Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017)

Recruitment Materials for

the 2016 Item Validation and Operational Field Tests

OMB# 1850-0911 v.3

Appendices T and U

National Center for Education Statistics

U.S. Department of Education

Institute of Education Sciences

Washington, DC

February 2015
Table of Contents 

Appendix T. MGLS:2017 Student Rostering Forms ................................................................................................................... 1

Appendix U. MGLS:2017 Survey Instruments .............................................................................................................................. 5

Student Survey................................................................................................................................................................. 6

Demographics Booklet .......................................................................................................................................... 9

Booklet 1...................................................................................................................................................................... 14

Booklet 2...................................................................................................................................................................... 18

Booklet 3...................................................................................................................................................................... 88

Parent Survey ................................................................................................................................................................... 161

Math Teacher Survey .................................................................................................................................................... 235

Special Education teacher Survey ........................................................................................................................... 314

School Administrator Survey..................................................................................................................................... 356
Appendix T. MGLS:2017 Student Rostering Forms 

Appendix T includes the student rostering two part form referenced in Appendix R. 

Appendix T.1.a Rostering Form, Part 1 

Item Validation Field Test and Operational Field Test, General Education sample 

Instructions: For each student currently enrolled in grades [5, 6, 7, and 8] in your school, please provide the below information. 

Please be certain to include all children in each grade. 

Last Name First Name

Student ID 

number

Date of birth

MM/DD/YY Grade Gender

Race and ethnicity IEP*

Race

(circle all that apply) Hispanic

Does 

student 

have 

IEP?

If yes to IEP,

Disability 

Code(s)

XX, XX, XX, ...

1.

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

2.

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

3.

Male Female

White 

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

...

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

*For Disability code, please circle the primary disability code. 

NCES is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002), 20 U.S. Code, § 9543. 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 1850-0911. Approval expires XX/XX/2018. The time 

required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information 

requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this 

information collection, please write directly to: National Center for Education Statistics, Middle Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650. 

1
Appendix T.1.b Rostering Form, Part 2 

Item Validation Field Test and Operational Field Test, General Education sample 

Instructions: For each student specified below, please provide parent contact information, student’s math teacher, and if applicable student’s special education 

teacher(s). 

Last Name First Name

Student ID 

number

Date of birth

MM/DD/YY Grade

Parent Contact information

Name

Address

Home phone number

Cell phone number

E-mail address Student’s Math Teacher

If applicable, 

student’s special education 

teacher(s)

1. [Based on sample selection, these fields will be completed]

2. [Based on sample selection, these fields will be completed]

3. [Based on sample selection, these fields will be completed]

...

NCES is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002), 20 U.S. Code, § 9543. 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 1850-0911. Approval expires XX/XX/2018. The time 

required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information 

requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this 

information collection, please write directly to: National Center for Education Statistics, Middle Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650. 

2
Appendix T.2.a Rostering Form, Part 1 

Operational Field Test, Students with Disabilities 

Instructions: For students with disabilities in your district who are currently enrolled in 6th grade please provide the below information. 

Please be certain to include all students with disabilities in your district currently enrolled in 6th grade. 

Last Name

First 

Name

Student ID 

number

Date of 

birth

MM/DD/YY Grade Gender

Race and ethnicity IEP*

School Contact 

Information

School name

School address

School phone number

Race

(circle all that apply) Hispanic

Does 

student 

have 

IEP?

If yes to 

IEP,

Disability 

Code(s)

XX, XX, 

XX, ...

1.

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

2.

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

3.

Male Female

White 

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

...

Male Female

White

Black or African American

Asian

Native Hawaiian or Pacific Islander

American Indian or Alaska Native

Yes No Yes No

*For Disability code, please circle the primary disability code. 

NCES is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002), 20 U.S. Code, § 9543. 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 1850-0911. Approval expires XX/XX/2018. The time 

required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information 

requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this 

information collection, please write directly to: National Center for Education Statistics, Middle Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650. 

