FORM PSS-1

(01-11-10) Draft 1

U.S. DEPARTMENT OF EDUCATION

NATIONAL CENTER FOR EDUCATION STATISTICS

PRIVATE SCHOOL SURVEY

2011-12 SCHOOL YEAR

PLEASE NOTE: 

OMB No. 1850-0641: Approval Expires 06/30/2013

Conducted by:

U.S. DEPARTMENT OF COMMERCE

Economics and Statistics Administration

U.S. CENSUS BUREAU

15119019

SCHOOLS that teach ANY of the following -

• At least one of grades 1 - 12

• Ungraded students between 5 and 18 years old

• Kindergarten - traditional year of school primarily for 5-year-olds prior to first grade

• Transitional (or readiness) kindergarten - extra year of school for kindergarten-age children 

who are judged not ready for kindergarten

• Transitional first (or prefirst) grade - extra year of school for children who have attended 

kindergarten but have been judged not ready for first grade

EARLY CHILDHOOD PROGRAMS AND DAY CARE CENTERS that have 

ANY of the following -

• Kindergarten

• Transitional (or readiness) kindergarten

• Transitional first (or prefirst) grade

For example:

An early childhood center that has a nursery school, a prekindergarten program, and a kindergarten

would be eligible for this survey, since it includes a kindergarten.

But an early childhood center that has a nursery school and a prekindergarten program ONLY

would NOT be eligible for this survey, since it does not include a kindergarten. You would mark

box 2 in item 2d.

PLEASE CONTINUE WITH ITEM 1 ON PAGE 3.

The 2011-12 Private School Survey is intended to include all private -
DEAR ADMINISTRATOR: 

The National Center for Education Statistics (NCES) of the U.S. Department of Education requests 

your participation in the 2011-12 Private School Survey, a national data collection that is very 

valuable to private schools across the country. The U.S. Census Bureau is conducting the survey for 

NCES; the survey is authorized by Title I, Part E, Sections 151(b) and 153(a) of Public Law 107-279,

the Education Sciences Reform Act of 2002.

WHY IS NCES SPONSORING THIS SURVEY?

The purpose of this data collection effort is to obtain current information about private schools, 

such as type of school, length of school year, number of students and teachers, and number of high 

school graduates, if any. We will use the data to produce a web-based private school search tool 

and statistical summaries about the providers of private education in the United States.

WHO SHOULD PARTICIPATE IN THIS SURVEY?

The 2011-12 Private School Survey includes all private schools and early childhood programs 

that provide educational instruction to students in kindergarten or at least one of grades 1-12.

WHY SHOULD YOUR SCHOOL PARTICIPATE IN THIS SURVEY?

Private schools are a significant segment of the nation’s educational system. Results from previous 

surveys show that approximately 25 percent of all elementary and secondary schools in the United 

States are private; these schools enroll approximately 10 percent of the nation’s children and 

employ 13 percent of the nation’s teachers. NCES has instituted this survey in recognition of the 

importance of private education in the United States. While there is no penalty for not responding, a 

high response rate is very important to the success of the survey. We encourage you to participate 

in this voluntary survey. 

WHERE SHOULD YOU MAIL YOUR COMPLETED QUESTIONNAIRE?

Please return your completed questionnaire using the enclosed envelope. If you do not have the return 

envelope, mail your questionnaire to:

15119027

2

FORM PSS-1

ACTING COMMISSIONER FOR EDUCATION STATISTICS

NATIONAL CENTER FOR EDUCATION STATISTICS

STUART KERACHSKY

SINCERELY,

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of

information unless such collection displays a valid OMB control number. The valid OMB control number for

this information collection is 1850-0641. The time required to complete this information collection is estimated

to average 20 minutes per response, including the time to review instructions, search existing data resources,

gather the data needed, and complete and review the information collection. 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 20202-4651. If you have comments or concerns about the contents

of this questionnaire, write directly to: Private School Survey, National Center for Education Statistics, 1990

K Street NW, #9012, Washington, DC 20006-5651.

Paperwork Burden Statement

THANK YOU FOR YOUR COOPERATION IN THIS VERY IMPORTANT EFFORT.

U.S. CENSUS BUREAU

ATTN: DCB 61G

1201 E. 10TH STREET

JEFFERSONVILLE, IN 47132-0001
15119035

3

FORM PSS-1

Please print your name, title, and school telephone number in case we have questions about 

any of your responses.

