### Appendix B.

NHES:2015 Screener Survey**24114019**



# §9,I4¤ NHES-1B **(12/06/2013) OMB No. 1850-0803: Approval Expires 09/30/2016**  

# National Household Education Survey UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration U.S. Census Bureau

**The National Center for Education Statistics is authorized to conduct this survey under U.S. Code Title 20, Section 9543 (20 USC § 9543). Your participation is voluntary. Your answers may be used only for statistical purposes and**  **may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 USC § 9573). The information you provide will be combined with information from other participants to produce statistical**  **summaries and reports. The Department of Education is**  **studying the education and training experiences of adults and children.**  **Each household is different, and we need your response so we can send**  **you a survey that is right for your household.**  **Return this form even if there are only one or two people in**  **the household. This survey should be filled out**  **by an adult household member living at this address.**  **Please use a blue or black pen if available.**  1. How many people live in this household? **Include adults and children who are temporarily away from home**  **(for example, living in college housing) if they have no other**  **permanent home.**▼▼▼ **24114027**



# §9,I<¤ 2. What is his or her first name, initials, or nickname? 

## You / Person 1

3. What is this person’s month and year of birth?

5. Is this person currently in

6. What is this person’s current grade or equivalent? **Female Male** 

**Public or private school, or preschool,**  . . . **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 2.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these** 

## Person 2

**Female Male** 

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 3.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these First names will**  **be used only to ask you questions**  **about the education of a specific person.**  

## ▼ ▼

**First name/initials/nickname First name/initials/nickname**

**College, university or vocational school, or**  **College, university or vocational school, or**  

# Start Here

4. What is this person’s sex?

**Mark [**  X **] ONE only.** 

**NHES-1B 2** 



# National Household Education Survey

Continue answering questions 2 through 6 for each person living in this household. Include all adults and children. Start with yourself. **month year /**  **month year /** If there are more than 5 people in your household, continue on the next page. Otherwise, stop here and return this form in the postage-paid envelope provided. **24114035**



# §9,ID¤ Person 4 Person 5 

## ▼ ▼

**First name/initials/nickname First name/initials/nickname** 

**3**▼ 

## Person 3 

## ▼

**First name/initials/nickname** 

### Conducted for: U.S. Department of Education National Center for Education Statistics

**Female Male** 

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 4.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or Female**  **Male**

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO page 4.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or Female**  **Male**

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 5.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or**

**NHES-1B month year**  **/ month year**  **/ month year**  **/**2. What is his or her first name, initials, or nickname? 

## Person 6 Person 7 

## ▼ ▼

**First name/initials/nickname First name/initials/nickname** If there are more than 5 people in your household, please continue answering for each person living in this household. **If you have finished answering about everyone in the household please**  **return the survey in the postage-paid envelope provided.**  **24114043**



# §9,IL¤ Continue

**4** 

# National Household Education Survey

**First names will be used only to**  **ask you questions about the education**  **of a specific person.** 3. What is this person’s month and year of birth?

5. Is this person currently in

6. What is this person’s current grade or equivalent? **Female Male** 

**Public or private school, or preschool,**  . . . **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 7.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these Female**  **Male**

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 8.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or College, university or**  **vocational school, or** 4. What is this person’s sex?

**Mark [**  X **] ONE only.** 

**NHES-1B month year**  **/ month year**  **/**

## Person 9 Person 10 

## ▼ ▼

**First name/initials/nickname First name/initials/nickname**  

## Person 8 

## ▼

**First name/initials/nickname**

Please verify you have filled out a column for everyone in your household. **24114050**



# §9,IS¤ **5**▼ Thank you. Please return this form in the postage-paid envelope provided or mail it to:▼ U.S. Census Bureau ATTN: DCB 60-A 1201 E. 10th Street Jeffersonville, IN 47132-0001 Toll-free number for questions: 1-888-840-8353 

### Conducted for: U.S. Department of Education National Center for Education Statistics

**Female Male** 

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 9.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or Female**  **Male**

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** Return survey.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or Female**  **Male**

**Public or private school, or preschool,**  **Homeschool instead**  **of school for some or all classes,** 

**Not in school?** GO TO person 10.
**Preschool Kindergarten**  **write grade 1 through 12**  **College, university or vocational school**  **None of these College, university or**  **vocational school, or**

**NHES-1B month year**  **/ month year**  **/ month year**  **/ 24114068** 



# §9,Ie¤ THIS PAGE INTENTIONALLY LEFT BLANK

**6 NHES-1B** **24114076**



# §9,Im¤ **7** 

# Thank you. **Please return this questionnaire in the postage-paid envelope provided. If you have lost the envelope, mail the completed questionnaire to:** 
U.S. Census Bureau ATTN: DCB 60-A 1201 E. 10th Street Jeffersonville, IN 47132-0001

**NHES-1B 24114084** 



# §9,Iu¤ **8** 

### Commonly Asked Questions Q: How did you get my address? **A: Your address was randomly selected from among all of the home addresses in the nation. It was selected using scientific sampling methods to represent other households in the U.S.**  Q: Why don’t you ask more questions about education in this questionnaire? **A: The purpose of this questionnaire is to find out if anyone in your household is eligible for the next stage of the survey. If so, we will send a second questionnaire that will ask about educational**  **experiences of a member of your household.** Q: If there are no children or anyone currently in school in my household, should I respond? **A: Yes, you should respond to this survey. Once you return the questionnaire, the study will be able to see if anyone in your household is eligible for the next and final survey. If no one is eligible,**  **you will not receive another survey.** Q: Why should I take part in this study? Do I have to do this?**A: This survey is the only way that the Department of Education can learn about children’s after school care and adult training and education from your perspective. You represent thousands of**  **other households like yours, and you cannot be replaced. Your answers and opinions are very important to the success of this study. You may choose not to answer any or all questions in this**  **survey. In order for the survey to be representative, it is important that you complete and return this questionnaire. Those who do not return the survey will not be represented in key statistics**  **used by policymakers and researchers.** Q: How will the information I provide be used? Will my privacy be protected? **A: Your responses will be combined with those of others to produce statistical summaries and reports. Your individual data will not be reported. Your answers may be used only for statistical**  **purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 USC § 9573).**  Q: How much time will it take? **A: On average, it should take 8 minutes or less for you to respond, including the time for reviewing instructions and completing and reviewing the collection of information.** 

**NHES-1B** 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education

. This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 5-10 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Andrew Zukerberg , National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e-mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353

### Appendix C. NHES:2015 Topi cal Surveys C.1 Credentials for Work Survey (CWS) C.2 Training for Work Survey (TWS) C.3 Early Childhood Program Participation (ECPP) Survey C.4 Parent and Family Involvement in Education (PFI) Survey for Enrolled Students C.5 Parent and Family Involvement in Education (PFI) Survey for Homeschooled Students

### C.1 Credentials for Work Survey (CWS)

# Adult Training and Education Survey

Part of the 2015 National Household Education Survey 

# Ad ul t

Conducted by UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration 

### U.S. Census Bureau 

# Adult Training and Education Survey Part of the 2015 National Household Education Survey OMB No. 1850-0803: Approval Expires 09/30/2016



# Thank you for helping us with this survey. Based on the information we received from your household in your last survey, we’re asking you to complete this final step.2 

# This page left blank intentionally.3 

# Instructions

 

### In response to the survey you answered earlier, we recorded that the person listed below is between the ages of 16 to 65, is not in high school, and lives in this household. If this information is not correct, please call us at the toll-free number below so we can be sure you received the correct survey.

 

### These questions should be filled out by:

No one else in the household should fill out the survey.

 

### You might be asked to skip questions that do not apply to you. Follow the arrows to answer the questions that apply to you. Please see the example below:  

### No  

### Yes

 

### To answer a question, simply mark the box [X] that best represents your answer.
 

### Use a black or blue pen, if available, to complete this survey.
 

### Please return the completed survey using the postage- paid envelope provided.
 

### If you have any questions about this survey, please call us at our toll- free number: 1-8 88 - 840 - 8353 . We are authorized to collect this information by U.S. Code, Title 20, Section 9543. You do not have to provide the information requested. However, the information you provide will help the Department of Education’s ongoing efforts to learn more about the educational experiences of adults. There are no penalties should you choose not to participate in this study. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (U.S. Code, Title 20, Section 9573). Your responses will be combined with those from other participants to produce summary statistics and reports. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0803. The time required to complete this survey is estimated to average 10 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Lisa Hudson, National Center for Education Statistics, National Household Education Surveys (NHES), 1990 K Street, NW, Washington, DC 20006. You may send email to NHES@census.gov. GO TO question 124 

### 1. What is the highest degree or level of school you have completed? (Mark one.)  

### Elementary or high school, but no high school diploma or GED ®  

### High school diploma  

### GED ® or alternative high school credential  

### Some college credit but less than one year of college credit  

### 1 or more years of college credit, no degree  

### Associate’s degree (for example, AA, AS)  

### Bachelor’s degree (for example, BA, BS)  

### Master’s degree (for example, MA, MS, MEng, MEd, MSW, MBA)  

### Professional degree beyond a bachelor’s degree (for example, MD, DDS, DVM, LLB, JD)  

### Doctorate degree (for example, PhD, EdD) 

# Level of Education 2. What was the major or field of study for your highest degree or level of education? (Mark one.) If there was more than one, please choose the one you consider most important.  

### General studies, no major, undeclared major  

### Accounting, finance, insurance, real estate  

### Administrative support  

### Arts, music, design  

### Audio, broadcasting, multimedia, or graphics technologies  

### Business management, marketing  

### Communications, journalism  

### Computer science, information technology  

### Construction, repair, manufacturing, transportation  

### Education  

### Engineering, architecture  

### English language, literature  

### Family or consumer science  

### Healthcare, nursing, medicine  

### Law enforcement, security, firefighting  

### Law, legal studies  

### Liberal arts  

### Political science, economics, history, other social sciences  

### Psychology  

### Religious vocations, theology  

### Sciences (biological or physical), mathematics  

### Social or human services, public administration  

### Other (specify)5 

### 3. Do you have a currently active professional certification or a state or industry license? Do not include business licenses, such as a liquor license or vending license. A professional certification or license shows you are qualified to perform a specific job and includes things like Licensed Realtor, Certified Medical Assistant, Certified Teacher, or an IT certification.

 

### No  

### Yes

4. If yes, how many certifications and licenses do you have? If you had to get a certification in order to get a license, count each certification and license separately. Number of certifications and licenses 

# Certifications and Licenses

GO TO question 10

CONTINUE on the next page.6



### 5. Please answer questions 5a – 5d for each currently active certification and license you have, up to three
. If you have more than three, answer for the three you last earned or renewed. Certification or License

#1 Certification or License #2 Certification or License #3 5a. What is the name of the certification or license? Do not include college degrees. 5b. Using Table A on the next page, what is its subject field? Number from Table A Number from Table A Number from Table A 5c. Was it issued by the federal, state, or local government? (For example, by a state board of education or other state board, OSHA, or FAA)  

### No  

### Yes  

### Don’t know  

### No  

### Yes  

### Don’t know  

### No  

### Yes  

### Don’t know

5d. Is it for your current job? (Mark one.) If you are not employed, answer “no”.  

### No  

### Yes, and it is required  

### Yes, but it is not required  

### No

 

### Yes, and it is required  

### Yes, but it is not required  

### No  

### Yes, and it is required  

### Yes, but it is not required

6. Of the certifications and licenses that you listed above, which did you earn or renew last? (Mark one.)

 

### Certification or license #1  

### Certification or license #2  

### Certification or license #3

CONTINUE on page 8.7



## TABLE A. FIELD OF CERTIFICATION OR LICENSE CODES FOR QUESTION 5 b
1. EMT, CPR, basic first aid
2. Health care (

for fitness use code 13 ) Includes nursing, health care technologist or technician, medical practitioners (such as MD, OD, PA, DC, PharmD, DVM), and health care specialties.
3. Accounting, finance, insurance, real estate ( for notary public use code 12 )
4. Business management or operations Includes project management, Six Sigma, Lean Manufacturing, and other business management and operations.
5. Childcare
6. Computer science, information technology Includes software development and applications, networking, and other computer and information technologies.
7. Cosmetology, barbering
8. Engineering, architecture, energyIncludes engineering and engineering technologies, architecture, drafting, LEED, energy auditing and other similar fields.
9. Food handling, sanitation Includes food handling, water treatment and sanitation, hazardous waste operations, and other sanitation fields. 10. Funeral, mortuary, taxidermy 11. Legal practice 12. Notary public Nursing ( use code 2) 13. Physical fitness Includes personal or athletic trainer, yoga instructor, and other fitness instruction. 14. Public safety , security Includes law enforcement, firefighting, flight attendant, and other public safety services ( for water and hazardous waste treatment use code 9 ). 15. Religious ordination 16. Skilled trades Includes auto repair, HVAC installation and maintenance, construction trades, welder, machinist, and manufacturing or production technician . 17. Social work, counseling 18. Teaching Includes preschool through grade 12 teaching, TESOL, and adult education. ( For other instructional fields, use the code for that field; for example, flight instructors use code 19 for transportation. ) 19. Transportation Includes CDL, aviation or marine piloting, and other transportation work ( for flight attendant use code 14 ). 20. Other fields not listed above8 

### 7. How useful has your last certification or license been for each of the following?

a. Getting a job (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell
b. Keeping a job (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell

c. Increasing your pay (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell
d. Keeping you marketable to employers or clients (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell

e. Improving your work skills (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell CONTINUE on the next page. 

### The rest of this section asks about the certification or license from question 6 that you last earned or renewed.
▼ ▼ 

### 8. Did you do any of the following to prepare for earning your last certification or license? (Mark ONE box in each row below.)

9. The next time your last certification or license is up for renewal, do you plan to renew it or let it expire? (Mark one.)  

### Renew it  

### Let it expire  

### Have not decided  

### It does not have to be renewed No Yes



### a. Earned a college degree b. Took classes from a college, technical school, or trade school (no degree)

c. Took classes or training from a company, association, union, or private instructor d. Studied on my own using textbooks or on - line resources e. Participated in on - the - job training, an internship, or apprenticeship9



# Certificates 10. People sometimes earn certificates for completing an education or training program. A certificate is different from a certification or license. Do NOT include certifications/licenses here; include them in the previous section only. Have you ever earned any of the following types of certificates?
a. A certificate for completing a training program from an employer, employment agency, union, software or equipment manufacturer, or other training provider, but NOT from a school.  

### No  

### Yes b. A certificate for completing a vocational program at a high school.  

### No  

### Yes
c. A high school equivalency certificate, such as a GED®.  

### No  

### Yes d. A certificate—rather than a degree—forcompleting a program at a community or technical college, or other school after high school. Do not include teaching certificates or college degrees.  

### No  

### Yes 11. (If yes.) We will refer to the certificates in question 10d as “post - secondary certificates.” Where did you get your last post - secondary certificate? (Mark one.)  

### A community college  

### A vocational, technical, trade, or business school  

### Another college or university  

### Someplace else Specify:______________ If you do NOT have a post

- secondary certificate, go to question 19. GO TO question 19 

### 12. What was the field of study for your last post - secondary certificate? (Mark one.)
 

### Accounting, finance, insurance, real estate  

### Administrative support  

### Agriculture  

### Arts, music, design  

### Audio, broadcasting, multimedia, or graphics technologies  

### Business management, marketing  

### Computer science, information technology  

### Construction trades  

### Cosmetology  

### Culinary arts  

### Drafting, engineering technologies  

### Education  

### Family or consumer science  

### Funeral or mortuary science  

### Healthcare, nursing  

### Law enforcement, security, firefighting  

### Law, legal studies  

### Liberal arts  

### Manufacturing, production (for example machinist, welder, boilermaker)  

### Mechanic, repair technologies  

### Transportation, materials moving  

### Other (specify)10



### 13. About how many hours of instruction did you complete in order to earn your last post - secondary certificate? (Mark one.)  