3
Appendix T.2.b Rostering Form, Part 2 

Operational Field Test, Students with Disabilities 

Instructions: For each student specified below, please provide student’s parent and/or guardian contact information. 

Last Name First Name

Student ID 

number

Date of birth

MM/DD/YY Grade

Parent and/or Guardian Contact information

Name

Address

Home phone number

Cell phone number

E-mail address

1. [Based on sample selection, these fields will be completed]

2. [Based on sample selection, these fields will be completed]

3. [Based on sample selection, these fields will be completed]

...

NCES is authorized to conduct this study under the Education Sciences Reform Act of 2002 (ESRA 2002), 20 U.S. Code, § 9543. 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 1850-0911. Approval expires XX/XX/2018. The time 

required to complete this information collection is estimated to average 5 minutes per row, including the time to review instructions, gather the data needed, and complete and review the information 

requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your individual response to this 

information collection, please write directly to: National Center for Education Statistics, Middle Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650. 

4
Appendix U. MGLS:2017 Survey Instruments 

Please note that Appendix U provides the current drafts of the survey instruments. The final versions of the 

surveys to be used in the 2016 field tests will be provided later in 2015 in the request for the MGLS:2017 field 

test data collections. 

5
Middle Grades Longitudinal Study of 

2016-2017 (MGLS:2017) 

Student Questionnaire

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Student 

Questionnaire. 

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 1850-0911. Approval expires XX/XX/20XX. 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 requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or 

concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle Grades 

Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

Student Survey 

September 2014

6
A. Introduction

Survey Information

A01a. Thank you for being part of the Middle Grades Longitudinal Study of 2016-2017

(MGLS:2017) field test.

We want to learn about some of the things you may think or do. This survey asks about

what your school, friends, and home life are like, activities that you do, and how you

think about yourself and school.

This survey is voluntary and you can skip questions you do not want to answer.

Please click below to start the survey.

Let’s get started

The National Center for Education Statistics (NCES) of the U. S. Department of Education is authorized to conduct 

the MGLS:2017 by the Education Sciences Reform Act of 2002 (20 U.S. Code, Section 9543). All of the information 

you provide 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 U.S. Code, Section 9573).

Student Survey 

September 2014

7
A01b. Thank you very much for participating! Before you get started, here are a few 

helpful hints. 

• To answer a question, click the box to choose your response. 

• Press the "Next" button to move forward. 

• Press the "Back" button to go back. 

• The "Stop and Come Back Later" button can be used to save your responses and 

finish later (button is at the bottom of each page). 

• To protect your data, your responses will be automatically saved and you will be

logged off if you are idle for more than 30 minutes. 

Student Survey 

September 2014

8
Demographics Booklet 

Student Survey 

September 2014

9
Introduction

Now we have a few questions about your background.

 

We hope you will respond to each item, but if you do not wish to answer then you can 

skip it. In order to skip an item, simply press the "Next" button on that screen. If you do 

press the "Next" button without answering the question, a screen will pop-up to make 

sure you meant to skip that question. If so, just click "Yes" and move on, but if not, click 

"No" and you’ll be taken back to the original question. 

 

Please click on the "Next" button to begin.

AA. Your Background

AA01. What is your birth date?

Drop-down menus:

Month: ____ (January to December)

Day: ____ (1 to 31)

Year: ____ (2000 to 2009)

AA02. What is your sex?

1. Male

2. Female

Student Survey 

September 2014

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AA03. Are you Hispanic or Latino/Latina?

1. Yes

2. No

{If AA03 = 1}

AA04. Which of the following best describes you? You may choose more than one.

1. Mexican, Mexican-American, or Chicano

2. Cuban

3. Dominican

4. Puerto Rican

5. Central American such as Guatemalan, Salvadoran, Nicaraguan, Costa Rican, 

Panamanian, or Honduran

6. South American, such as Colombian, Argentine, or Peruvian

7. Other Hispanic or Latino/Latina (specify):

AA05. Which of the following best describes your race? You may choose more than one.

