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 Evaluation 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 and 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 provide 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 files; 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 

reach me at (xxx) xxx-xxxx or xxxxxxxxxxxxxxxxx. 

Sincerely, 

xxxxxxxxxxxxxxxxxxxxxxxxxxx

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 minutes per respondent, including the time to review instructions, 

gather the data needed, and complete and review the information collected. If you have any comments concerning the accuracy of the 

time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC 20202. If you 

have comments or concerns regarding the status of your individual submission of this form, write directly to: U.S. Department of 

Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Washington, DC 20208. 
Item # Data Item 

Student’s Background and Demographic Information 

1 Last 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 (2014–2015) 

7 School Name 

8 School ID 

9 Days Enrolled 

10 Student’s grade level 

11 Free- or reduced-price school lunch status 

12 English Language Learner (ELL) status 

13 Special education/IEP status 

14 Type of disability, if any

15 504 Plan status 

Test Scores (Spring 2015 and Spring 2014) 

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 ranks, or 

number correct are acceptable (in descending 

order of preference). 

Attendance and Promotion Information (2014-2015) 

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 (2014-2015) 

Student’s Reading, Language Arts, or English teacher 

23 Last name of teacher 

24 First name of teacher 

25 District ID of teacher 

Student’s Math teacher 

26 Last 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 purposes. 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 team, 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 the data needed, and complete and review the 

information collected. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please 

write to: U.S. Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual 

submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, 

Washington, DC 20208.