### 480 or more hours (12 or more full

- time weeks)  

### 160 to 479 hours (4 full

- time weeks to less than 12 full

- time weeks)  

### 40

- 159 hours (1 full

- time week to less than 4 full

- time weeks)  

### Less than 40 hours (less than 1 full

- time week) 14. Which one of the following best describes the requirement for enrolling in your last post secondary certificate program? (Mark one.)  

### It required enrollment in or prior completion of an advanced degree program (Master’s or higher).  

### It required enrollment in or prior completion of a Bachelor’s degree program.  

### It required prior completion of high school or high school equivalency.  

### It did not have any of these educational requirements. 15. Did completing your last post - secondary certificate require any of the following? (Mark ONE box in each row below.) 16. Is your last post - secondary certificate related to your current job? If you are not employed, answer “no.”
 

### No  

### Yes 17. How useful has your last post - secondary certificate been for each of the following?

a. Getting a job (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell
b. Increasing your pay (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell

c. Improving your work skills (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell 18. Was your last post - secondary certificate part ofthe training you took for a professional certification or license?
 

### No  

### Yes No Yes ▼ ▼ 

### a. Passing a test or exam b. Some other evaluation of my knowledge or performance
c. Completion of a minimum number of credits d. Completion of a minimum number of instructional hours11 

### 19. People sometimes prepare to enter a trade or profession through a program that combines work experience with education or formal training. Have you ever COMPLETED one of these types of work experience programs—an internship, student teaching, co - op, practicum, clerkship, externship, residency, clinical experience, or apprenticeship?  

### No  

### Yes

20. If yes, do any of the following statements describe your last work experience program? (Mark ONE box in each row below.) 

# Work Experience Programs

GO TO question 21



### If you did NOT complete any of the types of work experience programs listed above, go to question 21. If you DID complete a program, answer the following question about the last work experience program you completed.

b. I got college credit for it.

a. It did or will help me earn a certification or license.

c. I received journeyman status at the end of an apprenticeship. d. I got a state or federal apprenticeship registration number. No Yes ▼ ▼ 21. Since leaving high school, have you taken any of the

following types of classes?

a. Classes to learn English as a second language, sometimes called ESL classes.  

### No  

### Yes b. Literacy classes to help improve my reading. Do not include college classes.
 

### No  

### Yes

c. Classes to earn a high school equivalency (such as the GED®).
 

### No  

### Yes 22. How many college classes have you taken in the past 12 months, including for - credit and non - credit classes?
 

### None  

### One  

### Two  

### Three or more 23. If one or more, did you take these classes as part of a degree program, or to transfer to a degree program?  

### No  

### Yes, as part of a degree program  

### Yes, to transfer to a degree program 

# College and Other Classes

CONTINUE on the next page. GO TO question 2412 

### 26. Last week, were you employed for pay at a job or business? If you were temporarily absent from a job or business (on vacation, temporarily ill, on maternity leave, etc.), answer “Yes”.
 

### No  

### Yes 27. If yes, for the job or business you were in last week, were you a member of a labor union or of an employee association similar to a union (for example, AFL - CIO, Change to Win Federation, NEA)?  

### No  

### Yes 28. Last week, how many jobs did you have?

Number of jobs 29. Last week, did you work at a full - time job (a job where you work 35 hours or more per week)?
 

### No  

### Yes 30. Last week, did you work at a part - time job (a job where you work fewer than 35 hours per week)?  

### No  

### Yes 31. If yes, would you have preferred to work at a full time job?  

### No  

### Yes 

# Employment

GO TO question 36 GO TO question 32

GO TO question 36 

### 24. People often participate in courses, training, or other instruction for work.These trainings can include classes, seminars, workshops, or on

- line instruction. They can be taken at the workplace or somewhere else, and can include topics such as:

 

### Job safety, security, sexual harassment, ethics, or other regulations,
 

### Equipment use,
 

### Communication, sensitivity, or team

- building,
 

### Computer or technical skills,
 

### Management skills, and
 

### Other job skills. Have you completed any work - related training in the past 12 months?
 

### No  

### Yes 25. If yes, how many work - related trainings have you completed in the past 12 months ? Count multiple sessions of the same training as one training. Number of trainings 

# Training for Work

GO TO question 2613 

### 38. In your current or last job, which one of the following were you? (Mark one.) If you had more than one job, describe the one at which you worked the most hours. If you had no job or business last week, give information for your last job or business.

 

### An employee of a private (for

- profit or not

- for

profit) company or business, or of an individual, for wages, salary, or commission  

### A local (city, county, etc.), state, or federal government employee  

### Self

- employed in own business, professional practice, or farm  

### Working without pay in family business or farm 39. For whom did you work?
 

### If now on active duty in the Armed Forces, mark (X) this box and print the branch of the Armed Forces below. All others, enter name of company, business, or other employer below. Name of company, business, or other employer:

40. What kind of business or industry was this? (For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank) 32. Last week, were you on layoff from a job?  

### No  

### Yes 33. During the last 4 weeks, have you been actively looking for work?  

### No  

### Yes 34. If no, do you intend to look for work within the next 5 years?  

### No  

### Yes  

### Don’t know 35. When did you last work, even for a few days? (Mark one.)

 

### Never worked for pay  

### Over 12 months ago  

### Within the past 12 months 36. During the past 12 months (52 weeks), how many weeks did you work, including paid vacation, paid sick leave, and military service? (Mark one.)  

### 50 to 52 weeks  

### 48 to 49 weeks  

### 40 to 47 weeks  

### 27 to 39 weeks  

### 14 to 26 weeks  

### 13 weeks or less 37. During the past 12 months, in the weeks you worked, how many hours did you usually work each WEEK?
Usual hours worked each WEEK GO TO question 48 GO TO question 38 GO TO question 3514



### 41. What kind of work were you doing? (For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant)

42. What were your most important activities or duties? (For example: patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records)

43. Did you have a license that was required by a federal, state, or local government agency to do this job?  

### No  

### Yes 44. Which category best fits your earnings from wages, salary, commissions, bonuses or tips, from your current or last job over the past 12 months? (Mark one.) Report amount before deductions for taxes, bonds, dues, or other items.
 

### $0 to $10,000  

### $10,001 to $20,000  

### $20,001 to $30,000  

### $30,001 to $40,000  

### $40,001 to $50,000  

### $50,001 to $60,000  

### $60,001 to $75,000  

### $75,001 to $150,000  

### $150,001 or more 45. What kind of position did you hold? (Mark one.)
 

### Permanent  

### Temporary 46. Would you have preferred to work at a permanent job?  

### No  

### Yes 47. How many people worked for your employer? Count employees at all locations. (Mark one.) If you were self

- employed, how many people worked for you, including yourself?
 

### 1—49 people  

### 50 —499 people  

### 500—999 people  

### 1,000 or more people GO TO question 4715 

### 54. Do you speak a language other than English at home?  

### No  

### Yes 55. How well do you speak English? (Mark one.)  

### Very well  

### Well  

### Not well  

### Not at all 56. How old are you?

years old 57. Are you of Hispanic or Latino origin?
 

### No  

### Yes 58. What is your race? Choose one or more.  

### White  

### Black or African American  

### Asian  

### American Indian or Alaska Native  

### Native Hawaiian or other Pacific Islander

GO TO question 56



# Thank You. Please return this questionnaire in the postage
- paid envelope provided. If you have lost the envelope, mail the completed questionnaire to: 

### National Household Education Survey [RETURN ADDRESS HERE] 48. Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard? (Mark one.)
 

### No, never served in the military  

### Yes, but only on active duty for training in the Reserve or National Guard  

### Yes, on active duty now or in past 49. Have you served on active duty since September 2001?  

### No  

### Yes 50. Are you male or female?
 

### Male  

### Female 51. What is your current marital status? (Mark one.)
 

### Now Married  

### Widowed  

### Divorced  

### Separated  

### Never married 52. Are you currently living with a boyfriend/girlfriend or partner?
 

### No  

### Yes 53. Are you currently in a registered domestic partnership or civil union?
 

### No  

### Yes 

# Background

GO TO question 50

GO TO question 5416 

### Commonly Asked Questions Q: How was my household chosen? A: Your address was randomly selected from among all of the home addresses in the nation. It was selectedusing scientific sampling methods to represent other U.S. households. The sample was designed so that surveys of only a few thousand people will accurately describe the educational experiences of almost all Americans. 

### Q: Why should I participate? Do I have to do this? A: Your answers are very important to the success of this study. You represent thousands of other adults like yourself, and you cannot be replaced. This survey is voluntary. You may choose not to answer any or all questions in this survey, but in order for the survey to be representative, it is important that you complete and return it. Those who do not return the survey will not be represented in statistics used by policymakers and researchers. There are no penalties should you choose not to participate in the study. 

### Q: Will the information I provide be kept confidential? Will my privacy be protected? A: Your responses will be combined with those from other adults to produce statistical summaries about education and training in the United States. Your individual data will not be reported. Your answers may beused only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 USC § 9573). 

### Q: How will my response help the Federal Government? A: The U.S. Departments of Education and Labor want to understand how adults acquire and maintain the skillsthey need for work. This survey is the only way these Departments can learn about the education and training that adults receive from schools, employers, and other training sponsors. The survey will allow policymakers and researchers to better understand the demand for education and training programs, and can help direct national policy in these areas. Your responses will be combined with those from other households to inform educators, policy makers, and schools about how adults in the U.S. learn the skills needed for work. 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education . This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 10 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Lisa Hudson, National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e-mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353

### C.2 Training for Work Survey (TWS)

# Conducted by

UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration 

### U.S. Census Bureau 

# Adult Training and Education Survey Part of the 2015 National Household Education Survey OMB No. 1850-0803: Approval Expires 09/30/2016



# Thank you for helping us with this survey. Based on the information we received from your household in your last survey, we’re asking you to complete this final step.2 

# This page left blank intentionally.3 

# Instructions

 

### In response to the survey you answered earlier, we recorded that the person listed below is between the ages of 16 to 65, is not in high school, and lives in this household. If this information is not correct, please call us at the toll-free number below so we can be sure you received the correct survey.

 

### These questions should be filled out by:

No one else in the household should fill out the survey.

 

### You might be asked to skip questions that do not apply to you. Follow the arrows to answer the questions that apply to you. Please see the example below:  

### No  

### Yes

 

### To answer a question, simply mark the box [X] that best represents your answer.
 

### Use a black or blue pen, if available, to complete this survey.
 

### Please return the completed survey using the postage- paid envelope provided.
 

### If you have any questions about this survey, please call us at our toll- free number: 1-8 88 - 840 - 8353 . We are authorized to collect this information by U.S. Code, Title 20, Section 9543. You do not have to provide the information requested. However, the information you provide will help the Department of Education’s ongoing efforts to learn more about the educational experiences of adults. There are no penalties should you choose not to participate in this study. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (U.S. Code, Title 20, Section 9573). Your responses will be combined with those from other participants to produce summary statistics and reports. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0803. The time required to complete this survey is estimated to average 10 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Lisa Hudson, National Center for Education Statistics, National Household Education Surveys (NHES), 1990 K Street, NW, Washington, DC 20006. You may send email to NHES@census.gov. GO TO question 124 

### 1. What is the highest degree or level of school you have completed? (Mark one.)  

### Elementary or high school, but no high school diploma or GED ®  

### High school diploma  

### GED ® or alternative high school credential  

### Some college credit but less than one year of college credit  

### 1 or more years of college credit, no degree  

### Associate’s degree (for example, AA, AS)  

### Bachelor’s degree (for example, BA, BS)  

### Master’s degree (for example, MA, MS, MEng, MEd, MSW, MBA)  

### Professional degree beyond a bachelor’s degree (for example, MD, DDS, DVM, LLB, JD)  

### Doctorate degree (for example, PhD, EdD) 

# Level of Education 2. What was the major or field of study for your highest degree or level of education? (Mark one.) If there was more than one, please choose the one you consider most important.  

### General studies, no major, undeclared major  

### Accounting, finance, insurance, real estate  

### Administrative support  

### Arts, music, design  

### Audio, broadcasting, multimedia, or graphics technologies  

### Business management, marketing  

### Communications, journalism  

### Computer science, information technology  

### Construction, repair, manufacturing, transportation  

### Education  

### Engineering, architecture  

### English language, literature  

### Family or consumer science  

### Healthcare, nursing, medicine  

### Law enforcement, security, firefighting  

### Law, legal studies  

### Liberal arts  

### Political science, economics, history, other social sciences  

### Psychology  

### Religious vocations, theology  

### Sciences (biological or physical), mathematics  

### Social or human services, public administration  

### Other (specify)5 

### 3. Do you have a currently active professional certification or a state or industry license? Do not include business licenses, such as a liquor license or vending license. A professional certification or license shows you are qualified to perform a specific job and includes things like Licensed Realtor, Certified Medical Assistant, Certified Teacher, or an IT certification.

 

### No  

### Yes

4. If yes, how many certifications and licenses do you have? If you had to get a certification in order to get a license, count each certification and license separately. Number of certifications and licenses 

# Certifications and Licenses

GO TO question 5

CONTINUE on the next page.6



# Certificates
5. People sometimes earn certificates for completing an education or training program. A certificate is different from a certification or license. Do NOT include certifications/licenses here; include them in the previous section only. Have you ever earned any of the following types of certificates?
a. A certificate for completing a training program from an employer, employment agency, union, software or equipment manufacturer, or other training provider, but NOT from a school.  

### No  

### Yes b. A certificate for completing a vocational program at a high school.  

### No  

### Yes
c. A high school equivalency certificate, such as a GED®.  

### No  

### Yes d. A certificate—rather than a degree—forcompleting a program at a community or technical college, or other school after high school. Do not include teaching certificates or college degrees.  

### No  

### Yes 6. If yes, in the rest of this section we will refer to the certificates described in question 5d as “post secondary certificates.” Where did you get your last post - secondary certificate? (Mark one.)  

### A community college  

### A vocational, technical, trade, or business school  

### Another college or university  

### Someplace else Specify:______________ If you do NOT have a post

- secondary certificate, go to question 8. GO TO question 8 

### 7. About how many hours of instruction did you complete in order to earn your last post - secondary certificate? (Mark one.)  

### 480 or more hours (12 or more full

- time weeks)  

### 160 to 479 hours (4 full

- time weeks to less than 12 full

- time weeks)  

### 40

- 159 hours (1 full

- time week to less than 4 full

- time weeks)  

### Less than 40 hours (less than 1 full

- time week)7 

### 8. People sometimes prepare to enter a trade or profession through a program that combines work experience with education or formal training. Have you ever COMPLETED one of these types of work experience programs—an internship, student teaching, co - op, practicum, clerkship, externship, residency, clinical experience, or apprenticeship?
 

### No  

### Yes

9. If yes, how long was your last work experience program? (Mark one.)  

### Less than 3 months  

### 3 months to less than 6 months  

### 6 months to less than 1 year  

### 1 year to less than 2 years  

### 2 years to less than 3 years  

### 3 years or more
10. What wage did you earn as part of your last work experience program? (Mark one.)
 

### No wage  

### A training wage that was lower than the wage of a fully qualified worker  

### The same wage as a fully qualified worker 

# Work Experience Programs 11. During your last work experience program, did you do any of the following? (Mark ONE box in each row below.)

