Study survey)

None.....................................................

0

Less than 1 hour ..................................

1

1-2 hours ..............................................

2

2-3 hours ..............................................

3

More than 3 hours ................................

4

Q6. Do you work hard at school? (new item)

( Check one)

Yes .......................................................

1

No.........................................................

2

Q7. How important are each of the following in causing you to want to work harder in school?

( Check one box on each row) (Bishop, CAHRS WP03-06 Item 15, revised)

Very 

important

Somewhat 

important

Not too 

important

Not at all 

important

Pressure from my parents................................

1 2 3 4

Pleasing my parents by getting good 

grades ................................................................

1 2 3 4

Teacher expectations.........................................

1 2 3 4

Pleasing my teacher...........................................

1 2 3 4

Encouragement from my teachers.....................

1 2 3 4

Learning the material .........................................

1 2 3 4

Interest in the subject.........................................

1 2 3 4

Keeping up with my friends................................

1 2 3 4

Getting a better job.............................................

1 2 3 4

Getting into college ............................................

1 2 3 4

Pressure from my friends ................................ 

1 2 3 4

Not embarrassing my family ..............................

1 2 3 4
Elementary School Student Questionnaire - Spring 2013 3

Part 2: About Your School and Classes

This section asks questions about your school and classes, support from 

teachers and other adults in the school and other students’ attitudes.

Q8. Do you agree or disagree with these statements about your school?

( Check one box on each row)

(Previous DC Choice Study survey)

Agree 

strongly Agree Disagree

Disagree 

strongly

Students are proud to go to this school ....... 

1 2 3 4

Students at this school have a lot of 

opportunities to learn....................................



1 2 3 4

Rules of behavior are strict .......................... 

1 2 3 4

I don’t feel safe............................................. 

1 2 3 4

People at my school are supportive............. 

1 2 3 4

I feel alone at my school .............................. 

1 2 3 4

I enjoy going to school ................................. 

1 2 3 4

Q9. Did the following ever happen to you at school this year?

( Check one box on each row) (Previous DC Choice Study survey)

Never

Once or 

twice

3 times or 

more

a. Had something stolen from your desk, 

locker, or other place ............................................... 

1 2 3

b. Been forced by other kids to give them 

money or my stuff .................................................... 

1 2 3

c. Been offered drugs .................................................. 

1 2 3

d. Been physically hurt by another student ................. 

1 2 3

e. Been threatened with physical harm ....................... 

1 2 3

f. Seen anyone with a real or toy gun or knife 

at school .................................................................. 

1 2 3

g. Been bullied at school ............................................. 

1 2 3

h. Been called a bad name.......................................... 

1 2 3
Elementary School Student Questionnaire - Spring 2013 4

Q10. Do you agree or disagree with these statements about the teachers and other adults at your 

school?

( Check one box on each row) (Previous DC Choice Study survey)

Agree 

strongly Agree Disagree

Disagree 

strongly

At my school, there is a teacher or 

some other adult who...

a. listens to me when I have something to 

say ................................................................ 

1 2 3 4

b. really cares about me ...................................... 

1 2 3 4

c. believes I will be a success ............................. 

1 2 3 4

d. always wants me to do my best....................... 

1 2 3 4

e. tells me when I do a good job.......................... 

1 2 3 4

f. notices when I’m not there............................... 

1 2 3 4

g. talks to me about problems I have at 

home or with my friends ................................ 

1 2 3 4

h. motivates me to work hard .............................. 

1 2 3 4

Q11. During the current school year (2012-2013), have teachers and other school staff provided you 

with support? If they did, was it helpful? 

( Check two boxes on each row) (NLTS 2012, Baseline Interview for Youth)

Yes No Very 

Helpful

Somewhat 

Helpful

Not 

Helpful

a. Extra help before or after school 

in academic subjects? ................................

1 2 1 2 3

b. Academic instruction on 

weekends?............................................................. 

1 2 1 2 3

Q12. Do you agree or disagree with these statements about the students at your school?

( Check one box on each row) (Previous DC Choice Study survey)

Agree 

strongly Agree Disagree

Disagree 

strongly

At my school, students...

a. behave well with the teachers .................... 