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

Student Survey 

September 2014

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{If AA05 = 3}

AA06. Which of the following best describes your Asian race? You may choose more than 

one.

1. Asian Indian

2. Chinese

3. Filipino 

4. Japanese

5. Korean 

6. Vietnamese

7. Other (specify):

Now we have a few questions about your grades in different subjects.

AA07a. What was your grade during the last grading period in...

English/language arts?

1. A

2. B

3. C

4. D

5. F

6. This class is ungraded or uses alternative grading

AA07b. What was your grade during the last grading period in...

Mathematics?

1. A

2. B

3. C

4. D

5. F

6. This class is ungraded or uses alternative grading

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September 2014

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AA07c. What was your grade during the last grading period in...

Science?

1. A

2. B

3. C

4. D

5. F

6. This class is ungraded or uses alternative grading

AA07d. What was your grade during the last grading period in...

Social studies?

1. A

2. B

3. C

4. D

5. F

6. This class is ungraded or uses alternative grading

{If STUDENT BOOKLET = 4, 5, 6}

Thank you for taking the time to answer our questions!

Student Survey 

September 2014

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Booklet 1: Version 1.0: 

Theories of Intelligence 

Student Survey 

September 2014

14
Introduction

The next set of questions asks for your opinion about different things, so there are no 

right or wrong answers.

 

Let’s get started.

E. About Yourself

E06a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You have a certain amount of intelligence and you can’t really do much to change it.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06b. How much do you agree or disagree with the following statements?

Your intelligence is something about you that you can’t change very much.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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September 2014

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E06c. How much do you agree or disagree with the following statements?

No matter who you are, you can significantly change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06d. How much do you agree or disagree with the following statements?

You can learn new things, but you can’t really change your basic intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06e. How much do you agree or disagree with the following statements?

You can always substantially change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

Student Survey 

September 2014

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E06f. How much do you agree or disagree with the following statements?

No matter how much intelligence you have, you can always change it quite a bit.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

Thank you for taking the time to answer our questions!

Student Survey 

September 2014

17
Booklet 2: Version 2.1

All items across Versions 2.1 and 2.2 are the same except for items marked “This item only appears in 

Version 2.1”

Student Survey 

September 2014

18
Introduction

Next we are interested in learning about what your school, friends, and home life are 

like, activities that you do, and how you think about yourself and school. 

 

These questions ask for your opinion so there are no right or wrong answers. This is your 

chance to tell us about you.

 

Let’s get started.

A. Your School Experiences

First are some questions about things that may happen at school.

A01a. How many times did the following happen in the last month?

(Select one answer for each row.)

I was tardy for school.

1. 0 times

2. 1 or 2 times

3. 3 to 6 times

4. 7 to 9 times

5. 10 to 12 times

6. 13 or more times

A01b. How many times did the following happen in the last month?

I cut or skipped class.

1. 0 times

2. 1 or 2 times

3. 3 to 6 times

4. 7 to 9 times

5. 10 to 12 times

6. 13 or more times

Student Survey 

September 2014

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A02a. How often does the following happen at your school?

(Select one answer for each row.)

I feel like a real part of my school.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02b. How often does the following happen at your school?

People notice when I'm good at something.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02c. How often does the following happen at your school?

Other students take my opinions seriously.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

Student Survey 

September 2014

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A02d. How often does the following happen at your school?

People are friendly to me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02e. How often does the following happen at your school?

I'm included in lots of activities.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

The next questions are about the students at your school.

A06a. How often did the following happen at your school in the last month?

(Select one answer for each row.)

Physical conflicts (fights) among students.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

Student Survey 

September 2014

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A06b. How often did the following happen at your school in the last month?

Students bullied other students.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06c. How often did the following happen at your school in the last month?