GO TO question 18


### If you did NOT complete any of the types of work experience programs listed above, go toquestion 18. If you DID complete a program, answer the rest of this section about the last work experience program you completed. a. Took classes from a college, technical school, or trade school b. Took classes or training from a company, association, union, or private instructor
c. Studied on my own using textbooks or on - line resources d. Got instruction from a mentor or coworker at my worksite

e. Got evaluated by a mentor or supervisor No Yes ▼ ▼8



### 12. Did you take your last work experience program as part of a school’s education or training program? (Mark one.)
 

### No  

### Yes, as part of a high school program  

### Yes, as part of a post

- secondary certificate program from a community college, technical college, or other school after high school  

### Yes, as part of an associate’s degree program  

### Yes, as part of a bachelor’s degree program  

### Yes, as part of an advanced degree program 13. Do any of the following statements describe your last work experience program? (Mark ONE box in each row below.)

b. I got college credit for it.

a. It did or will help me earn a certification or license.

c. I received journeyman status at the end of an apprenticeship. d. I got a state or federal apprenticeship registration number. No Yes ▼ ▼ 14. What type of work was your last work experience

program for? (Mark one.) Building or construction trades  

### Carpenter  

### Electrician  

### Plumber, pipefitter  

### Sheet metal worker, structural

- steel worker  

### Other building and construction trades Health care, nursing, medicine  

### Medical doctor  

### Nursing  

### Other healthcare  

### Accounting, finance, insurance, real estate  

### Chef, cook, food preparation  

### Computer networking, programming  

### Cosmetology, barbering  

### Driving, piloting, or other transport  

### Engineering, architecture  

### Funeral/mortuary services  

### Legal practice  

### Machinist, tool and die maker  

### Management  

### Mechanic or repair work  

### Printing  

### Public safety or security, corrections  

### Social work, counseling, religious vocations  

### Teaching  

### Utility or telecommunications technician  

### Other (specify)9



### 15. Are you currently working in a job related to your last work experience program?  

### No  

### Yes 16. In your current job, how often do you use the skills or knowledge that you learned during your last work experience program? If you are not employed, please answer “Never or almost never”.

 

### Never or almost never  

### Sometimes  

### All or most of the time17. How useful was your last work experience program for each of the following?
a. Getting a job (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell
b. Increasing your pay (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell

c. Improving your work skills (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell10 

### 18. Since leaving high school, have you taken any of the following types of classes?

a. Classes to learn English as a second language, sometimes called ESL classes.  

### No  

### Yes b. Literacy classes to help improve my reading. Do not include college classes.
 

### No  

### Yes

c. Classes to earn a high school equivalency (such as the GED®).
 

### No  

### Yes 19. How many college classes have you taken in the past 12 months, including for - credit and non - credit classes?
 

### None  

### One  

### Two  

### Three or more 

# College and Other Classes

GO TO question 27

CONTINUE with question 20. 

### 20. If one or more, did you take these classes as part of a degree program, or to transfer to a degree program?  

### No  

### Yes, as part of a degree program  

### Yes, to transfer to a degree program 21. Among all the college classes you have taken in the past 12 months, how many were not for college credit (that is, non - credit)?  

### Don’t know  

### None  

### One  

### Two  

### Three or more Go to question 27 if you do not know how many college classes you took, or if you did not take any in the last 12 months. If you took more than one non

- credit class during thesame time period, please answer the following questions for the class you took earlier in the week or if on the same day, earlier in the day. The rest of this section asks about the last non - credit class you took. 22. What was the primary subject or field of study for your last non - credit class? GO TO question 2711 

### 25. Was your last non - credit class required by your employer? If you were self

- employed or not employed when you took the class, answer “does not apply.”  

### No  

### Yes  

### Does not apply 26. Did your employer pay for your last non - credit class? Include reimbursements from your employer. (Mark one.) If you were self

- employed or not employed when you took the class, answer “does not apply.”  

### No  

### Yes, partly  

### Yes, completely  

### Does not apply 23. Did you take your last non - credit class for any of the following reasons? (Mark ONE box in each row below.)

24. How useful was your last non - credit class for each of the following?
a. Increasing your pay (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell
b. Keeping you marketable to employers or clients (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell

c. Improving your work skills (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell a. To prepare for or to consider further education b. For personal interest

c. To earn or renew a professional certification or license d. For my current job

e. For a future job No Yes ▼ ▼12 

### 27. People often participate in courses, training, or other instruction for work.These trainings can include classes, seminars, workshops, or on

- line instruction. They can be taken at the workplace or somewhere else, and can include topics such as:

 

### Job safety, security, sexual harassment, ethics, or other regulations,
 

### Equipment use,
 

### Communication, sensitivity, or team

- building,
 

### Computer or technical skills,
 

### Management skills, and
 

### Other job skills. Have you completed any work - related training in the past 12 months?
 

### No  

### Yes 28. If yes, how many work - related trainings have you completed in the past 12 months ? Count multiple sessions of the same training as one training. Number of trainings 

# Training for Work

GO TO question 31

If none, go to question 31. If one or more, continue on page 14.13 

# This page left blank intentionally.14 

### 29. Answer questions 29a – 29f in the following grid for each work - related training you have completed in the past 12 months. If you had more than three, answer for the last three you had. Training #1 Training #2 Training #3 29a. What was the topic or title of this training? 29b. Using Table A on the next page, which category best fits this training? Number from Table A Number from Table A Number from Table A

29c. In total, how many hours did this training take? Round to the nearest hour. Count less than 1 hour as 1 hour. Hours Hours Hours

29d. Was this training for your current job? (Mark one.) If you are not employed, answer “No”.  

### No  

### Yes, and it was required  

### Yes, but it was not required  

### No  

### Yes, and it was required  

### Yes, but it was not required  

### No  

### Yes, and it was required  

### Yes, but it was not required 29e. Did you take this training to earn or renew a professional certification or license?  

### No  

### Yes  

### No  

### Yes  

### No  

### Yes

29f. How useful was this training for improving your work skills? (Mark one.)  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell  

### Not useful  

### Somewhat useful  

### Very useful  

### Too soon to tell15 

### TABLE A. TRAINING CATEGORIES FOR QUESTION 29b 1 Compliance training: Provides information on company, professional, or government policies and regulations concerning legal and ethical issues. 2 Safety training: Provides information on workplace safety, including safety procedures and processes. 3 Communication or team training: Includes training to improve communication in the workplace or how to work in teams or groups. 4 Supervisory/management training: Includes training in supervising employees and in implementing employment practices, regulations, and policies related to personnel or budget management. 5 Job skills training: Includes all other training to develop the professional or technical skills needed to do your work, such as sales and customer relations training, use of computer applications, and other skills that you use on your job.16



### 30. How much do each of the following factors motivate you to take work - related training?
a. Your employer’s requirements. (Mark one.)  

### Not at all  

### Somewhat  

### A great deal
b. Certification or licensing requirements. (Mark one.)  

### Not at all  

### Somewhat  

### A great deal

c. Your desire to get a job. (Mark one.)  

### Not at all  

### Somewhat  

### A great deal
d. Your desire to move up in your career. (Mark one.)  

### Not at all  

### Somewhat  

### A great deal

e. Your desire to increase your pay. (Mark one.)  

### Not at all  

### Somewhat  

### A great deal

CONTINUE on the next page17



### 31. Last week, were you employed for pay at a job or business? If you were temporarily absent from a job or business (on vacation, temporarily ill, on maternity leave, etc.), answer “Yes”.
 

### No  

### Yes 32. If yes, for the job or business you were in last week, were you a member of a labor union or of an employee association similar to a union (for example, AFL - CIO, Change to Win Federation, NEA)?  

### No  

### Yes 33. Last week, how many jobs did you have?

Number of jobs 34. Last week, did you work at a full - time job (a job where you work 35 hours or more per week)?
 

### No  

### Yes 35. Last week, did you work at a part - time job (a job where you work fewer than 35 hours per week)?  

### No  

### Yes 36. If yes, would you have preferred to work at a full time job?  

### No  

### Yes 37. Last week, were you on layoff from a job?  

### No  

### Yes 38. During the last 4 weeks, have you been actively looking for work?  

### No  

### Yes 39. If no, do you intend to look for work within the next 5 years?  

### No  

### Yes  

### Don’t know 40. When did you last work, even for a few days? (Mark one.)

 

### Never worked for pay  

### Over 12 months ago  

### Within the past 12 months 41. During the past 12 months (52 weeks), how many weeks did you work, including paid vacation, paid sick leave, and military service? (Mark one.)  

### 50 to 52 weeks  

### 48 to 49 weeks  

### 40 to 47 weeks  

### 27 to 39 weeks  

### 14 to 26 weeks  

### 13 weeks or less 42. During the past 12 months, in the weeks you worked, how many hours did you usually work each WEEK?
Usual hours worked each WEEK 

# Employment

GO TO question 41 GO TO question 55 GO TO question 43 GO TO question 37 GO TO question 40

GO TO question 4118



### 43. In your current or last job, which one of the following were you? (Mark one.) If you had more than one job, describe the one at which you worked the most hours. If you had no job or business last week, give information for your last job or business.

 

### An employee of a private (for

- profit or not

- for

profit) company or business, or of an individual, for wages, salary, or commission  

### A local (city, county, etc.), state, or federal government employee  

### Self

- employed in own business, professional practice, or farm  

### Working without pay in family business or farm 44. For whom did you work?
 

### If now on active duty in the Armed Forces, mark (X) this box and print the branch of the Armed Forces below. All others, enter name of company, business, or other employer below. Name of company, business, or other employer:

45. What kind of business or industry was this? (For example: hospital, newspaper publishing, mail order house, auto engine manufacturing, bank) 46. What kind of work were you doing? (For example: registered nurse, personnel manager, supervisor of order department, secretary, accountant)

47. What were your most important activities or duties? (For example: patient care, directing hiring policies, supervising order clerks, typing and filing, reconciling financial records)

48. Did you have a license that was required by a federal, state, or local government agency to do this job?  

### No  

### Yes 49. Which category best fits your earnings from wages, salary, commissions, bonuses or tips, from your current or last job over the past 12 months? (Mark one.) Report amount before deductions for taxes, bonds, dues, or other items.
 

### $0 to $10,000  

### $10,001 to $20,000  

### $20,001 to $30,000  

### $30,001 to $40,000  

### $40,001 to $50,000  

### $50,001 to $60,000  

### $60,001 to $75,000  

### $75,001 to $150,000  

### $150,001 or more19



### 50. What kind of position did you hold? (Mark one.)
 

### Permanent  

### Temporary 51. Would you have preferred to work at a permanent job?  

### No  

### Yes 52. How many people worked for your employer? Count employees at all locations. (Mark one.) If you were self

- employed, how many people worked for you, including yourself?
 

### 1—49 people  

### 50 —499 people  

### 500—999 people  

### 1,000 or more people 53. How supportive was your employer of your training needs? (Mark one.)
 

### Not at all supportive  

### Somewhat supportive  

### Very supportive  

### Not applicable 54. When you started your current or last job, did it have a clear training path laid out, or did you needto figure out on your own what training you needed? (Mark one.)
 

### A clear training path was laid out  

### Some parts of the training path were clear  

### I needed to figure it out on my own  

### There was no training path 55. Have you ever served on active duty in the U.S. Armed Forces, Reserves, or National Guard? (Mark one.)
 

### No, never served in the military  

### Yes, but only on active duty for training in the Reserve or National Guard  

### Yes, on active duty now or in past 56. Have you served on active duty since September 2001?  

### No  

### Yes 57. Are you male or female?
 

### Male  

### Female 58. What is your current marital status? (Mark one.)
 

### Now Married  

### Widowed  

### Divorced  

### Separated  

### Never married 59. Are you currently living with a boyfriend/girlfriend or partner?
 

### No  

### Yes 60. Are you currently in a registered domestic partnership or civil union?
 

### No  

### Yes GO TO question 52 

# Background

GO TO question 57

GO TO question 6120



### 61. Do you speak a language other than English at home?  

### No  

### Yes 62. How well do you speak English? (Mark one.)  

### Very well  

### Well  

### Not well  

### Not at all 63. How old are you?

years old 64. Are you of Hispanic or Latino origin?
 

### No  

### Yes 65. What is your race? Choose one or more.  

### White  

### Black or African American  

### Asian  

### American Indian or Alaska Native  

### Native Hawaiian or other Pacific Islander

GO TO question 63



# Thank You. Please return this questionnaire in the postage
- paid envelope provided. If you have lost the envelope, mail the completed questionnaire to: 

### National Household Education Survey [RETURN ADDRESS HERE]21 

### Commonly Asked Questions Q: How was my household chosen? A: Your address was randomly selected from among all of the home addresses in the nation. It was selectedusing scientific sampling methods to represent other U.S. households. The sample was designed so that surveys of only a few thousand people will accurately describe the educational experiences of almost all Americans. 

### Q: Why should I participate? Do I have to do this? A: Your answers are very important to the success of this study. You represent thousands of other adults like yourself, and you cannot be replaced. This survey is voluntary. You may choose not to answer any or all questions in this survey, but in order for the survey to be representative, it is important that you complete and return it. Those who do not return the survey will not be represented in statistics used by policymakers and researchers. There are no penalties should you choose not to participate in the study. 

### Q: Will the information I provide be kept confidential? Will my privacy be protected? A: Yes. Your responses will be combined with those from other adults to produce statistical summaries about education and training in the United States. Your individual data will not be reported. Your answers may beused only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (20 USC § 9573). 

### Q: How will my response help the Federal Government? A: The U.S. Departments of Education and Labor want to understand how adults acquire and maintain the skillsthey need for work. This survey is the only way these Departments can learn about the education and training that adults receive from schools, employers, and other training sponsors. The survey will allow policymakers and researchers to better understand the demand for education and training programs, and can help direct national policy in these areas. Your responses will be combined with those from other households to inform educators, policy makers, and schools about how adults in the U.S. learn the skills needed for work. 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education . This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 10 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Lisa Hudson, National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e-mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353

### C.3 Early Childhood Program Participation (ECPP) Survey**OMB No. 1850-0768: Approval Expires 11/30/2014**

NHES-21AC **(02/14/2011)** 

# The National Household Education Survey

**Our Children’s Future: A Survey of Young Children’s Care and Education**



# Thank you for helping us with this **survey. Based on the information we received from your household**  **in your last survey, we’re asking you to complete this final step.** **24252017**§9:52¤ 

# Conducted by UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration 

### U.S. Census Bureau**NHES-21AC 2**  **We are authorized to collect this information by Section 9543, 20 U.S. Code. You do not have to provide the information requested. However, the information you provide will help the Department**  **of Education’s ongoing efforts to learn more about the educational experiences of children and families. There are no penalties should you choose not to participate in this study. Your answers**  **may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 U.S. Code). Your responses will**  **be combined with those from other participants to produce summary statistics and reports.** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0803. The time required to complete this survey is estimated to average 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Andrew Zukerberg, National Center for Education Statistics, National Household Education Surveys (NHES), 1990 K Street, NW, Washington, DC 20006. You may send email to NHES@census.gov. 

## Instructions ◆ **In response to the survey you answered earlier, we recorded that the child/youth listed below has not yet started kindergarten. If this child is**  **attending public or private school or is homeschooled for kindergarten through 12th grade or equivalent, please call us at the toll-free number**  **below so we can be sure you received the correct survey.** ◆ **These questions should be filled in by a parent or guardian who knows about:** 

**Please answer all the survey questions thinking about this child or youth.** ◆ **To answer a question, simply mark the box that best represents your answer.**  ◆ **Please use a black or blue pen, if available, to complete this survey.** ◆ **If this questionnaire has been sent to the wrong household or the child/youth listed above does not live here, please call to let us know.**  ◆ **Our toll-free number is 1-888-840-8353.** X**24252025**§9:5:¤

# ● Thank you for your help with the previous survey your household completed.

**NHES-21AC 3** 

2. Are any of these care arrangements regularly scheduled at least once a week? **age** 

### Answer all the survey questions thinking about the child listed below:

3. These next questions are about the care that this child receives from the relative who provides the most care. How is that relative related to this child? **Mark ONE only. Grandmother/Grandfather**  **Aunt/Uncle Brother/Sister**  **Another relative** 4. How old is the relative who provides the most care to this child?

5. Is this care provided in your home or another home? **Own home Other home**  **Both**

8. How old was this child in years and months when this particular regular care arrangement with this relative began? **Yes No**  GO TO question 17

9. What language does this relative speak most when caring for this child? 

### Care Your Child Receives from Relatives **These questions ask about different types of child care this child may now receive**  **on a regular basis from someone other than**  **his/her parents or guardians.** 

## i

1. Is this child now receiving care from a relative other than a parent or guardian on a regular basis , for example, from grandparents, brothers or sisters, or any other relatives?