1.

050

YOUR NAME

051

TITLE

SCHOOL TELEPHONE NUMBER

Area code

052

– –

For questions regarding this survey, please call the Census Bureau at 1-800-221-1204, 

Monday through Friday, between 8:30 a.m. and 5:00 p.m. (Eastern time).

Number

e. Is this school located in the United States?

105

1 Yes

2 No - Please explain

GO TO item 3 below.

106

Is this school a private school? (For this survey, all elementary or secondary schools that are 

non-public are considered private schools, e.g., Roman Catholic schools, Hebrew day schools, 

Lutheran schools, private boarding schools, nonsectarian private schools, private schools that 

provide special education services to public school districts.)

b.

130

1 Yes

No - Please describe the type of school, (e.g., public school, Bureau of Indian Affairs school, 

state school, charter school).

2

GO TO item 3 below.

131

If you marked "No" for any of items 2a-e, do not complete this questionnaire. Please return it 

in the enclosed envelope. If you do not have the return envelope, mail your questionnaire to:

3.

If you marked "Yes" for all of items 2a-e above, continue with item 4.

U.S. CENSUS BUREAU

ATTN: DCB 61G

1201 E. 10TH STREET

JEFFERSONVILLE, IN 47132-0001

125

1 Yes

2 No - Please specify the country in which this school is located.

126

2a. Is the institution or organization named on the front of this questionnaire a school?

100

1 Yes

2

GO TO item 3 below.

c. Is this school still in operation?

Does this school teach any students in AT LEAST one of grades K to 12, or comparable 

ungraded levels (e.g., K to 6, 9 to 12, PK to 12, PK to K)?

d.

115

1 Yes

No - Please record the grade level(s) taught in this school (e.g., nursery and prekindergarten, 

adult education, postsecondary).

2

116

101

Month

102

Day

103

Year

GO TO item 3 below.

No - Please record the 

date when the 

school closed.
15119043

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FORM PSS-1

INSTRUCTIONS

b. If you have any questions, call the U.S. Census Bureau at 1-800-221-1204. Someone will be available

to take your call Monday through Friday, between 8:30 a.m. and 5:00 p.m. (Eastern Time).

If you are unsure about how to answer a question, please give the best answer you can rather than

leaving it blank.

a.

1 Yes

2 No

1 Yes

2 No

OR

1 Yes

X 2 No

3 5 35 3 5

x

CORRECT marking example – INCORRECT marking example –

(Use care to keep characters

in their designated spaces.)

4. At the end of this questionnaire, you will be asked how long it took to complete this 

questionnaire. To help you with this, please record the time you begin.

Time started

:

The data you enter on this form will be captured through the use of imaging technology. Please print all

information clearly in ordinary characters, using a black ballpoint pen.

5. How many students were enrolled in each of the following grade levels around the first

of October?

Report only for the school or program named on the front of this questionnaire.

140

,

1 Yes

Do NOT include postsecondary or adult education students, or children who are enrolled only in

day care at this school or program.

In column (1), mark (X) “Yes” or “No” for each grade level.

In column (2), record the number of students for each grade level with “Yes” marked in column (1).

135

2 No

Does this 

school or program

have students in this

grade?

Number of students

in this grade

(1) (2)

Ungraded (including ungraded special

education students)

a.

150

,

1 Yes 145

2 No b. Nursery and prekindergarten

160

,

1 Yes 155

2 No Kindergarten (traditional year of school

primarily for 5-year-olds prior to first grade)

c.

170

,

1 Yes 165

2 No

Transitional (or readiness) kindergarten (extra

year of school for kindergarten-age children

who are judged not ready for kindergarten)

d.

180

,

1 Yes 175

2 No

Transitional first (or prefirst) grade (extra

year of school for children who have attended

kindergarten but have been judged not ready

for first grade)

e.

Grade levels
15119050

5

FORM PSS-1

5. Continued – How many students were enrolled in each of the following grade levels around the 

first of October?

190

,

1 Yes 185

2 No

Does this

school or program

have students in this

grade?

Number of students

in this grade

(1) (2)

f. 1st

Grade levels

200

,

1 Yes 195

2 No g. 2nd

210

,

1 Yes 205

2 No h. 3rd

220

,

1 Yes 215

2 No i. 4th

230

,

1 Yes 225

2 No j. 5th

240

,

1 Yes 235

2 No k. 6th

250

,

1 Yes 245

2 No l. 7th

260

,

1 Yes 255

2 No m. 8th

270

,

1 Yes 265

2 No n. 9th

280

,

1 Yes 275

2 No o. 10th

290

,

1 Yes 285

2 No p. 11th

300

,

1 Yes 295

2 No q. 12th

6. What was the total number of students enrolled in this school or program

around the first of October?