Students yelled and screamed at the teachers.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06d. How often did the following happen at your school in the last month?

Students physically attacked teachers.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

Student Survey 

September 2014

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A06e. How often did the following happen at your school in the last month?

Students used alcohol.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06f. How often did the following happen at your school in the last month?

Students used drugs.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06g. How often did the following happen at your school in the last month?

Students brought in weapons.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

Student Survey 

September 2014

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A07a. During this school year, how often have other students...

(Select one answer for each row.)

Teased you, made fun of you, or called you names?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A07b. During this school year, how often have other students...

Told lies or untrue stories about you?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A07c. During this school year, how often have other students...

Pushed, shoved, slapped, hit, or kicked you?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

Student Survey 

September 2014

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A07d. During this school year, how often have other students...

Left you out when they were hanging out, sitting together, or doing other activities?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

C. Your Peers

The next questions are about your classmates this school year. Please think only about 

the students who are in your classes.

C01a. How often are the following statements true?

(Select one answer for each row.)

My classmates think it is important to be my friend.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01b. How often are the following statements true?

My classmates like me the way I am.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

Student Survey 

September 2014

25
C01c. How often are the following statements true?

My classmates care about my feelings.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01d. How often are the following statements true?

My classmates like me as much as they like others.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01e. How often are the following statements true?

My classmates really care about me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

Student Survey 

September 2014

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Next are a few questions about people your age who you hang out with, including those 

who you know from school or from somewhere else.

C02a. Of the people your age who you hang out with, how important is it to them that they...

(Select one answer for each row.)

Attend classes regularly?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

C02b. Of the people your age who you hang out with, how important is it to them that they...

Get good grades?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

C02c. Of the people your age who you hang out with, how important is it to them that they...

Work hard in school?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

Student Survey 

September 2014

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C03a. Of the people your age who you hang out with, how many...

Are members of a gang?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03b. Of the people your age who you hang out with, how many...

Have ever used a weapon in a fight?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03c. Of the people your age who you hang out with, how many...

Have ever stolen things?

1. None

2. Some

3. About half

4. Most

5. All or almost all

Student Survey 

September 2014

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C03d. Of the people your age who you hang out with, how many...

Have ever hit someone, trying to seriously hurt them?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03e. Of the people your age who you hang out with, how many...

Have ever damaged property that didn't belong to them on purpose?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03f. Of the people your age who you hang out with, how many...

Have been suspended from school at least once this year?

1. None

2. Some

3. About half

4. Most

5. All or almost all

Student Survey 

September 2014

29
C03g. Of the people your age who you hang out with, how many...

Have skipped school at least once this year?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04a. Of the people your age who you hang out with, how many have ever pressured you to...

(Select one answer for each row.)

Try cigarettes?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04b. Of the people your age who you hang out with, how many have ever pressured you to...

Try marijuana or other drugs?

1. None

2. Some

3. About half

4. Most

5. All or almost all

Student Survey 

September 2014

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C04c. Of the people your age who you hang out with, how many have ever pressured you to...

Drink beer, wine, or liquor?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04d. Of the people your age who you hang out with, how many have ever pressured you to...

Skip school?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04e. Of the people your age who you hang out with, how many have ever pressured you to...

Commit a crime or do something violent?

1. None

2. Some

3. About half

4. Most

5. All or almost all

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September 2014

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E. About Yourself

Now we’d like to know a little more about what you think and how you behave.

E01a. How often are the following statements true for you? I see myself as someone who...

(Select one answer for each row.)

Does things carefully and completely.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01b. How often are the following statements true for you? I see myself as someone who...

Can be somewhat careless.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01c. How often are the following statements true for you? I see myself as someone who...

Is a reliable worker.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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September 2014

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E01d. How often are the following statements true for you? I see myself as someone who...

Tends to be disorganized.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01e. How often are the following statements true for you? I see myself as someone who...