GO TO question 17

X **days each week** 6. How many days each week does this child receive care from this relative?

**hours each week** 7. How many hours each week does this child receive care from this relative?

**years months** 

**English and another language equally English**  **Spanish A language other than English or Spanish**  **English and Spanish equally Yes**  **No**▼▼▼ 

# 1. Childhood Care and Programs**24252033**§9:5B¤**NHES-21AC 4**  **hours each week No**  **Yes** GO TO question 15 10. Will this relative care for this child when the child is...

Is that amount per... 13. How much does your household pay for this relative to care for this child, not counting any money that may be received from others to help pay for care? **Write ’0’ if your household does not pay this relative for care.** 
11. Is there any charge or fee for the care this child receives from this relative, paid either by you or some other person or agency? **a. Sick but does not have a fever?** 
**. . . . . . . . . . . . . . . . . . b. Sick and has a fever?** 
**. . . . . . . .**

12. Do any of the following people, programs, or organizations help pay for this relative to care for this child? **Mark ONE box for each item below. a. A relative of this child**  **outside your household who provides money**  **specifically for that care,**  **not including general child support**  **b. Temporary Assistance for Needy Families, or TANF. . . . .**  **c. Another social service, welfare, or child care agency . .**  X

**d. An employer, not including a tax-free spending account**  **for child care**
**. . . . . . . . . . . . . . e. Someone else** 
**. . . . . . . . . . . . . . . . . . . . . . . . . . .**  **$ .00** 

**Hour Day**  **Week Month**  **Year**
**Other — Specify: Every 2 weeks** 

14. How many children from your household is this amount for, including this child? **This child only 2 children**  **3 children 4 children**  **5 or more children**

**No Yes**  GO TO question 17 15. Does this child have any other care arrangements with a relative on a regular basis ?

16. How many total hours each week does this child spend in those other care arrangements with relatives? **No Yes** ▼ ▼

**No Yes** ▼ ▼**24252041**§9:5J¤

# ●

**NHES-21AC 5** 

18. Are any of these care arrangements regularly scheduled at least once a week?

19. These next questions are about the care that this child receives from someone who is not related to him/her who provides the most care. Is this care provided in your own home or in another home? **Own home Other home**  **Both** 23. How old was this child in years and months when this particular regular care arrangement with this person began?

**No Yes**  GO TO question 35

26. What language does this care provider speak most when caring for this child? 

### Care Your Child Receives from Non-relatives **The next questions ask about any care this child receives from someone not**  **related to him/her, either in your home or someone**  **else’s home . This includes home child care**  **providers or neighbors, but not day care centers or preschools.**  

## i

17. Is this child now receiving care in your home or another home on a regular basis from someone who is not related to him/her?

**No Yes**  GO TO question 35

**days each week** 21. How many days each week does this child receive care from this person? **hours each week** 22. How many hours each week does this child receive care from this person?

**years months** 

**English and another language equally English**  **Spanish A language other than English or Spanish**  **English and Spanish equally**

20. Does this person who cares for this child live in your household? 27. Will this care provider care for this child when this child is...
**a. Sick but does not have a fever?** 
**. . . . . . . . . . . . . . . . . . b. Sick and has a fever?** 
**. . . . . . . .** 24. Was this care provider someone you already knew? **No Yes**  25. Is this child’s care provider age 18 or older? **No Yes**  **No Yes** 

**No Yes** ▼ ▼▼**24252058**§9:5[¤**NHES-21AC 6**  **hours each week No**  **Yes** GO TO question 33 28. Would you recommend this care provider to another parent?

Is that amount per... 31. How much does your household pay for this person to care for this child, not counting any money that may be received from others to help pay for care? **Write ’0’ if your household does not pay this non-relative for care.**  29. Is there any charge or fee for the care this child receives from this care provider, paid either by you or some other person or agency?

30. Do any of the following people, programs, or organizations help pay for this person to care for this child? **Mark ONE box for each item below. a. A relative of this child**  **outside your household who provides money**  **specifically for that care,**  **not including general child support**  **b. Temporary Assistance for Needy Families, or TANF. . . . .**  **c. Another social service, welfare, or child care agency . .**  **d. An employer, not including a tax-free spending account**  **for child care**
**. . . . . . . . . . . . . . e. Someone else** 
**. . . . . . . . . . . . . . . . . . . . . . . . . . .**  **$ .00** 

**Hour Day**  **Week Month**  **Year**
**Other — Specify: Every 2 weeks** 

32. How many children from your household is this amount for, including this child? **This child only 2 children**  **3 children 4 children**  **5 or more children**

**No Yes**  GO TO question 3533. Does this child have any other homebased care arrangements on a regular basis with someone who is not a relative? Do not include arrangements at day care centers or preschools.

34. How many total hours each week does this child spend in those other care arrangements with non-relatives? **No Yes** 

X **No Yes** ▼ ▼**24252066**§9:5c¤

# ●

**NHES-21AC 7** 

36. Does this child go to a day care center, preschool, or prekindergarten, at least once each week?

37. The next questions ask about the program where this child spends the most time. Is this child’s current program a day care program, a preschool program, or a prekindergarten program? **Day care Preschool**  **Prekindergarten No**  **Yes** GO TO question 54 

### Day Care Centers and Preschool Programs Your Child Attends

**The next questions ask about any day care centers and early childhood programs**  **that this child attends. This does not include care provided in a private home.**  

## i

35. Is this child now attending a day care center, preschool, or prekindergarten not in a private home?

**No Yes**  GO TO question 54

**days each week** 42. How many days each week does this child go to this program? 39. Where is this program located? **Mark ONE only.**

38. Is this program a Head Start or Early Head Start program?

**No Yes**  40. Is this program run by a church, synagogue, or other religious group? **No Yes**  41. Is this program located at your workplace or this child’s other parent’s workplace? **No Yes** 

**Don’t know** 

# ● **Head Start and Early Head Start are federally sponsored preschool programs**  **primarily for children from low-income families.**  

## i

44. How old was this child in years and months when he/she started going to this particular program? **hours each week** 43. How many hours each week does this child go to this program?

**years months**  **In a church, synagogue, or other place of worship**  **In a public elementary or secondary school**  **In a private elementary or secondary school**  **At a college or university At a community center**  **At a public library In its own building, office space, or**  **storefront Some other place – Specify:** 

X▼**24252074**§9:5k¤**NHES-21AC 8**  **No Yes**  45. What language does this child’s main care provider or teacher at this program speak most when caring for this child?

46. Would you recommend this program to another parent?

47. Does this program provide any of the following services to this child or your family? **Mark ONE box for each item below.**

**a. Hearing, speech, or**  **vision testing b. Physical examinations** 
**. . . . . . . c. Dental examinations** 
**. . . . . . . . . d. Formal testing for**  **developmental or learning problems . . . . . . . . . .**  **e. Sick child care when this child is sick but**  **does not have a fever**
**. . . . . . . . . . . . . . . . . . . . .** 

Is that amount per... 50. How much does your household pay for this child to go to this program, not counting any money that you may receive from others to help pay for care? **Write ‘0’ if your household does not pay for this program.**  **$ .00** 

**Hour Day**  **Week Month**  **Year**
**Other — Specify: Every 2 weeks**  49. Do any of the following people, programs, or organizations help pay for this child to go to this program? **Mark ONE box for each item below. a. A relative of this child**  **outside your household who provides money**  **specifically for that care,**  **not including general child support**  **b. Temporary Assistance for Needy Families, or TANF. . . . .**  **c. Another social service, welfare, or child care agency . .**  **d. An employer, not including a tax-free spending account**  **for child care**
**. . . . . . . . . . . . . . e. Someone else** 
**. . . . . . . . . . . . . . . . . . . . . . . . . . .** 

**No Yes**  GO TO question 52 48. Is there any charge or fee for this program, paid either by you or some other person or agency? **f. Sick child care when**  **this child is sick and has a fever** 
**. . . . . . . . . . . . . . . .**

**English and another language equally English**  **Spanish A language other than English or Spanish**  **English and Spanish equally** X **No Yes** ▼ ▼

X **No Yes** ▼ ▼**24252082**§9:5s¤**NHES-21AC 9**  **hours each week** 51. How many children from your household is this amount for, including this child? **This child only 2 children**  **3 children 4 children**  **5 or more children**

**No Yes**  GO TO question 54 52. Does this child have any other care arrangements at a day care center or preschool on a regular basis ?

53. How many total hours each week does this child spend at those day care centers or preschools? 54. Has this child ever attended a Head Start or Early Head Start program?

**No Yes**  **Don’t know** 

# ● **Head Start and Early Head Start are federally sponsored preschool programs**  **primarily for children from low-income families.**  

## i

55. What is the main reason your household wanted a care program for this child in the past year? **Mark ONE only.** X **To provide care when a parent was at work or school**  **To prepare child for school To provide cultural or language learning**  **To make time for running errands or relaxing**  **Some other reason Did not have care in the past year**  

### Continue with section 2.▼ 

# 2. Finding and Choosing Care for Your Child**24252090**§9:5{¤**NHES-21AC 10**  56. Do you feel there are good choices for child care or early childhood programs where you live?

**Have not tried to find care**  GO TO question 59 57. How much difficulty did you have finding the type of child care or early childhood program you wanted for this child? **No Yes**  **Don’t know**

**Did not find the child care program you wanted**  **A lot of difficulty Some difficulty**  **A little difficulty No difficulty**  58. How important was each of these reasons when you chose the child care arrangement or program where this child spends the most time?

c. The reliability of the arrangement? d. The learning activities at the arrangement?

e. The child spending time with other kids his/her age?

a. The location of the arrangement? **Not at all important A little important**  **Somewhat important Very important**  b. The cost of the arrangement? **Not at all important A little important**  **Somewhat important Very important** 

**Not at all important A little important**  **Somewhat important Very important**  **Not at all important A little important**  **Somewhat important Very important** 

f. The times during the day that this caregiver is able to provide care? **Not at all important A little important**  **Somewhat important Very important** 

**Not at all important A little important**  **Somewhat important Very important**  g. The number of other children in the child’s care group? **Not at all important A little important**  **Somewhat important Very important** **24252108**§9:6)¤ 

### h
. 

### Your city or state's Quality Rating and Improvement System (QRIS). A QRIS is a voluntary "star" rating system that informs families about the quality of early learning programs (including child care and preschools) in their communities. Some areas do not have a QRIS. 

### Did not use a QRIS **Not at all important A little important**  **Somewhat important Very important** 

# ●

**NHES-21AC 11**  **times Not at all**  GO TO question 62 **The next questions ask about this child’s activities with family members in the past**  **week or month.** 

## i

**days Yes**  **No**



### Continue with section 4 on the next page. **number of books** 59. About how many books does this child have of his/her own, including those shared with brothers or sisters?

62. In the past week , how many times has anyone in your family done the following things with this child? c. Sang songs with this child?

d. Worked on arts and crafts with this child?

a. Told this child a story? (Do not include reading to this child.) **Not at all 1 or 2 times**  **3 or more times** b. Taught this child letters, words, or numbers? 60. How many times have you or someone in your family read to this child in the past week ?

61. About how many minutes on each of those times did you or someone in your family read to this child?
**minutes**

**Not at all 1 or 2 times**  **3 or more times Not at all**  **1 or 2 times 3 or more times** 

**Not at all 1 or 2 times**  **3 or more times** 63. In the past month , have you or someone in your family visited a library with this child?

**Yes No**  64. In the past month , have you or someone in your family visited a bookstore with this child?

65. In the past week , how many days has your family eaten the evening meal together? **Write ‘0’ if none.**▼ 

# 3. Family Activities**24252116**§9:61¤

# ●

**NHES-21AC 12**  **2 years or older Under 2 years**  GO TO question 74 **These next questions ask about things that different children do at different ages.**  **These things may or may not be true for this child.**  

## i

66. Is this child under 2 years old or is he/she 2 years old or older?

**Yes, some of them No** 



### Continue with section 5, question 74 on the next page. 67. Can this child identify the colors red, yellow, blue, and green by name?

**Yes, all of them**

**Yes, some of them No**  68. Can this child recognize the letters of the alphabet?

**Yes, most of them Yes, all of them** 

**Up to 5 This child cannot count**  69. How high can this child count?

**Up to 10 Up to 20**  **Up to 50 Up to 100 or more**  **Yes No** 

**Actually reads the written words**  **Pretends to read**

**Does both**

**Tells what’s in each picture Sounds like connected story**  73. When this child pretends to read a book, does it sound like a connected story, or does he/she tell what is in each picture without much connection between them?

**Does both Does neither**  70. Can this child write his/her first name, even if some of the letters are backwards?

**Yes No** 

72. Does this child actually read the words written in the book, or does he/she look at the book and pretend to read?

GO TO question 74▼ 

# 4. Things Your Child May be Learning

71. Does this child ever read or pretend to read storybooks on his/her own? GO TO question 74 {**24252124**§9:69¤**NHES-21AC 13**  74. In general, how would you describe this child’s health? **Excellent** 76. (If child is under 3 years old) Has a health, education, or early intervention professional told you this child is “at-risk” for a substantial developmental delay?

79. Are these services provided by any of the following sources? **Mark ONE box for each item below.**

**a. Your local school district**
**. . . . . b. A state or local health or**  **social service agency**

**. . . . . . . . . c. A doctor, clinic, or other**  **health care provider . . . . . . . .**  75. Has a health, education, or early intervention professional told you that this child has any of the following conditions? **Mark ONE box for each item below.**

**a. A specific learning disability. . . b. An intellectual disability**  **(mental retardation)**

**. . . . . . . . . . . . . . . c. A speech or language**  **impairment . . . . . . . . .** 

**d. A serious emotional disturbance . . . . . . . . . . . . . . .**  **e. Deafness or another hearing impairment** 

**. . . . . . . . . . . . . . . f. Blindness or another visual**  **impairment not corrected with glasses**  **g. An orthopedic impairment**
**. . . . . . . . . . . . . . . . . . .**  **Very good Good**  **Fair Poor** 

**h. Autism**
**. . . . . . . . . . . . . . . . . . . i. Pervasive Developmental**  **Disorder (PDD)**

**. . . . . . . . . . . . . j. Attention Deficit Disorder,**  **ADD or ADHD k. A developmental delay** 
**. . . . . . . . . . . . . . . . . . . .** 

**. . . . . . . l. Traumatic brain injury**  **m. Another health impairment lasting 6 months or more** 
**. . . . . No**  **Yes**

78. Is this child receiving services for his/her condition? **No Yes**  GO TO question 83 77. Did you mark yes to any condition in question 75 or question 76? **No Yes**  GO TO question 85 **Child is age 3 or older**

X **No Yes** ▼ ▼

**No Yes** ▼ ▼ X 

# 5. This Child’s Health**24252132**§9:6A¤**NHES-21AC 14**  80. Are any of these services provided through an Individualized Family Service Plan (IFSP) or an Individualized Education Program (IEP)? **No Yes**  GO TO question 83

83. Is this child currently enrolled in any special education classes or services? **No Yes**  81. Did any adult in your household work with the service provider or school to develop or change this child’s IFSP or IEP? **No Yes**  82. Since September, how satisfied or dissatisfied have you been with the following aspects of this child’s IFSP or IEP? a. The service provider’s or school’s communication with your family?

b. The child’s special needs teacher or therapist? c. The service provider’s or school’s ability to accommodate this child’s special needs?

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply**

**Does not apply**

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply Very satisfied**  **Somewhat satisfied Somewhat dissatisfied**  **Very dissatisfied Does not apply** 

84. Does this child’s condition interfere with his/her ability to do any of the following things? **Mark**

**a. Learn b. Participate in play with**  **other children**
**c. Go on outings**  X **ONE box for each item below.**

**. . . . . . . . . . . . . . d. Make friends**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**  **No Yes** ▼ ▼



### Continue with section 6, question 85, on the next page.▼ d. The service provider’s or school’s commitment to help this child learn?