1 2 3 4

b. often don’t do their homework.................... 

1 2 3 4

c. often make fun of each other...................... 

1 2 3 4

d. often disrupt class ...................................... 

1 2 3 4

e. who misbehave often get away with it........ 

1 2 3 4
Elementary School Student Questionnaire - Spring 2013 5

Q13. What overall grade would you give your school?

( Check one)

(Previous DC Choice Study survey)

A-Excellent ........................................

1

B-Good..............................................

2

C-Fair ................................................

3

D-Unsatisfactory................................

4

F-Failing ............................................

5

Q14. During this year, have you taken classes in?

( Check yes or no on each row) (Previous DC Choice Study survey)

Yes No

a. Art, music, or dance lessons ................ 

1 2

a. Foreign language classes..................... 

1 2

b. Religion................................................. 

1 2

c. Sports exercise or gymnastics ............. 

1 2

Q15. How much do you agree or disagree with the following statements about your teacher?

Remember, your teacher and your principal will not see any of the answers you provide. Your 

teacher...( Check one box on each row) (HSLS, 2009 – Baseline)

Agree 

strongly Agree Disagree

Disagree 

strongly

a. Values and listens to students’ ideas ............

1 2 3 4

b. Treats students with respect..........................

1 2 3 4

c. Treats every student fairly .............................

1 2 3 4

d. Thinks every student can be 

successful......................................................

1 2 3 4

e. Thinks mistakes are okay as long as 

all students learn ...........................................

1 2 3 4

f. Treats some kids better than other 

kids ................................................................

1 2 3 4

g. Makes learning interesting.............................

1 2 3 4

h. Treats males and females differently ............

1 2 3 4

i. Makes things easy to understand..................

1 2 3 4

Q16. On average, how many minutes do you spend doing homework per day?

( Check one) (Adapted Bishop, CAHRS WP03-06 Item 9)

0 minutes...........................................

0

1 to 10 minutes .................................

1

11 to 20 minutes ...............................

2

21 to 30 minutes.............................

3

31 to 60 minutes................................

4

More than 60 minutes .......................

5
Elementary School Student Questionnaire - Spring 2013 6

Part 3: About Your Friends 

This section asks questions about your friends.

Q17. How many of your close friends do your parents know by name?

( Check one) (Previous DC Choice Study survey)

All of them ........................................

1

Most of them .....................................

2

Some of them....................................

3

None of them.....................................

4

Q18. Think about your close friends. How many of them do the following?

( Check one box on each row)

(Previous DC Choice Study survey)

All of 

them

Some 

of 

them

A few of 

them None

Use bad language regularly ............................... 

1 2 3 4

Smoke cigarettes regularly ................................ 

1 2 3 4

Drink beer or alcohol regularly ........................... 

1 2 3 4

Use illegal drugs regularly................................

1 2 3 4

Talk about classes in school and what 

they are learning ................................................ 

1 2 3 4

Talk about what could be done to 

improve the neighborhoods and the city............ 

1 2 3 4

Q19. Do you agree or disagree with the following statements:

( Check one box on each row) (Bishop, CAHRS WP03-06 Item 19)

Agree 

strongly Agree Disagree

Disagree 

strongly

My friends make fun of people who try 

to do real well in school......................................



1 2 3 4

My friends joke around and annoy the 

teacher ............................................................... 

1 2 3 4

To keep up with my friends, I have to 

work hard at my school work ............................. 

1 2 3 4

My friends think kids who study a lot are

less popular........................................................ 

1 2 3 4
Elementary School Student Questionnaire - Spring 2013 7

Q20. How important do your friends think it is to:

( Check one box on each row) (Bishop, CAHRS WP03-06 Item 23)

Very 

important

Somewhat 

important

Not too 

important

Not at all 

important

Study hard to get good grades...........................

1 2 3 4

Talk/hang out with friends ................................

1 2 3 4

Participate in class .............................................

1 2 3 4

Q21. Which group of friends do you listen to the most when you think about school?

( Check one box) (new item)

Friends from your neighborhood....................................

1

Friends from school........................................................

2

My neighborhood friends are the same 

as my school friends ......................................................

3

Thank you, please hand in your survey.