Tends to be lazy.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01f. How often are the following statements true for you? I see myself as someone who...

Keeps working until things are done.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

Student Survey 

September 2014

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E01g. How often are the following statements true for you? I see myself as someone who...

Does things efficiently (quickly and correctly).

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01h. How often are the following statements true for you? I see myself as someone who...

Makes plans and sticks to them.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01i. How often are the following statements true for you? I see myself as someone who...

Is easily distracted.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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September 2014

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E01j. How often are the following statements true for you? I see myself as someone who...

Has trouble paying attention.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E02a. How often are the following statements true for you?

(Select one answer for each row.)

I think I am doing pretty well.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02b. How often are the following statements true for you?

I can think of many ways to get the things in life that are most important to me.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

Student Survey 

September 2014

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E02c. How often are the following statements true for you?

I am doing just as well as other people my age.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02d. How often are the following statements true for you?

When I have a problem, I can come up with lots of ways to solve it.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02e. How often are the following statements true for you?

I think the things I have done in the past will help me in the future.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

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E02f. How often are the following statements true for you?

Even when others want me to quit, I know that I can find ways to solve the problem.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E06a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You have a certain amount of intelligence and you can’t really do much to change it.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06b. How much do you agree or disagree with the following statements?

Your intelligence is something about you that you can’t change very much.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E06c. How much do you agree or disagree with the following statements?

No matter who you are, you can significantly change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06d. How much do you agree or disagree with the following statements?

You can learn new things, but you can’t really change your basic intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06e. How much do you agree or disagree with the following statements?

You can always substantially change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E06f. How much do you agree or disagree with the following statements?

No matter how much intelligence you have, you can always change it quite a bit.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E07a. How true are the following statements for you?

(Select one answer for each row.)

When I become confused about something I’m learning at school, I go back and try to 

figure it out.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E07b. How true are the following statements for you?

I work my hardest to learn at school, even if I do not like the subject.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E07c. How true are the following statements for you?

When something I’m studying at school is difficult, I spend extra time and effort until I 

understand it.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E07d. How true are the following statements for you?

Even if it is boring, I try to learn as much as I can about what I am studying.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

Now we’d like you to tell us about how you’ve been feeling during the past week.

E08a. How often in the past week have you...

(Select one answer for each row.)

Felt bothered by things that usually don't bother you? 

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08b. How often in the past week have you...

Felt like not eating; your appetite was poor?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08c. How often in the past week have you...

Felt that you could not shake off the blues even with help from your family or friends?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08d. How often in the past week have you...

Felt that you had trouble keeping your mind on what you were doing?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08e. How often in the past week have you...

Felt depressed?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08f. How often in the past week have you...

Felt that everything you did was an effort?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08g. How often in the past week have you...

Felt fearful?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08h. How often in the past week have you...

Felt that your sleep was restless?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08i. How often in the past week have you...

Felt that you talked less than usual?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08j. How often in the past week have you...

Felt lonely?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08k. How often in the past week have you...

Felt sad?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08l. How often in the past week have you...

Felt that you could not get going?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E10a. Imagine that this ladder represents how American society is set up. 

[*NOTE: WE WILL VISUALLY REPRESENT A LADDER WITH 10 RUNGS, EACH OF WHICH 

WILL HAVE A CORRESPONDING RADIO BUTTON. THE STUDENT WILL SELECT THE RADIO 

BUTTON THAT MATCHES WHERE HE/SHE THINKS HIS/HER FAMILY WOULD BE ON THE 

LADDER.]

- At the top of the ladder are the people who are the best off--they have the most 

money, the most education, and the most respected jobs.

- At the bottom are the people who are the worst off--they have the least money, the 

least education, and the least respected jobs.

Now think about your family. Where would your family be on this ladder?

Select the place on the ladder that best represents where your family would be.

1 (top of the ladder) to 

10 (bottom of the ladder)

E10b. Now imagine the ladder represents how your school is set up.