**. . . . . . . . . . . . . . 24252140** §9:6I¤**NHES-21AC 15**  90. Since September, has this child usually lived at this address or another address (for example, because of a joint custody arrangement)? **Do not include vacation properties.** 

# 6. Child’s Background

Continue with section 7 on the next page.▼ **age English and another language equally**  85. In what month and year was this child born?

**One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  86. Where was this child born?

89. What is this child’s race? You may mark one or more races. 88. Is this child of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes Child usually lived at this address**  **Child usually lived at another address**

91. What language does this child speak most at home? **Mark ONE only. Child has not**  **started to speak English**  **Spanish A language other than English or Spanish**  **English and Spanish equally month year**  **/**

GO TO question 88

87. How old was this child when he/she first moved to the 50 United States or the District of Columbia?

**Native Hawaiian or other Pacific Islander White**  92. Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program? **No Yes**  GO TO section 7

X

89b. What is this child’s sex? **Male Female** **24252157**§9:6Z¤ 

### Child lived at at this address and another address for an equal amount of time {**NHES-21AC 16**  

### PARENT 1 LIVING IN HOUSEHOLD **Answer questions 93 to 109 about yourself if you are the child’s parent or guardian.**  **If you are not the child’s parent or guardian, answer questions 93 to 109 about one of this child’s parents**  **or guardians living in the household. English**  GO TO question **100 Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally Biological parent**  **Adoptive parent Stepparent**  **Foster parent Grandparent**  93. Is this parent or guardian the child’s...

**Other guardian**

**Male Female**  94. Is this person male or female? 

### 98 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally** 

### 99 . What language does this person speak most at home now ? **Mark ONE only.** 

# 7. Child’s Family

X X

**No Yes**  **One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country** 

**age** 

### 102 . Is this person of Spanish, Hispanic, or Latino origin?

GO TO question **102**



### 101 . How old was this person when he or she first moved to the 50 United States or the District of Columbia? 

### 100 . Where was this parent or guardian born?**24252165**§9:6b¤ 

### 95 . What is this person’s current marital status? ONE only. Now married Widowed Divorced Separated Never married Mark X



### 96 . Is this person currently living with a boyfriend/girlfriend or partner in this household?

Yes 

### 97 . Is this person currently in a registered domestic partnership or civil union? No Yes **GO TO question 98**

No**NHES-21AC 17**  **Some graduate or professional education, but no degree**  

### 104 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only. American Indian or Alaska Native**  **Asian Black or African American** 

**8th grade or less High school, but no diploma**  **High school diploma or equivalent (GED) Vocational diploma after high school**  **Some college, but no degree Associate’s degree (AA, AS)**  **Bachelor’s degree (BA, BS) Native Hawaiian or other Pacific Islander**  **White**



### 105 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  

### 103 . What is this person’s race? You may mark one or more races.

**Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)**  GO TO question **108**

GO TO question **109** X



### 108 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  

### 109 . In the past 12 months , how many months (if any) has this person worked for pay or income? 

### 106 . Which of the following best describes this person’s employment status? **Mark ONE only.**

**months** 

### 110 . How old is this person?

**age** 

### 111 . How old was this person when he or she first became a parent to any child? **Retired Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Disabled or unable to work** 

X {



### 107 . (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs?

**hours**

**Don’t know age**  GO TO question **109 24252173** §9:6j¤**NHES-21AC 18**  **No Yes**  GO TO question **132** 

### 112 . Is there a second parent or guardian living in this household? 

### PARENT 2 LIVING IN HOUSEHOLD **Answer questions 110 to 127 about a second parent or guardian living in the household.** 

**Biological parent Adoptive parent**  **Stepparent Foster parent**  **Grandparent** 

### 113 . Is this person the child’s...

**Male Female**  **Other guardian** 

### 114 . Is this person male or female? GO TO question **120 English**  **Spanish A language other than English or Spanish**  **English and Spanish equally English and another language equally**  

### 118 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English Spanish**  **A language other than English or Spanish English and Spanish equally**  

### 119 . What language does this person speak most at home now ? **Mark ONE only.** X

X

**age** 

### 122 . Is this person of Spanish, Hispanic, or Latino origin? **No Yes**  

### 121 . How old was this person when he or she first moved to the 50 United States or the District of Columbia? **English and another language equally** 

### 120 . Where was this parent or guardian born? **One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  GO TO question **122 24252181** §9:6r¤ 

### 115 . What is this person’s current marital status? ONE only. Now married Widowed Divorced Separated Never married Mark X



### 116 . Is this person currently living with a boyfriend/girlfriend or partner in this household? No Yes 

### 117 . Is this person currently in a registered domestic partnership or civil union? No Yes 

### GO TO question **118 NHES-21AC**  **19 Some graduate or professional**  **education, but no degree** 

### 124 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only. American Indian or Alaska Native**  **Asian Black or African American** 

**8th grade or less High school, but no diploma**  **High school diploma or equivalent (GED) Vocational diploma after high school**  **Some college, but no degree Associate’s degree (AA, AS)**  **Bachelor’s degree (BA, BS) Native Hawaiian or other Pacific Islander**  **White**



### 125 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  

### 123 . What is this person’s race? You may mark one or more races.

**Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)**  GO TO question **128**

GO TO question **129** X



### 128 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  

### 129 . In the past 12 months , how many months (if any) has this person worked for pay or income? 

### 126 . Which of the following best describes this person’s employment status? **Mark ONE only.**

**months** 

### 130 . How old is this person?

**age** 

### 131 . How old was this person when he or she first became a parent to any child? **Retired Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Disabled or unable to work** 

X {



### 127 . (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs?

**hours**

**Don’t know age**  GO TO question **129 24252199** §9:6ƒ¤**NHES-21AC 20** 



### 132 . Including yourself, how many total people live in this household? **people** 

### 134 . How are you related to this child? **Mark ONE only.**



### 133 . Other than the parents or guardians already reported, how many of the following people live in the household with this child? **Example: Brother(s)** 

### 2

**This child’s... Brother(s) . . . . . . . . . . . . .**  **Sister(s) . . . . . . . . . . . . . . Aunt(s) . . . . . . . . . . . . . . .**  **Uncle(s) . . . . . . . . . . . . . . Grandmother(s) . . . . . . . .**  **Grandfather(s)**

**. . . . . . . . . . Cousin(s) . . . . . . . . . . . . .**  **Parent’s girlfriend/ boyfriend/partner . . . . . . .**  **Other relative(s) . . . . . . . . Other non-relative(s). . . . .**  **Write ’0’ if none. Number** 



### 135 . Which language(s) are spoken at home by the adults in this household? **Mark all that apply. English**  **Spanish or Spanish Creole French (including Patois, Creole, Cajun)**  **Chinese Other languages – Specify:**  **Mother (birth, adoptive, step, or foster) Father (birth, adoptive, step, or foster)**  **Aunt Uncle**  **Grandmother Grandfather**  **Parent’s girlfriend/boyfriend/partner Other relationship – Specify:**  

# 8. Your Household

Continue with question 

### 136 on the next page.▼ X

X**24252207**§9:7(¤**NHES-21AC 21** 



### 136 . In the past 12 months , did your family ever receive benefits from any of the following programs? **Mark ONE box for each item below.**
**a. Temporary Assistance for Needy Families, or TANF** 
**. . . . . b. Your state welfare or**  **family assistance program. . . . c. Women, Infants, and**  **Children, or WIC**
**. . . . . . . . . . . . years at this address**  

### 139 . Is this house... **Mark ONE only. Owned or being bought by someone**  **in this household, Rented by someone in this household, or**  **Occupied by some other arrangement?**

**$0 to $10,000 $10,001 to $20,000**  **$20,001 to $30,000 $30,001 to $40,000**  **$40,001 to $50,000** 

### 137 . Which category best fits the total income of all persons in your household over the past 12 months? **Include your own income. Include money from jobs or other earnings,**  **pensions, interest, rent, Social Security payments, and so on.**  **No Yes**  

### 140 . Do you have access to the Internet at this address?

**No Yes**  

### 141 . Is there at least one telephone inside this home that is currently working and not a cell phone?

**No Yes**  

### 142 . Do you have a working cell phone? 

### 138 . How many years have you lived at this address? **Write ’0’ if less than 1 year.**

**d. Food Stamps . . . . . . . . . . . . . . e. Medicaid** 
**. . . . . . . . . . . . . . . . . f. Child Health Insurance**  **Program (CHIP)**

**. . . . . . . . . . . . . g. Section 8 housing assistance** 
**. .**

**$50,001 to $60,000 $60,001 to $75,000**  **$75,001 to $100,000 $100,001 to $150,000**  **$150,001 or more No Yes**  ▼ ▼ X

X**24252215**§9:70¤**NHES-21AC 22**  

# Thank you. **Please return this questionnaire in the postage-paid envelope provided. If you have lost the envelope, mail the completed questionnaire to:** 
U.S. Census Bureau ATTN: DCB 60-A (7198) 1201 E. 10th Street Jeffersonville, IN 47132-0001**24252223**§9:78¤**NHES-21AC 23**  

### THIS PAGE INTENTIONALLY LEFT BLANK**24252231**§9:7@¤**NHES-21AC 24**  

### Commonly Asked Questions Q: How did you get my address? **A: Your address was randomly selected from among all of the home addresses in the nation. It was selected using scientific sampling methods to represent other households in the**  **United States.** Q: How did you get my child’s name and age? **A: When you returned the initial National Household Education Survey to us, we randomly chose one child to ask additional questions about. We are interested in understanding**  **your child’s experiences with care and early education.** Q: Why should I take part in this study? Do I have to do this? **A: You represent thousands of other households like yours, and you cannot be replaced. Your answers and opinions are very important to the success of this study. You may**  **choose not to answer any or all questions in this survey. In order for the survey to be representative, it is important that you complete and return this questionnaire. Those who**  **do not return the survey will not be represented in key statistics used by policymakers and researchers.**  Q: How will the information I provide be used? Will my privacy be protected? **A: Your responses will be combined with those of others to produce statistical summaries and reports. Your individual data will not be reported. Your answers may be used only for**  **statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 U.S. Code).**  Q: I have more than one child in my household. Will I receive additional surveys for the other children in my household? **A: No, each household will receive a survey for only one child, even if there are multiple children living in the household. In households with multiple children, one child was**  **randomly selected to be included in the study.** Q: How will my response help the Department of Education? **A: The Department of Education wants to understand the care and early education of children. This survey is the only way that the Department of Education can learn about**  **the types of care and early learning activities children receive. Your responses will be combined with those from other households to inform educators, policymakers, schools,**  **and universities about changes in the condition of education in the United States. Reports from past surveys can be found at www.nces.ed.gov/nhes.** **24252249**§9:7R¤ 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education

. This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 

### 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Andrew Zukerberg , National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e-mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353

### C.4 Parent and Family Involvement in Education Survey for Enrolled StudentsNHES-42BC **(02/09/2012)** 

## A Survey about Students’ and Families’ Experience with Their Schools



# Conducted by **OMB No. 1850-0768: Approval Expires 11/30/2014** 

# The National Household Education Survey**24542011**§9W5,¤



### UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration 

### U.S. Census Bureau 

# Thank you for helping us with this **survey. Based on the information we received from your household**  **in your last survey, we’re asking you to complete this final step.** **NHES-42BC 2**  **We are authorized to collect this information by Section 9543, 20 U.S. Code. You do not have to provide the information requested. However, the information you provide will help the Department**  **of Education’s ongoing efforts to learn more about the educational experiences of children and families. There are no penalties should you choose not to participate in this study. Your answers**  **may be used only for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 U.S. Code). Your responses will**  **be combined with those from other participants to produce summary statistics and reports.** According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0803. The time required to complete this survey is estimated to average 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Andrew Zukerberg, National Center for Education Statistics, National Household Education Surveys (NHES), 1990 K Street, NW, Washington, DC 20006. You may send email to NHES@census.gov. 

## Instructions ◆ **In response to the survey you answered earlier, we recorded that the child/youth listed below attends school. If this child is homeschooled**  **instead of attending public or private school, or if this child has not yet started kindergarten, please call us at the toll-free number below so we**  **can be sure you received the correct survey.** ◆ **These questions should be filled in by a parent or guardian who knows about:** 

**Please answer all the survey questions thinking about this child or youth.** ◆ **To answer a question, simply mark the box that best represents your answer.**  ◆ **Please use a black or blue pen, if available, to complete this survey.** ◆ **If this questionnaire has been sent to the wrong household or the child/youth listed above does not live here, please call to let us know.**  ◆ **Our toll-free number is 1-888-840-8353.** X**24542029**§9W5>¤**NHES-42BC 3**  1. What is this child’s current grade or year of school?
**If this child is not assigned a specific grade, mark or write the grade he/she would be in**  **at a school with regular grades.**

**Full-day kindergarten**

2. 

### Some parents decide to educate their children at home rather than send them to public or private school. Is this child being school e d at home instead of at school for at least some classes or subjects? **grade (1 through 12) Partial-day kindergarten** 

4. Is it his/her regularly assigned school? 3. What type of school does this child attend? **Private, Catholic Private, religious**  **but not Catholic Private, not religious**  **Public school** GO TO question 6 5. Is this school a charter school?

6. Did you move to your current neighborhood so that this child could attend his/her current school?

7. Does your public school district let you choose which public school you want this child to attend? **This may include applying to a magnet program in a public school, transferring to**  **another public school within the district, or transferring to a public school outside of the**  **district.**

**Don’t know** 8. Did you consider other schools for this child? GO TO question 10

9. In deciding between schools, did you seek information on the performance of the schools you were considering, like test scores, dropout rates, and so on?

10. Is the school this child attends your first choice, that is, the school you wanted most for him/her to attend?

11. Since the beginning of this school year, has this child been in the same school? **No Yes**  - 

### For how many hours each week does this child attend a public or privates chool?

**No Yes**  **No Yes** 

**No Yes** 

**No Yes** 

**No Yes** 

**No Yes** 

**No Yes**  

### Thank you for your help with the previous survey your household completed.

**Child has not yet started kindergarten** 

### Answer all the survey questions thinking about the child listed below:

**Please STOP now and call 1-888-840-8353 so we can verify that**  **you received the correct survey.**

**No Yes** ▼▼

{ 

# 1. Child’s Schooling**24542037**§9W5F¤ 

### hours per week**NHES-42BC 4**  **Strongly agree month (1 through 12)** 

**Agree No**  **Yes** GO TO question 20 12. In which month did this child start at his/her current school this school year?

13. How much do you agree or disagree with the following statement: "This child enjoys school."

**Disagree Strongly disagree** 

**Mostly A’s Mostly B’s**  14. Please tell us about this child’s grades during this school year. Overall, across all subjects, what grades does this child get?

**Mostly C’s Mostly D’s or lower**  **This child’s school does not give these grades** 

**No Yes**  15. Is 

### he/she currently enrolled in Advanced Placement (AP) classes?

**Does not apply** 16. Since the beginning of this school year, how many times have any of this child’s teachers or school staff contacted your household about... **Write ’0’ if none. a. Behavior problems this child**  **is having in school . . . . . . . . . . . . b. Problems this child is having**  **with school work . . . . . . . . . . . . . c. Very good behavior . . . . . . . . . . .**  **d. Very good school work. . . . . . . . . Number**  **days** 17. Since the beginning of this school year, how many days has this child been absent from school?

