**APPENDIX E** 

**STUDENT RECORDS DATA COLLECTION**

**1. Cover Letter** 

**2. Instructions for Providing Student Records** **STUDENT RECORDS DATA REQUEST**

Dear [DISTRICT CONTACT]:

We would like to thank your district for participating in the national Evaluatio n of the Teacher Incentive Fund (TIF) conducted in prior years by Mathematica Policy Research for the U.S. Department of Education. This study will produce valuable information on the impact of performance

- based incentive programs on student achievement an d educator mobility and retention. We greatly

appreciate your assistance with this important study.

As part of the study, we are collecting information from district records for the students in the study. I am writing to request that your district provi de us with data for each student in tested grades in the study schools. Please note that cooperation with these activities is a condition of your grant (EDGAR: part 75.591, Authority: 20 U.S.C. 1221e

– 3 and 3474).
The attached table indicates the specific items that we are requesting for the current school year. Also attached are instructions for returning the data to us. You can choose among three ways to return the data: (1) posting the files to our secure website; (2) emailing the password

- protected fil es; or (3) sending the hard copy lists via Federal Express.

Thank you very much for your assistance with this data request. A member of our study team will contact you in the next week to determine if you have any questions about this request. You can

re ach me at (xxx) xxx

- xxxx or xxxxxxxxxxxxxxxxx.
Sincerely
,

xxxxxxxxxxxxxxxxxxxxxxxxxxx

Acc ording to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it di splays a valid OMB control number. The valid OMB control number for this information collection is **xxxx -** **xxxx** . The time required to complete this information collection is estimated to average 8 hours per year minutes per respondent, including the time to review ins tructions, gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please w rite to: U.S. Department of Education, Washington, DC 20202. If you hav e comments or concerns regarding the status of your individual submission of this form, w rite direct ly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, N W, Wa shington, DC 20208.**Item # Data Item** 

**Student’s Background and Demographic Information** 1 La st and first name 2 Sex 3 District ID number 4 Date of birth (mm/dd/yy) 5 Ethnicity (Hispanic or Latino origin) 6 Race **Year**

**- Specific Information (201**  **4**

**– 201**  **5 )**  7 School Name 8 School ID 9 Day s Enrolled 10 Student’s grade level 11 Free

- or reduced

- price school lunch status 12 English Language Learner (ELL) st atus 13 Special education/IEP status 14 Ty pe of disability , if any 15 504 Plan status **Test Scores (Spring 201 5**  **and Spring 201 4**  **)** 16 Math test information Name of test, publisher, grade level administered. If alternative assessment, please indicate. 17 Math scale score Scale score from math section of state or district test. Scale score is preferred, but normal curve equivalents, percentile ranks, or number correct are acceptable (in descending order of preference). 18 Reading test information Name of test, publisher, grade level administered. If alternative assessment, indicate this. 19 Reading scale score Scale score from math section of state or district test. Scale score is preferred, but normal curve equivalents, percentile rank s, or number correct are acceptable (in descending order of preference). **Attendance and Promotion Information (201 4** 

**- 201**  **5 )**  20 Promotion status Indicate whether the student was promoted to a higher grade as of May/June prior to the start of the school year. 21 Number of days absent from school 22 Disciplinary record Information on suspensions or other disciplinary action**Teacher Information (201 4** 

**- 2015**  **)**

**Student’s Reading, Language Arts, or English teacher** 23 La st name of teacher 24 First name of teacher 25 District ID of teacher **Student’s Math teacher** 26 La st name of teacher 27 First name of teacher 28 District ID of teacher

**Notice of Confidentiality**

Responses to this data collection will be used only for statistical purp oses. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study te am, except as required by law. Additionally, no one at your school or in your district will see your responses. Participation or cooperation with this activity is a condition of your grant (EDGAR: part 75.591, Authority: 20 U.S.C. 1221e

– 3 and 3474).

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is **xxxx -**  **xxxx** . The time required to complete this information collection is estimated to average 8 hours per year, including the time to review instructions, gather th e data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you h av e comments or concerns regarding the status of your individual submission of this form, w rite directly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Ave nue, NW, Wa shington, DC 20208.