Please sum lines 5(a) through 5(q).

305

,

Students
15119068

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FORM PSS-1

7. Around the first of October, how many students enrolled in grades K-12 and comparable

ungraded levels were –

Do NOT include nursery, prekindergarten, postsecondary, or adult education students, or 

children who are enrolled only in day care at this school or program.

If none, please mark (X) the box.

Hispanic or Latino, regardless of race?

White, not of Hispanic or Latino origin?

Black or African American, not of Hispanic or Latino origin?

Asian, not of Hispanic or Latino origin?

Native Hawaiian or other Pacific Islander, not of Hispanic or Latino origin?

a.

b.

c.

d.

e.

0 None or

320

, Students

0 None or

330

, Students

0 None or

325

, Students

0 None or

316

, Students

0 None or

318

, Students

8a. Is this school or program coeducational?

335

1 Yes

2 No, it is an all-female school

GO TO item 9a on page 7.

3 No, it is an all-male school }

b. Around the first of October, how many MALE students in grades K-12 and comparable 

ungraded levels were enrolled in this school or program?

Do NOT include nursery, prekindergarten, postsecondary, or adult education students, 

or children who are enrolled only in daycare at this school or program.

If none, please mark (X) the box.

0 None or

340

, Male students

American Indian or Alaska Native, not of Hispanic or Latino origin?

Two or more races, not of Hispanic or Latino origin?

f.

g.

0 None or

310

, Students

0 None or

332

, Students
15119076

7

FORM PSS-1

9a. LAST school year (2010-11), were any students enrolled in 12th grade?

1 Yes

2 No

345

GO TO item 10a below.

,

GO TO item 10a below.

b. How many students were enrolled in 12th grade around October 1, 2010?

350

12th graders

c. How many students graduated from the 12th grade with a diploma last school year (2010-11)?

0 None

d. Of those who graduated with a diploma last school year, approximately what percentage

went to four-year colleges?

Include 2010 summer graduates. Do not include students who received only vocational

certificates, certificates of attendance, or certificates of completion.

If none, please mark (X) the box.

355

, Graduates

Round to the nearest whole percent.

Percent

If none, please mark (X) the box.

0 None or

360

10a. How long is the school day for a kindergarten, transitional kindergarten, or transitional

first grade student?

Mark (X) only one box.

365

1 Full day (4 hours or more per day)

2 Half day (less than 4 hours per day)

3 Both offered

b. How many days per week does a kindergarten, transitional kindergarten, or transitional 

first grade student attend?

If the number of days per week varies (e.g., some students attend 3 days per week and some

attend 5 days per week), record the most days that a student would attend in a week.

370

Days per week

School or program does not offer kindergarten,

transitional kindergarten, or transtional first grade

0

GO TO instructions for 

item 11 at top of page 8. {
15119084

8

FORM PSS-1

INSTRUCTIONS AND AN EXAMPLE FOR ITEM 11

In item 11, we ask for the number of teachers for grades K-12 by the amount of time they

teach at THIS school or program.

Example:

The following is an example to illustrate how to report teachers in this item for a school or program

that includes prekindergarten through grade 8.

If this school or program has eight full-time teachers for grades 1-8, one full-time teacher who 

teaches kindergarten 1⁄2 time and prekindergarten 1⁄2 time, a music teacher who teaches two days 

each week, a physical education teacher who teaches three days each week, and a teaching 

principal who teaches one 30-minute class each day, you would complete item 11 as follows:

0 None or

Full-time teachers

0 None or

Teach at least 3⁄4 time but less than full time

0 None or

Teach at least 1⁄2 time but less than 3⁄4 time

This number includes the one full-time teacher who teaches

kindergarten 1⁄2 time and prekindergarten 1⁄2 time. The time he or she

spends teaching prekindergarten is not counted in item 11. 

This number also includes the physical education teacher who teaches

three days a week.

0 None or

Teach at least 1⁄4 time but less than 1⁄2 time

This includes the music teacher who teaches two days a week.

0 None or

Teach less than 1⁄4 time

This includes the principal who teaches one 30-minute class each day.