18. Since starting kindergarten, has this child repeated any grades?

19. What grade or grades did he/she repeat? **Mark all that apply.**
**Kindergarten First grade**  **Second grade Third grade**  **Fourth grade** Elementary through Middle school

**Fifth grade Sixth grade**  **Seventh grade Eighth grade** 
**Ninth grade - freshman**  **Tenth grade - sophomore**  **Eleventh grade - junior**  **Twelfth grade - senior**  High school X



### Continue with question 20 on the next page.▼**24542045**§9W5N¤**NHES-42BC 5**  **No Yes**  **GO TO question 27** 20. Has this child ever had the following experiences? **Mark ONE box for each item below.**

**Complete less than a high school diploma Graduate from high school**  **Attend a vocational or technical school after high school**  **Attend two or more years of college Earn a bachelor’s degree** 

**No Yes**  25. Is there a charge or fee for that instruction? **a. An out-of-school suspension . . b. An in-school suspension not**  **counting detentions. . . . . . . . . c. Been expelled from school** 
**. . . .** 23. Some students take school-related courses over the Internet. Is this child receiving any instruction this way?

24. Is that instruction provided by any of the following places? **Mark all that apply. Your local public school**  **A charter school Another public school**  **A private school A college, community college, or**  **university Someplace else — Specify:**  21. How far do you expect this child to go in his/her education? **Mark ONE only.**

**Earn a graduate degree or professional degree beyond a bachelor’s** 

**Excellent Above average**  **Average Below average**  **Failing** 22. How would you describe his/her work at school? **Mark ONE only. No Yes**  ▼ ▼

X

X X

X**24542052**§9W5U¤ 

### 26 . What is the main reason this child took schoolrelated courses over the internet?

ONE only
**.** 

### Extra-credit Tutoring School did not offer the class or subject **Mark** X



### Other — Specify: Improve basic reading, writing, math or science skills To earn college credit Due to an illness or health condition**NHES-42BC 6** 



### 27 . Since the beginning of this school year, has any adult in this child’s household done any of the following things at this child’s school? **Mark ONE box for each item below.**
**a. Attended a school or class event, such as a play, dance,**  **sports event, or science fair**
**. . . b. Served as a volunteer in**  **this child’s classroom or elsewhere in the school** 

**. . . . . . . . . . . . . . . c. Attended a general school**  **meeting, for example, an open house, or a back-to**  **school night . . . . . .** 

**d. Attended a meeting of the parent-teacher organization**  **or association**
**. . . . . . . . . . . . . . e. Gone to a regularly**  **scheduled parent-teacher conference with this child’s**  **teacher**

**. . . . . . . . . . . . . . f. Participated in fundraising**  **for the school . . . . . . . . . . . . . . . . . . .** 
**g. Served on a school committee** 

**. . . . . . . . . h. Met with a guidance**  **counselor in person . . . . . . . . . . . . . . . .** 



### 28. During this school year, how many times has any adult in the household gone to meetings or participated in activities at this child’s school?
**number of times** 

### 29. During this school year, has your family received any of the following: a. Notes or emails specifically about this child from his/her teachers or school administrators?

b. Newsletters, memos, emails, or notices addressed to all parents?

c. Phone calls specifically about this child from his/her teachers or school administrators?

**Very well Just okay**  

### 30. How well has this child’s school been doing the following things during this school year? a. Letting you know how this child is doing in school between report cards.

**Not very well Does not do it at all**  b. Providing information about how to help this child with homework. **Very well Just okay**  **Not very well Does not do it at all**  **No Yes** 

**No Yes** 

**No Yes**  **No Yes** ▼ ▼ 

# 2. Families & School

X**24542060**§9W5]¤**NHES-42BC 7**  

### 31. How satisfied or dissatisfied are you with each of the following: a. The school this child attends this year?

b. The teachers this child has this year?

c. The academic standards of the school?

d. The order and discipline at the school?

e. The way that school staff interacts with parents? c. Providing information about why this child is placed in particular groups or classes. **Very well Just okay**  **Not very well Does not do it at all**  d. Providing information on your expected role at this child’s school. **Very well Just okay**  **Not very well Does not do it at all**  e. Providing information on how to help this child plan for college or vocational school. **Very well Just okay**  **Not very well Does not do it at all**  **Does not apply Very satisfied**  **Somewhat satisfied Somewhat dissatisfied**  **Very dissatisfied**
**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied** 
**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied** 
**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied** 

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied** **24542078**§9W5o¤**NHES-42BC 8**  **number of hours per week Less than once a week**  **1 to 2 days a week 3 to 4 days a week**  **5 or more days a week GO TO section 4,**  **question 39** 

### 37 . How often does any adult in your household check to see that this child’s homework is done? 

### 32. How often does this child do homework at home, at an after-school program, or somewhere else outside of school?

**Never Child does not have**  **homework** 

### 33. In an average week , how many hours does this child spend on homework outside of school?

**The amount is about right It’s too much**  **It’s too little** 

### 34. How do you feel about the amount of homework this child is assigned?



### 35. How does this child feel about the amount of homework he or she is assigned?



### 36. Is there a place in your home that is set aside for this child to do homework? **The amount is about right It’s too much**  **It’s too little**

**No Yes**  **Child does not do homework at home Never**  **Rarely Sometimes**  **Always** 

### 38 . During this school year, about how many days in an average week does anyone in your household help this child with his/her homework? **Less than once a week 1 to 2 days a week**  **3 to 4 days a week 5 or more days a week**  **Never** 

# 3. Homework {



### Continue with section 4, question 39, on the next page.▼**24542086**§9W5w¤**NHES-42BC 9** 



### 39 . In the past week , has anyone in your family done the following things with this child? **Mark ONE box for each item below.**
**a. Told him/her a story (Do not include reading to this child.). .**  **b. Done activities like arts and crafts, coloring, painting,**  **pasting, or using clay**

**. . . . . . . . c. Played board games or did**  **puzzles with him/her . . . . . . . .** 
**d. Worked on a project like building, making, or fixing**  **something**
**. . . . . . . . . . . . . . . . . e. Played sports, active games,**  **or exercised together**

**. . . . . . . . . . . . f. Discussed with him/her how**  **to manage time g. Talked with him/her about**  **the family’s history or ethnic heritage . . . . . . . . . . . . . . . . . .**  

### 40 . In the past week , how many days has your family eaten the evening meal together? **Write ‘0’ if none.** 

### 41. In the past month , has anyone in your family done the following things with this child? **Mark ONE box for each item below.**

**days a. Visited a library** 
**. . . . . . . . . . . . b. Visited a bookstore** 

**. . . . . . . . . . . . c. Gone to a play, concert, or**  **other live show . . . . . . . . .** 
**d. Visited an art gallery, museum, or historical site** 
**. . . . e. Visited a zoo or aquarium** 

**. . . . . . . . . . . . . . f. Attended an event sponsored**  **by a community, religious, or ethnic group**  **g. Attended an athletic or sporting event outside of**  **school in which this child was not a player . . . . . . . . . . .**  **. . . . . . . . . . . .**  **No Yes No Yes** 

▼ ▼ ▼ ▼ 

# 4. Family Activities

Continue with section 5, question 42, on the next page.▼ X X**24542094**§9W5¡¤**NHES-42BC 10** 



### 42 . In general, how would you describe this child’s health? **Excellent** 44 . Did you mark yes to any condition in question 42?



### 46 . Are these services provided by any of the following sources? **Mark ONE box for each item below.**

**a. Your local school district**
**. . . . . b. A state or local health or**  **social service agency**

**. . . . . . . . . c. A doctor, clinic, or other**  **health care provider . . . . . . . .**  

### 43 . Has a health or education professional told you that this child has any of the following conditions? **Mark ONE box for each item below.**

**a. A specific learning disability**
**. . . b. An intellectual disability**  **(mental retardation)**

**. . . . . . . . . . . . . . . c. A speech or language**  **impairment . . . . . . . . .** 

**d. A serious emotional disturbance . . . . . . . . . . . . . . .**  **e. Deafness or another hearing impairment** 

**. . . . . . . . . . . . . . . f. Blindness or another visual**  **impairment not corrected with glasses**  **g. An orthopedic impairment**
**. . . . . . . . . . . . . . . . . . .**  **Very good Good**  **Fair Poor** 

**h. Autism**
**. . . . . . . . . . . . . . . . . . . i. Pervasive Developmental**  **Disorder (PDD)**

**. . . . . . . . . . . . . j. Attention Deficit Disorder,**  **ADD or ADHD k. A developmental delay** 
**. . . . . . . . . . . . . . . . . . . .** 

**. . . . . . . l. Traumatic brain injury**  **m. Another health impairment lasting 6 months or more** 
**. . . . . GO TO question 52** 

45 . Is this child receiving services for his/her condition? **GO TO question 50**



### 47 . Are any of these services provided through an Individualized Education Program (IEP)?

**GO TO question 50**



### 48 . Did any adult in your household work with the service provider or school to develop or change this child’s IEP? **No Yes**  **No Yes** 

**No Yes** 

**No Yes**  **No Yes**  **No Yes** ▼ ▼ ▼ ▼ 

# 5. Child’s Health

X X**24542102**§9W6#¤**NHES-42BC 11**  

### 50 . Is this child currently enrolled in any special education classes or services?

51 . Does this child’s condition interfere with his/her ability to do any of the following things? **Mark**

**a. Learn b. Participate in sports, clubs,**  **or other organized activities c. Attend school on a regular**  **basis . . .** 

**No Yes**  

### 49 . During this school year, how satisfied or dissatisfied have you been with the following aspects of this child’s IEP?

**Very satisfied Somewhat satisfied**  a. The service provider’s or school’s communication with your family?

**Somewhat dissatisfied Very dissatisfied** 

b. The child’s special needs teacher or therapist? **Does not apply**

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply**

**Very satisfied Somewhat satisfied**  c. The service provider’s or school’s ability to accommodate this child’s special needs?

**Somewhat dissatisfied Very dissatisfied** 

d. The service provider’s or school’s commitment to help this child learn? **Does not apply**

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply** X **ONE box for each item below.**

**. . . . . . . . . . . . . . d. Make friends**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**  **No Yes** ▼ ▼



### Continue with section 6, question 52, on the next page.▼**24542110**§9W6+¤**NHES-42BC 12**  

# 6. Child’s Background

Continue with section 7 on the next page.▼ **age English and another language equally**  

### 57 . For this school year, does this child usually live at this address or another address (for example, because of a joint custody arrangement)? **Do not include vacation properties.** 

### 52 . In what month and year was this child born?

**One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  

### 53 . Where was this child born?



### 56 . What is this child’s race? You may mark one or more races. 

### 55 . Is this child of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes Child usually lives at this address**  **Child usually lives at another address**



### 58 . What language does this child speak most at home? **Mark ONE only. Child is not able to**  **speak English**  **Spanish A language other than English or Spanish**  **English and Spanish equally month year**  **/**

**GO TO question 55**



### 54 . How old was this child when he/she first moved to the 50 United States or the District of Columbia?

**Native Hawaiian or other Pacific Islander White**  

### 59 . Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program? **No Yes**  GO TO section 7

X**24542128**§9W6=¤ { 

### Child lived at at this address and another address for an equal amount of time**NHES-42BC 13**  

### PARENT 1 LIVING IN HOUSEHOLD **Answer questions 59 to 78 about yourself if you are the child’s parent or guardian.**  **If you are not the child’s parent or guardian, answer questions 59 to 78 about one of this child’s parents**  **or guardians living in the household. English**  **GO TO question 70 Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally**



### 67 . How difficult is it for this person to participate in activities at this child’s school because he/she speaks a language other than English? **Biological parent Adoptive parent**  **Stepparent Foster parent**  **Grandparent** 

### 60 . Is this parent or guardian the child’s...

**Other guardian**

**Male Female**  

### 61 . Is this person male or female? 

### 65 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English GO TO question 70**  **Spanish A language other than English or Spanish**  **English and Spanish equally English and another language equally**  

### 66 . What language does this person speak most at home now ? **Mark ONE only.**

**Very difficult Somewhat difficult**  **Not at all difficult** 

### 68 . Does the school have interpreters who speak this person’s native language for meetings or parent-teacher conferences? **No Yes**  

### 69 . Does the school have written materials, such as newsletters or school notices, that are translated into this person’s native language? **No Yes**  

# 7. Child’s Family

X X**24542136**§9W6E¤ 

### 62 . What is this person’s current marital status? Mark X ONE only. Now married Widowed Divorced Separated Never married


### 63 . Is this person currently living with a boyfriendsgirlfriend or partner in this household No Yes Is this person currently in a registered domestic partnership or civil union? No Yes 

### GO TO question **6 5** 



### 64 .**NHES-42BC 14**  **Some graduate or professional education, but no degree**  

### 74 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only.**



### 72. Is this person of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes 8th grade or less**  **High school, but no diploma High school diploma or equivalent (GED)**  **Vocational diploma after high school Some college, but no degree**  **Associate’s degree (AA, AS) Bachelor’s degree (BA, BS)**  

### 71 . How old was this person when he or she first moved to the 50 United States or the District of Columbia?

**Native Hawaiian or other Pacific Islander White**  

### 75 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  

### 70 . Where was this parent or guardian born?



### 73 . What is this person’s race? You may mark one or more races. **Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)** 

X

**age One of the 50 United States or the**  **District of Columbia**

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  **GO TO question 72**



### Continue with question 76 on the next page.▼**24542144**§9W6M¤**NHES-42BC 15**  **No Yes**  **GO TO question 10 5**  

### 82 . Is there a second parent or guardian living in this household? 

### PARENT 2 LIVING IN HOUSEHOLD **Answer questions 79 to 99 about a second parent or guardian living in the household.** 

**Biological parent Adoptive parent**  **Stepparent Foster parent**  **Grandparent** 

### 83. Is this person the child’s...

**Other guardian**

**Male Female**  

### 84 . Is this person male or female?


### 78 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  

### 79 . In the past 12 months , how many months (if any) has this person worked for pay or income? 

### 76 . Which of the following best describes this person’s employment status? **Mark ONE only.**



### 80 . How old is this person?



### 81 . How old was this person when he or she first became a parent to any child? **Retired Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Disabled or unable to work**  **GO TO question 78**

**GO TO question 79** X {



### 77. (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs?

**months GO TO question 79**  **hours**

**Don’t know age** 

**age 24542151** §9W6T¤ 

### 85 . What is this person’s current marital status? Mark X ONE only. Now married Widowed Divorced Separated Never married 

### 86 . Is this person currently living with a boyfriend/girlfriend or partner in this household? No Yes Is this person currently in a registered domestic partnership or civil union? No Yes 

### GO TO question **8 8** 

87 .**NHES-42BC 16**  **English GO TO question 93**  **Spanish A language other than English or Spanish**  **English and Spanish equally English and another language equally** 



### 90 . How difficult is it for this person to participate in activities at this child’s school because he/she speaks a language other than English? 

### 88 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English GO TO question 93**  **Spanish A language other than English or Spanish**  **English and Spanish equally English and another language equally**  

### 89 . What language does this person speak most at home now ? **Mark ONE only.**

**Very difficult Somewhat difficult**  **Not at all difficult** 

### 91 . Does the school have interpreters who speak this person’s native language for meetings or parent-teacher conferences? **No Yes**  

### 92 . Does the school have written materials, such as newsletters or school notices, that are translated into this person’s native language? **No Yes**  

### Continue with question 97 on the next page.▼ X

X



### 95 . Is this person of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes** 

### 94 . How old was this person when he or she first moved to the 50 United States or the District of Columbia?

**Native Hawaiian or other Pacific Islander White**  

### 93 . Where was this parent or guardian born?



### 96 . What is this person’s race? You may mark one or more races.

**age One of the 50 United States or the**  **District of Columbia**

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  **GO TO question 95 24542169** §9W6f¤**NHES-42BC 17**  **Some graduate or professional education, but no degree**  

### 97 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only. 8th grade or less**  **High school, but no diploma High school diploma or equivalent (GED)**  **Vocational diploma after high school Some college, but no degree**  **Associate’s degree (AA, AS) Bachelor’s degree (BA, BS)** 



### 98 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  **Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)** 



### Continue with section 8, question 105, on the next page.▼ X



### 101 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  

### 102 . In the past 12 months , how many months (if any) has this person worked for pay or income? 

### 99 . Which of the following best describes this person’s employment status? **Mark ONE only.**



### 103 . How old is this person?



### 104 . How old was this person when he or she first became a parent to any child? **Retired Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Disabled or unable to work**  **GO TO question 101**

**GO TO question 102** X {



### 100 . (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs?

**months GO TO question 102**  **hours**

**Don’t know age** 

**age 24542177** §9W6n¤**NHES-42BC 18** 



### 105 . Including yourself, how many total people live in this household? **people** 

### 107 . How are you related to this child? **Mark ONE only.**



### 106 . Other than the parents or guardians already reported, how many of the following people live in the household with this child? **Example: Brother(s)** 

### 2

**This child’s... Brother(s)** 

**. . . . . . . . . . . . . Sister(s)** 

**. . . . . . . . . . . . . . Aunt(s)** 

**. . . . . . . . . . . . . . . Uncle(s)** 

**. . . . . . . . . . . . . . Grandmother(s)** 

**. . . . . . . . Grandfather(s). . . . . . . . . .**  **Cousin(s)**

**. . . . . . . . . . . . . Parent’s girlfriend/**  **boyfriend/partner**
**. . . . . . . Other relative(s)** 

**. . . . . . . . Other non-relative(s). . . . .** 

**Write ’0’ if none. Number** 



### 108 . Which language(s) are spoken at home by the adults in this household? **Mark all that apply. English**  **Spanish or Spanish Creole French (including Patois, Creole, Cajun)**  **Chinese Other languages – Specify:**  **Mother (birth, adoptive, step, or foster) Father (birth, adoptive, step, or foster)**  **Aunt Uncle**  **Grandmother Grandfather**  **Parent’s girlfriend/boyfriend/partner Other relationship – Specify:**  

# 8. Your Household

Continue with question 109 on the next page.▼ X

X**24542185**§9W6v¤**NHES-42BC 19** 



### 109 . In the past 12 months , did your family ever receive benefits from any of the following programs? **Mark ONE box for each item below.**
**a. Temporary Assistance for Needy Families, or TANF** 
**. . . . . b. Your state welfare or**  **family assistance program. . . . c. Women, Infants, and**  **Children, or WIC**
**. . . . . . . . . . . . years at this address**  

### 112 . Is this house... **Mark ONE only. Owned or being bought by someone**  **in this household, Rented by someone in this household, or** 

**$0 to $10,000 $10,001 to $20,000**  **$20,001 to $30,000 $30,001 to $40,000**  **$40,001 to $50,000** 

### 110 . Which category best fits the total income of all persons in your household over the past 12 months? **Include your own income. Include money from jobs or other earnings,**  **pensions, interest, rent, Social Security payments, and so on.**  **No Yes**  **Occupied by some other arrangement?** 

### 113 . Do you have access to the Internet at this address?

**No Yes**  

### 114 . Is there at least one telephone inside this home that is currently working and not a cell phone?

**No Yes**  

### 115 . Do you have a working cell phone? 

### 111 . How many years have you lived at this address? **Write ’0’ if less than 1 year.**

**d. Food Stamps . . . . . . . . . . . . . . e. Medicaid** 
**. . . . . . . . . . . . . . . . . f. Child Health Insurance**  **Program (CHIP)**

**. . . . . . . . . . . . . g. Section 8 housing assistance** 
**. .**

**$50,001 to $60,000 $60,001 to $75,000**  **$75,001 to $100,000 $100,001 to $150,000**  **$150,001 or more No Yes**  ▼ ▼



### Continue with question 

### 11 6 on the

next page.▼ X

X**24542193**§9W6~¤**NHES-42BC 20** 



### 11 6 . We would like to identify this child’s school so we can include information about the school in our study. Using the list of schools below, mark the box next to the school this child attends. If this child’s school is not in this list, GO TO question 113. School Name Address City ▼ ▼ ▼ X**24542201**§9W7"¤**NHES-42BC 21** 



### 11 7 . To help us identify the school this child attends, write the name and address of this child’s school in the spaces below. **Please use block or capital letters, for example:** a. School name If you found and marked this child’s school in the list provided in question 112, then SKIP this question and return your survey in the postage-paid envelope. Otherwise, continue with question 113.

b. School street address

c. School city SC HOO L

d. School state

e. School zip code



# Thank you. **Please return this questionnaire in the postage-paid envelope provided.**  **If you have lost the envelope, mail the completed questionnaire to:**  U.S. Census Bureau ATTN: DCB 60-A (7198) 1201 E. 10th Street Jeffersonville, IN 47132-0001 **SCHOOL NAME**

**NUMBER AND STREET ADDRESS**

**CITY**

**STATE**

**ZIP** 

# !**24542219**§9W74¤**NHES-42BC 22**  

### THIS PAGE INTENTIONALLY LEFT BLANK**24542227**§9W7<¤**NHES-42BC 23**  

### THIS PAGE INTENTIONALLY LEFT BLANK**24542235**§9W7D¤**NHES-42BC 24**  

### Commonly Asked Questions Q: How did you get my address? **A: Your address was randomly selected from among all of the home addresses in the nation. It was selected using scientific sampling methods to represent other households in the**  **United States.** Q: How did you get my child’s name and grade? **A: When you returned the initial National Household Education Survey to us, we randomly chose one child to ask additional questions about. We are interested in understanding**  **your child’s experiences with schooling.** Q: Why should I take part in this study? Do I have to do this? **A: You represent thousands of other households like yours, and you cannot be replaced. Your answers and opinions are very important to the success of this study. You may**  **choose not to answer any or all questions in this survey. In order for the survey to be representative, it is important that you complete and return this questionnaire. Those who**  **do not return the survey will not be represented in key statistics used by policymakers and researchers.**  Q: How will the information I provide be used? Will my privacy be protected? **A: Your responses will be combined with those of others to produce statistical summaries and reports. Your individual data will not be reported. Your answers may be used only for**  **statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 U.S. Code).**  Q: I have more than one child in my household. Will I receive additional surveys for the other children in my household? **A: No, each household will receive a survey for only one child, even if there are multiple children living in the household. In households with multiple children, one child was**  **randomly selected to be included in the study.** Q: How will my response help the Department of Education? **A: The Department of Education wants to understand the condition of education in the United States. This survey is the only way that the Department of Education can learn**  **about schooling from your perspective. Your responses will be combined with those from other households to inform educators, policymakers, schools, and universities**  **about changes in the condition of education in the United States. Reports from past surveys can be found at www.nces.ed.gov/nhes.** **24542243**§9W7L¤ 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education

. This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 

### 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Andrew Zukerberg , National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e
- mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353

### C.5 Parent and Family Involvement in Education Survey for Homeschooled Students**OMB No. 1850-0768: Approval Expires 11/30/2014**

NHES-31AC 

# A Survey About Homeschooling in America

**Thank you for helping us with this survey. Based on the information**  **we received from your household in your last survey, we’re asking**  **you to complete this final step.** 

# The National Household Education Survey**24352015**§9D50¤ 

# Conducted by UNITED STATES DEPARTMENT OF COMMERCE Economics and Statistics Administration 

### U.S. Census Bureau

**(02/16/2012) NHES-31AC**  **2 We are authorized to collect this information by Section 9543, 20 U.S. Code. You do not have to**  **provide the information requested. However, the information you provide will help the Department of Education’s ongoing efforts to learn more about the educational experiences of children and**  **families. There are no penalties should you choose not to participate in this study. Your answers may be used only for statistical purposes and may not be disclosed, or used, in identifiable form**  **for any other purpose except as required by law (Section 9573, 20 U.S. Code). Your responses will be combined with those from other participants to produce summary statistics and reports.**  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850-0803. The time required to complete this survey is estimated to average 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving this survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to: Andrew Zukerberg, National Center for Education Statistics, National Household Education Surveys (NHES), 1990 K Street, NW, Washington, DC 20006. You may send email to NHES@census.gov. 

## Instructions ◆ **In response to the survey you answered earlier, we recorded that the child/youth listed below is currently homeschooled for at least some classes.**  **If this child attends public or private school instead of homeschooling, or is not homeschooled for kindergarten through 12th grade or equivalent, please**  **call us at the toll-free number below so we can be sure you received the correct survey.**  ◆ **These questions should be filled in by a parent or guardian who knows about:** 

**Please answer all the survey questions thinking about this child or youth.** ◆ **To answer a question, simply mark the box that best represents your answer.**  ◆ **Please use a black or blue pen, if available, to complete this survey.** ◆ **If this questionnaire has been sent to the wrong household or the child/youth listed above does not live here, please call to let us know.**  ◆ **Our toll-free number is 1-888-840-8353.** X**24352023**§9D58¤

### Thank you for your help with the previous survey your household completed.

**NHES-31AC 3** 

1. Who is the person that mainly provides this child’s home instruction?

**Brother/sister Mother** 

2. Is any of this child’s home instruction provided by a private tutor or teacher? 

### Answer all the survey questions thinking about the child listed below: 5. What type of school(s) does this child attend? **Mark all that apply.**

**No Yes**  **Public school (K - 12) Private school (K - 12)** 

**Grandparent Father** 

**Another person**

3. Is any of this child’s instruction provided by a local homeschooling group or co-op? **No Yes**  4. Does this child attend a public or private school or a college or university for instruction?

**Yes No**  GO TO question 7 **College, community college, or university** 6. How many hours each week does this child usually go to a school for instruction? Do not include time spent in extracurricular activities.
**hours**▼▼ X

**Who is that? 24352031** §9D5@¤ 

# 1. Child’s Homeschooling**NHES-31AC 4**  11. Thinking about sources of curriculum or books you use to homeschool this child, please tell us about all the sources that apply to you. Since September, have you used materials from... **Mark ONE box for each item below.** 7. What grade or year would this child be in if he/she was attending school? **Mark ONE only. Kindergarten** 
**Grade (1 through 12)** 8. These next questions ask you to estimate the amount of time you homeschool this child. a. How many days each week is this child homeschooled? **days each week** b. About how many total hours each week is he/she homeschooled? **hours per week** 9. Since September, has this child participated in activities with other children who are homeschooled? **No Yes**  10. Which of the following statements best describes the teaching style used to homeschool this child? **Mark ONE only. We strictly follow a formal curriculum.**  **We mostly follow a formal curriculum, but also use informal learning (i.e. child**  **led learning, "teaching moments"). We mostly use informal learning, but**  **sometimes use a formal curriculum. We always use informal learning, and**  **never follow a formal curriculum. a. A public library?** 
**. . . . . . . . . . . . b. A homeschooling catalog,**  **publisher, or individual who specializes in homeschooling**  **materials?**

**. . . . . . . . . . . . . . . . c. Another educational**  **publisher? . . . . . . . . . . . . . . . .** 
**d. A homeschooling organization?** 
**. . . . . . . . . . . . . . e. A church, synagogue, or**  **other religious organization?**

**. . . . . . . . . . . . . f. Your local public school or**  **school district? g. A private school?. . . . . . . . . . .**  **. .**

**. . . . . . . . . . h. A bookstore or other store**  **(including online)?**

**. i. Websites, excluding retailers?** 

12. In the past year, have you or another family member taken any courses, either online or in-person, to help you prepare your child’s home instruction? **No Yes, both online and in-person**  **Yes, online only Yes, in-person only**  X

X X **No Yes** ▼ ▼**24352049**§9D5R¤ **j. Other source — Specify:**
**. . NHES-31AC**  **5** 13. Some homeschooled children take courses over the Internet taught by people outside the household. Is this child receiving any instruction this way?

**No Yes**  15. Is there a charge or fee for that instruction? **Your local public school A charter school**  **Another public school A private school**  **A college, community college, or university** 
**Someplace else — Specify:** 14. Is that instruction provided by any of the following places? **Mark all that apply. No**  **Yes** GO TO question 16 16. Thinking about typical grade levels, for which grades was this child schooled at home for at least some classes or subjects? **Mark all that apply. Include the current year.** 
**Kindergarten (Including transitional K and**  **Pre-first grade) First grade**  **Second grade Third grade**  **Fourth grade** Elementary through Middle School

**Fifth grade Sixth grade**  **Seventh grade Eighth grade** 
**Ninth grade - freshman**  **Tenth grade - sophomore**  **Eleventh grade - junior**  **Twelfth grade - senior**  High School **Offered by my state**

X X**24352056**§9D5Y¤**NHES-31AC 6**  17. There are many different reasons that parents choose to homeschool their children. Did your family choose to homeschool this child because: **Mark ONE box for each item below.**

**. . . . . . . . . . . . .**

**. . . . . . . . . . . . . . . . . . . .** 

**. . . .**

**. . . . . . . . . . . . . . . . . . . . . . . . . . .** 

**. . . . . . . . .** 

**. . .** 18. Of the reasons your family chose to homeschool this child, which one would you say is the most important to you? **Write the letter from question 17 for the most important reason you chose to homeschool**  **your child. letter from question 17** 

**Complete less than a high school diploma Graduate from high school**  **Attend a vocational or technical school after high school**  **Attend two or more years of college Earn a bachelor’s degree**  19. How far do you expect this child to go in his/her education? **Mark ONE only.**

**Earn a graduate degree or professional degree beyond a bachelor’s**  X

X **No Yes** ▼ ▼**24352064**§9D5a¤ **a. You are concerned about the school environment, such as**  **safety, drugs, or negative peer pressure?**  **b. You are dissatisfied with the academic instruction at other**  **schools? c. You prefer to teach this child**  **at home so that you can provide religious instruction?**  **d. You prefer to teach this child**  **at home so that you can provide moral instruction?** 
**e. This child has a physical or**  **mental health problem that has lasted six months or**  **more? f.**  **This child has a temporary illness that prevents him/her**  **from going to school? g.**  **This child has other special needs that you feel the**  **school can’t or won’t meet? h. You are interested in a**  **nontraditional approach to children’s education?**  **i. You have another reason for**  **homeschooling your child? Specify:** **NHES-31AC 7**  20. Thinking about all years this child has been homeschooled, which of the following subject areas has this child been taught during his or her home instruction? **Mark all that apply. Art**  **Music Basic algebra (Algebra I)**  **Advanced algebra (Algebra II) Geometry**  **Calculus Probability**  **Scientific inquiry or experiments Earth sciences or geology**  **Biology Chemistry or physics**  **Geography English or literature**  **Computer science (e.g., computer programming)**  **Social science, history, social studies Foreign language** 

X**24352072**§9D5i¤ 

### Continue with section 2, question 21 on the next page.▼**NHES-31AC 8**  21. In the past week , has anyone in your family done the following things with this child? **Mark ONE box for each item below.**
**a. Told him/her a story (Do not include reading to this child.). .**  **b. Done activities like arts and crafts, coloring, painting,**  **pasting, or using clay**

**. . . . . . . . c. Played board games or did**  **puzzles with him/her . . . . . . . .** 
**d. Worked on a project like building, making, or fixing**  **something**
**. . . . . . . . . . . . . . . . . e. Played sports, active games,**  **or exercised together**

**. . . . . . . . . . . . f. Discussed with him/her how**  **to manage time g. Talked with him/her about**  **the family’s history or ethnic heritage . . . . . . . . . . . . . . . . . .**  22. In the past week , how many days has your family eaten the evening meal together? **Write ‘0’ if none.** 23. In the past month , has anyone in your family done the following things with this child? **Mark ONE box for each item below.**

**days a. Visited a library** 
**. . . . . . . . . . . . b. Visited a bookstore** 

**. . . . . . . . . . . . c. Gone to a play, concert, or**  **other live show . . . . . . . . .** 
**d. Visited an art gallery, museum, or historical site** 
**. . . . e. Visited a zoo or aquarium** 

**. . . . . . . . . . . . . . f. Attended an event sponsored**  **by a community, religious, or ethnic group**  **g. Attended an athletic or sporting event outside of**  **school in which this child was not a player . . . . . . . . . . .**  **. . . . . . . . . . . .** 

GO TO question 26 **No Yes**  24. Does your family participate in the activities or meetings of a local homeschooling association, co-op, or other local homeschool group?