The time he or she spends working as a principal is not included in 

item 11.

TOTAL TEACHERS

8

2

1

1

1 2
15119092

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FORM PSS-1

11. Around the first of October, how many persons were teaching in grades K-12 and/or

COMPARABLE ungraded levels at this school or program in the following time categories?

Consider only the amount of time an individual works as a teacher during a typical week

at THIS school or program.

Include:

• Regular classroom teachers

• Teachers who teach subjects such as music, art, physical education, and special education

• Teaching principals or administrators who teach a regularly scheduled class at this school or 

program

Do NOT include:

• Teachers who teach ONLY nursery, prekindergarten, postsecondary, or adult education

• Student teachers, teacher aides, day care aides, or short-term substitute teachers

• Counselors, library media specialists or librarians, speech therapists, social workers, or

administrators UNLESS they also teach a regularly scheduled class at THIS school or program

If none, please mark (X) the box.

0 None or

Full-time teachers

0 None or

Teach at least 3⁄4 time but less than full time

0 None or Teach at least 1⁄2 time but less than 3⁄4 time

0 None or

Teach at least 1⁄4 time but less than 1⁄2 time

0 None or

Teach less than 1⁄4 time

TOTAL TEACHERS

385

390

395

400

405

410
15119100

FORM PSS-1

10

13a.

Which of the following best describes this school or program?

Mark (X) only one box.

1 REGULAR school – elementary or secondary

SPECIAL PROGRAM EMPHASIS school – such as a science or math school, performing

arts school, talented or gifted school, foreign language immersion school, etc.

3

4 SPECIAL EDUCATION school – primarily serves students with disabilities

CAREER/TECHNICAL/VOCATIONAL school – primarily serves students being trained

for occupations

5

EARLY CHILDHOOD PROGRAM OR DAY CARE CENTER – such as kindergarten only,

prekindergarten and kindergarten only, kindergarten and transitional first grade only,

day care and transitional kindergarten only, etc.

7

415

2 MONTESSORI school

ALTERNATIVE/OTHER school – offers a curriculum designed to provide alternative or

nontraditional education; does not specifically fall into the categories of regular, special

program emphasis, special education, or vocational school – Please describe.

6

416

b.

Is a major role of this school or program to support homeschooling?

12.

Is this school or program located in a private home that is used primarily as a family residence?

1 Yes

420

2 No

1 Yes

425

2 No

14a. Does this school or program have a religious orientation or purpose?

430

1 Yes

2 No GO TO item 15 on page 12.

b. Is this school or program affiliated with a religious organization or institution?

1 Yes

435

2 No
15119118

11

FORM PSS-1

14c. What is this school’s or program’s religious orientation or affiliation?

Mark (X) only one box.

1 Roman Catholic 440

2 African Methodist Episcopal

3 Amish

4 Assembly of God

5 Baptist

6 Brethren

7 Calvinist

8 Christian (no specific denomination)

9 Church of Christ

10 Church of God

11 Church of God in Christ

12 Church of the Nazarene

13 Disciples of Christ

14 Episcopal

15 Friends

16 Greek Orthodox

17 Islamic

18 Jewish

19 Latter Day Saints

20 Lutheran Church – Missouri Synod

21 Evangelical Lutheran Church in America (formerly AELC, ALC, or LCA)

22 Wisconsin Evangelical Lutheran Synod

23 Other Lutheran

24 Mennonite

25 Methodist

26 Pentecostal

27 Presbyterian

28 Seventh-Day Adventist

29 Other – Specify

441

Mark (X) only one box.

Is this school –

1 Parochial (or inter-parochial) 445

2 Diocesan

3 Private
15119126

FORM PSS-1

12

15. To which of the following associations or organizations does this school or program belong?

450 1 This school or program does NOT belong to ANY associations or organizations

Mark (X) all that apply.