25. Since September, how many times has your family gone to meetings or participated in the activities of a local homeschooling association, co-op, or other local homeschool group?
**number of times** 26. Is your family or someone in your household a member of a national homeschooling organization? **No Yes**  X **No Yes** ▼ ▼ X **No Yes** ▼ ▼**24352080**§9D5q¤ 

# 2. Family Activities**NHES-31AC 9**  27. In general, how would you describe this child’s health? **Excellent** 29. Did you mark yes to any condition in question 28?

31. Are these services provided by any of the following sources? **Mark ONE box for each item below.**

**a. Your local school district**
**. . . . . b. A state or local health or**  **social service agency**

**. . . . . . . . . c. A doctor, clinic, or other**  **health care provider . . . . . . . .**  28. Has a health or education professional told you that this child has any of the following conditions? **Mark ONE box for each item below.**

**a. A specific learning disability**
**. . . b. An intellectual disability**  **(mental retardation)**

**. . . . . . . . . . . . . . . c. A speech or language**  **impairment . . . . . . . . .** 

**d. A serious emotional disturbance . . . . . . . . . . . . . . .**  **e. Deafness or another hearing impairment** 

**. . . . . . . . . . . . . . . f. Blindness or another visual**  **impairment not corrected with glasses**  **g. An orthopedic impairment**
**. . . . . . . . . . . . . . . . . . .**  **Very good Good**  **Fair Poor** 

**h. Autism**
**. . . . . . . . . . . . . . . . . . . i. Pervasive Developmental**  **Disorder (PDD)**

**. . . . . . . . . . . . . j. Attention Deficit Disorder,**  **ADD or ADHD k. A developmental delay** 
**. . . . . . . . . . . . . . . . . . . .** 

**. . . . . . . l. Traumatic brain injury**  **m. Another health impairment lasting 6 months or more** 
**. . . . .** GO TO question 37

30. Is this child receiving services for his/her condition? GO TO question 35

32. Are any of these services provided through an Individualized Education Program (IEP)? GO TO question 35

33. Did any adult in your household work with the service provider or school to develop or change this child’s IEP? **No Yes** 

**No Yes** 

**No Yes** 

**No Yes**  X X
**No Yes** ▼ ▼ **No Yes** ▼ ▼**24352098**§9D5¥¤ 

# 3. Child’s Health**NHES-31AC 10**  35. Is this child currently enrolled in any special education classes or services?

36. Does this child’s condition interfere with his/her ability to do any of the following things? **Mark**

**a. Learn b. Participate in sports, clubs,**  **or other organized activities c. Attend school on a regular**  **basis . . .** 

**No Yes**  34. During this school year, how satisfied or dissatisfied have you been with the following aspects of this child’s IEP?

**Very satisfied Somewhat satisfied**  a. The service provider’s or school’s communication with your family?

**Somewhat dissatisfied Very dissatisfied** 

b. The child’s special needs teacher or therapist? **Does not apply**

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply**

**Very satisfied Somewhat satisfied**  c. The service provider’s or school’s ability to accommodate this child’s special needs?

**Somewhat dissatisfied Very dissatisfied** 

d. The service provider’s or school’s commitment to help this child learn? **Does not apply**

**Very satisfied Somewhat satisfied**  **Somewhat dissatisfied Very dissatisfied**  **Does not apply** X **ONE box for each item below.**

**. . . . . . . . . . . . . . d. Make friends**  **. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .**  **No Yes** ▼ ▼**24352106**§9D6’¤ 

### Continue with section 4, question 37 on the next page.▼**NHES-31AC 11**  **age English and another language equally**  42. For this school year, does this child usually live at this address or another address (for example, because of a joint custody arrangement)? **Do not include vacation properties.** 37. In what month and year was this child born?

**One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  38. Where was this child born?

41. What is this child’s race? You may mark one or more races. 40. Is this child of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes Child usually lives at this address**  **Child usually lives at another address**

43. What language does this child speak most at home? **Mark ONE only. Child is not able to**  **speak English**  **Spanish A language other than English or Spanish**  **English and Spanish equally month year**  **/**

39. How old was this child when he/she first moved to the 50 United States or the District of Columbia?

41b. What is this child’s sex? **Native Hawaiian or other Pacific Islander White** 

**Male Female**  44. Is this child currently enrolled in English as a second language, bilingual education, or an English immersion program? **No Yes**  GO TO section 5

X**24352114**§9D6/¤ 

### Continue with section 5, on the next page.▼ GO TO question 40 

# 4. Child’s Background

Child lived at at this address and another address for an equal amount of time {**NHES-31AC 12**  

### PARENT 1 LIVING IN HOUSEHOLD **Answer questions 45 to 61 about yourself if you are the child’s parent or guardian.**  **If you are not the child’s parent or guardian, answer questions 45 to 61 about one of this child’s parents**  **or guardians living in the household. English**  **GO TO question 52 Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally Biological parent**  **Adoptive parent Stepparent**  **Foster parent Grandparent**  45. Is this parent or guardian the child’s...

**Other guardian**

**Male Female**  46. Is this person male or female? 

### 50 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally** 

### 51 . What language does this person speak most at home now ? **Mark ONE only.**

**age** 

### 54 . Is this person of Spanish, Hispanic, or Latino origin? **No Yes**  

### 53 . How old was this person when he or she first moved to the 50 United States or the District of Columbia? 

### 52 . Where was this parent or guardian born? X X

**One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  **GO TO question 54 24352122** §9D67¤ 

# 5. Child’s Family

47 . What is this person’s current marital status? ONE only. Now married Widowed Divorced Separated Never married Mark X



### 4 8 . Is this person currently living with a boyfriend/girlfriend or partner in this household?

Yes 

### 4 9 . Is this person currently in a registered domestic partnership or civil union? No Yes No 

### GO TO question **50 NHES-31AC**  **13 Some graduate or professional**  **education, but no degree** 

### 56 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only. American Indian or Alaska Native**  **Asian Black or African American** 

**8th grade or less High school, but no diploma**  **High school diploma or equivalent (GED) Vocational diploma after high school**  **Some college, but no degree Associate’s degree (AA, AS)**  **Bachelor’s degree (BA, BS) Native Hawaiian or other Pacific Islander**  **White**



### 57 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  

### 55 . What is this person’s race? You may mark one or more races.

**Retired** 

### 58 . Which of the following best describes this person’s employment status? **Mark ONE only. Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)**  **Disabled or unable to work**  **GO TO question 60**

**GO TO question 61**

**months** 

### 60 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  **GO TO question 61**



### 61 . In the past 12 months , how many months (if any) has this person worked for pay or income? 

### 59 . (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs?

**hours** X {

X**24352130**§9D6?¤**NHES-31AC 14**  **Don’t know No**  **Yes** GO TO question **84** 

### 64 . Is there a second parent or guardian living in this household? **age** 

### 62 . How old is this person?



### 63 . How old was this person when he or she first became a parent to any child? 

### PARENT 2 LIVING IN HOUSEHOLD **Answer questions 62 to 79 about a second parent or guardian living in the household.** 

**Biological parent Adoptive parent**  **Stepparent Foster parent**  **Grandparent** 

### 65 . Is this person the child’s...

**Other guardian**

**Male Female**  

### 66 . Is this person male or female? **age 24352148** §9D6Q¤ 

### 67 . What is this person’s current marital status? ONE only. Now married Widowed Divorced Separated Never married Mark X



### 68. Is this person currently living with a boyfriend/girlfriend or partner in this household?

Yes Is this person currently in a registered domestic partnership or civil union? No Yes No 

### GO TO question **70**

69 .**NHES-31AC 15**  **English** GO TO question **72 Spanish**  **A language other than English or Spanish**  **English and Spanish equally English and another language equally**  

### 70 . What was the first language this parent or guardian learned to speak? **Mark ONE only.**

**English Spanish**  **A language other than English or Spanish English and Spanish equally**  **English and another language equally** 

### 71 . What language does this person speak most at home now ? **Mark ONE only.**

**age** 

### 74 . Is this person of Spanish, Hispanic, or Latino origin?

**American Indian or Alaska Native Asian**  **Black or African American No**  **Yes**



### 73 . How old was this person when he or she first moved to the 50 United States or the District of Columbia? **Native Hawaiian or other Pacific Islander White** 



### 72 . Where was this parent or guardian born? 

### 75 . What is this person’s race? You may mark one or more races.

**Some graduate or professional education, but no degree**  

### 76 . What is the highest grade or level of school that this parent or guardian completed? **Mark ONE only. 8th grade or less**  **High school, but no diploma High school diploma or equivalent (GED)**  **Vocational diploma after high school Some college, but no degree**  **Associate’s degree (AA, AS) Bachelor’s degree (BA, BS)** 

**Professional degree beyond bachelor’s degree (MD, DDS, JD, LLB)**  **Master’s degree (MA, MS) Doctorate degree (PhD, EdD)**  X

X

X

**One of the 50 United States or the District of Columbia** 

**One of the U.S. territories (Puerto Rico, Guam, American Samoa,**  **U.S. Virgin Islands, or Mariana Islands) Another country**  **GO TO question**  **7**

**4 24352155** §9D6X¤**NHES-31AC 16** 



### 77 . Is he or she currently attending or enrolled in a school, college, university, or adult learning center, or receiving vocational education or job training? **No Yes**  

### 78 . Which of the following best describes this person’s employment status? **Mark ONE only. months** 



### 80 . (If unemployed or out of work) Has this parent or guardian been actively looking for work in the past 4 weeks ? **No Yes**  

### 81 . In the past 12 months , how many months (if any) has this person worked for pay or income?

**Don’t know**



### 79 . (If employed or self-employed) About how many hours per week does he or she usually work for pay or income, counting all jobs? **age** 

### 82 . How old is this person?



### 83 . How old was this person when he or she first became a parent to any child? X

**Retired Employed for pay or income**  **Self-employed Unemployed or**  **out of work Full-time student**  **Stay at home parent** 

**Disabled or unable to work**  **GO TO question**  **80**

**GO TO question 81**  **0**

**GO TO question 80 hours**  { **age 24352163** §9D6‘¤ 

### Continue with section 6, question 8 4 on the next page.▼**NHES-31AC 17** 



### 84 . Including yourself, how many total people live in this household? **people** 

### 86 . How are you related to this child? **Mark ONE only.**



### 85 . Other than the parents or guardians already reported, how many of the following people live in the household with this child? **Example: Brother(s)** 

### 2

**This child’s... Brother(s) . . . . . . . . . . . . .**  **Sister(s) . . . . . . . . . . . . . . Aunt(s) . . . . . . . . . . . . . . .**  **Uncle(s) . . . . . . . . . . . . . . Grandmother(s) . . . . . . . .**  **Grandfather(s)**

**. . . . . . . . . . Cousin(s) . . . . . . . . . . . . .**  **Parent’s girlfriend/ boyfriend/partner . . . . . . .**  **Other relative(s) . . . . . . . . Other non-relative(s). . . . .**  **Write ’0’ if none. Number** 



### 87 . Which language(s) are spoken at home by the adults in this household? **Mark all that apply. English**  **Spanish or Spanish Creole French (including Patois, Creole, Cajun)**  **Chinese Other languages – Specify:**  **Mother (birth, adoptive, step, or foster) Father (birth, adoptive, step, or foster)**  **Aunt Uncle**  **Grandmother Grandfather**  **Parent’s girlfriend/boyfriend/partner Other relationship – Specify:** 

X

X**24352171**§9D6h¤ 

### Continue with question 88 on the next page.▼ 

# 6. Your Household**NHES-31AC 18** 



### 88 . In the past 12 months , did your family ever receive benefits from any of the following programs? **Mark ONE box for each item below.**
**a. Temporary Assistance for Needy Families, or TANF** 
**. . . . . b. Your state welfare or**  **family assistance program. . . . c. Women, Infants, and**  **Children, or WIC**
**. . . . . . . . . . . .** 

### 91 . Is this house... **Mark ONE only. Owned or being bought by someone**  **in this household, Rented by someone in this household, or**  **Occupied by some other arrangement?**

**$0 to $10,000 $10,001 to $20,000**  **$20,001 to $30,000 $30,001 to $40,000**  **$40,001 to $50,000** 

### 89 . Which category best fits the total income of all persons in your household over the past 12 months? **Include your own income. Include money from jobs or other earnings,**  **pensions, interest, rent, Social Security payments, and so on.**  **No Yes**  

### 92 . Do you have access to the Internet at this address?

**No Yes**  

### 93 . Is there at least one telephone inside this home that is currently working and not a cell phone?

**No Yes**  

### 94 . Do you have a working cell phone? 

### 90 . How many years have you lived at this address? **Write ’0’ if less than 1 year.**

**d. Food Stamps . . . . . . . . . . . . . . e. Medicaid** 
**. . . . . . . . . . . . . . . . . f. Child Health Insurance**  **Program (CHIP)**

**. . . . . . . . . . . . . g. Section 8 housing assistance** 
**. .**

**$50,001 to $60,000 $60,001 to $75,000**  **$75,001 to $100,000 $100,001 to $150,000**  **$150,001 or more years at this address** 

X

X **No Yes** ▼ ▼**24352189**§9D6z¤**NHES-31AC 19**  

# Thank you. **Please return this questionnaire in the postage-paid envelope provided. If you have lost the envelope, mail the completed questionnaire to:**  U.S. Census Bureau ATTN: DCB 60-A (7198) 1201 E. 10th Street Jeffersonville, IN 47132-0001**24352197**§9D6¿¤**NHES-31AC 20**  

### Commonly Asked Questions**24352205**§9D7&¤ Q: How did you get my address? **A: Your address was randomly selected from among all of the home addresses in the nation. It was selected using scientific sampling methods to represent other households in the**  **United States.** Q: How did you get my child’s name and age? **A: When you returned the initial National Household Education Survey to us, we randomly chose one child to ask additional questions about. We are interested in understanding**  **your child’s experiences with homeschooling.** Q: Why should I take part in this study? Do I have to do this? **A: You represent thousands of other households like yours, and you cannot be replaced. Your answers and opinions are very important to the success of this study. You may**  **choose not to answer any or all questions in this survey. In order for the survey to be representative, it is important that you complete and return this questionnaire. Those who**  **do not return the survey will not be represented in key statistics used by policymakers and researchers.**  Q: How will the information I provide be used? Will my privacy be protected? **A: Your responses will be combined with those of others to produce statistical summaries and reports. Your individual data will not be reported. Your answers may be used only for**  **statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law (Section 9573, 20 U.S. Code).**  Q: I have more than one child in my household. Will I receive additional surveys for the other children in my household? **A: No, each household will receive a survey for only one child, even if there are multiple children living in the household. In households with multiple children, one child was**  **randomly selected to be included in the study.** Q: How will my response help the Department of Education? **A: The Department of Education wants to understand the condition of education in the United States. This survey is the only way that the Department of Education can learn**  **about homeschooling from your perspective. It is the Department of Education’s primary source of information on homeschooling in America. Your responses will be combined**  **with those from other households to inform educators, policymakers, schools, and universities about changes in the condition of education in the United States. Reports**  **from past surveys can be found at www.nces.ed.gov/nhes.** 

### Q: Who is sponsoring this study? A: The National Center for Education Statistics, within the U.S. Department of Education, is authorized to conduct this study (20 USC § 9543). The U.S. Census Bureau is conducting this study on behalf of the U.S. Department of Education

. This study has been approved by the Office of Management and Budget, the office that re v iews all federally sponsored surveys. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this voluntary survey is 1850
- 0803. The average time required to complete this survey is estimated to average 

### 20 minutes per response, including the time to review instructions, gather the data needed, and complete and review the survey. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey, or any comments or concerns regarding the status of your individual submission of this survey, please write to : Andrew Zukerberg , National Center for Education Statistics, National Household Education Surveys (NHES) , 1990 K Street NW, Washington, DC 20006
- 5650. You may send email to NHES@census.gov. 

### Q: What if I have other questions? A: If you have any questions about the study, you may send e
- mail to NHES @census.gov or you may call 

### the Census Bureau toll-free at 1-888-840-8353