RELIGIOUS

455 1 Accelerated Christian Education (ACE) (or School of Tomorrow)

460 1 American Association of Christian Schools (AACS)

465 1 Association of Christian Schools International (ACSI)

467 1 Association of Christian Teachers and Schools (ACTS)

468 1 Association of Classical and Christian Schools (ACCS)

470 1 Christian Schools International (CSI)

480 1 Evangelical Lutheran Education Association (ELEA)

485 1 Friends Council on Education (FCE)

490 1 General Conference of the Seventh-Day Adventist Church (GCSDAC)

492 1 Islamic School League of America (ISLA)

495 1 Jesuit Secondary Education Association (JSEA)

500 1 National Association of Episcopal Schools (NAES)

505 1 National Catholic Educational Association (NCEA)

510 1 National Christian School Association (NCSA)

515 1 National Society for Hebrew Day Schools (Torah U’Mesorah)

520 1 Oral Roberts University Educational Fellowship (ORUEF)

522 1 The Jewish Community Day School Network (RAVSAK)

525 1 Solomon Schechter Day School Association (SSDSA)

530 1 Southern Baptist Association of Christian Schools (SBACS)

535 1 Other religious school association(s) – Specify

536
15119134

13

FORM PSS-1

15. Continued – To which of the following associations or organizations does this school or program 

belong?

Mark (X) all that apply.

1 American Montessori Society (AMS) 540

606

SPECIAL EMPHASIS

1 Association Montessori International (AMI) 542

1 Other Montessori association(s) 545

1 Association of Military Colleges and Schools (AMCS) 550

1 Association of Waldorf Schools of North America (AWSNA) 555

1 National Association of Private Special Education Centers (NAPSEC) 575

1 Other association(s) for exceptional children 580

1 European Council for International Schools (ECIS) 585

1 National Association for the Education of Young Children (NAEYC) 590

1 National Association of Laboratory Schools (NALS) 600

1 National Coalition of Girls Schools (NCGS) 602

1 Other special emphasis association(s) – Specify 605

1 Alternative School Network (ASN) 610

1 National Association of Independent Schools (NAIS) 620

1 State or regional independent school association 622

1 National Coalition of Alternative Community Schools (NCACS) 625

1 National Independent Private Schools Association (NIPSA) 630

1 The Association of Boarding Schools (TABS) 635

1 Other school association(s) – Specify 640

OTHER SCHOOL ASSOCIATIONS OR ORGANIZATIONS

641
15119142

FORM PSS-1

14

16. How many days are in the school year for students in this school or program?

645

Days per school year

17. How long is the school day for students in this school or program?

Report BOTH hours and minutes, e.g., 06 hours and 00 minutes, 05 hours and 45 minutes, etc.

If the length of day varies by grade level, record the longest day.

19. Not counting interruptions, how many minutes did it take to complete this questionnaire?

665

Minutes

650

Hours AND

655

Minutes

18. Does this school or program have a library media center?

(A library media center is an organized collection of printed and/or audiovisual and/or computer

resources which is administered as a unit, is located in a designated place or places, and makes

resources and services available to students, teachers, and administrators. A library media center

may be called a school library, media center, resource center, information center, instructional 

materials center, learning resource center, or any other similar name.)

1 Yes

2 No

660

670

20. Please enter the date you completed this questionnaire.

Report month as a number, i.e., 01 for January, 02 for February, etc.

Month

671

Day

672

Year
15119159

15

FORM PSS-1

700

21. Please verify this school’s or program’s name and mailing address that are preprinted below.

If any part of the name and mailing address is incorrect, enter the correction(s), as necessary,

in the appropriate space(s) below.

School or program name

701

Mailing address

702

City

703

State

704

–

ZIP Code + 4

706

Street

707

City

708

State

709

ZIP Code

b. Please print this school’s or program’s physical or street address.

22a. Is the physical or street address of this school or program the same as the mailing address?

705 1 Yes

2 No

THANK YOU FOR PARTICIPATING IN THIS IMPORTANT SURVEY.

YOUR TIME AND EFFORT ARE APPRECIATED.

PLEASE RETURN THE QUESTIONNAIRE IN THE ENCLOSED ENVELOPE.

IF YOU DO NOT HAVE THE RETURN ENVELOPE, MAIL YOUR QUESTIONNAIRE TO:

U.S. CENSUS BUREAU

ATTN: DCB 61G

1201 E. 10TH STREET

JEFFERSONVILLE, IN 47132-0001
15119167

FORM PSS-1

16

To learn more about the Private School Survey

(PSS) and to access reports from earlier

collections, see the PSS website at:

http://nces.ed.gov/surveys/pss

Additional data collected by the National

Center for Education Statistics (NCES) on

a variety of topics in elementary,

secondary, postsecondary, and

international education are available

from NCES’s website at:

http://nces.ed.gov

For additional data collected by various

Federal agencies, including the

Department of Education, visit the

Federal Statistics clearinghouse at:

http://www.fedstats.gov