[*NOTE: WE WILL VISUALLY REPRESENT A LADDER WITH 10 RUNGS, EACH OF WHICH 

WILL HAVE A CORRESPONDING RADIO BUTTON. THE STUDENT WILL SELECT THE RADIO 

BUTTON THAT MATCHES WHERE HE/SHE THINKS HE/SHE WOULD BE ON THE LADDER.]

- At the top of the ladder are the students in your school who have the most respect, 

receive the highest grades, and are the most popular.

- At the bottom are the students who have the least respect, receive the worst grades, 

and are the least popular. 

Where would you place yourself on this ladder?

Select the place on the ladder that best represents where you would be.

1 (top of the ladder) to 

10 (bottom of the ladder)

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E11a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You feel close to others who share your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E11b. How much do you agree or disagree with the following statements?

Other people judge you based on your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E11c. How much do you agree or disagree with the following statements?

You get in fights with other people because of your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E11d. How much do you agree or disagree with the following statements?

People do not want to hang out with you because of your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E12. How would you describe your gender? 

(Select all that apply.)

1. Male

2. Female

3. Transgender

4. Other: (specify)

G. Your Future

This item appears only in Version 2.1

Next we are going to ask you a few questions about what you want in the future.

{IF grade=7, 8}

G01a. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

(Select one answer for each row.)

Be successful in the job I have.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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This item appears only in Version 2.1

{IF grade=7, 8}

G01b. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

Find the right person to be with and have a happy life together.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

This item appears only in Version 2.1

{IF grade=7, 8}

G01c. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

Have lots of money.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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This item appears only in Version 2.1

{IF grade=7, 8}

G01d. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

Have strong friendships.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

This item appears only in Version 2.1

{IF grade=7, 8}

G01e. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

Help other people in my community.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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This item appears only in Version 2.1

{IF grade=7, 8}

G01f. How much do you agree or disagree with the following statements?

When I become an adult, it will be important for me to...

Have a good education.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

G02. As things stand now, how far in school do you think you will get?

1. Won’t finish high school. 

2. Will graduate from high school, but won’t go any further. 

3. Will go to a technical or trade school after high school. 

4. Will attend college. 

5. Will graduate from college. 

6. Will attend a higher level of school after graduating from college. 

7. Don’t know.

G03a. How true are the following statements for you?

I will graduate from high school.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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G03b. How true are the following statements for you?

I will go to college.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

This item appears only in Version 2.1

Finally, we have a few questions about conversations you may have had with a parent, 

teacher, or someone else.

G04. Since the beginning of this school year, have you talked with any of the following people 

about what math courses to take next year?

Choose all that apply.

1. My mother or female guardian

2. My father or male guardian

3. My friends

4. A teacher

5. A school counselor

6. I have talked to someone else (specify): _____

7. I have not talked to anyone about this

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This item appears only in Version 2.1

G05. Since the beginning of this school year, have you talked with any of the following people 

about going to college?

Choose all that apply.

1. My mother or female guardian

2. My father or male guardian

3. My friends

4. A teacher

5. A school counselor

6. I have talked to someone else (specify): _____

7. I have not talked to anyone about this

This item appears only in Version 2.1

{IF grade=8}

G06. Since the beginning of this school year, have you talked with any of the following people 

about possible jobs or careers when you are an adult?

Choose all that apply.

1. My mother or female guardian

2. My father or male guardian

3. My friends

4. A teacher

5. A school counselor

6. I have talked to someone else (specify): _____

7. I have not talked to anyone about this

Thank you for taking the time to answer our questions!

Student Survey 

September 2014

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Booklet 2: Version 2.2 

All items across Versions 2.1 and 2.2 are the same except for items marked “This item only appears in 

Version 2.2”

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53
Introduction

Next we are interested in learning about what your school, friends, and home life are 

like, activities that you do, and how you think about yourself and school. 

 

These questions ask for your opinion so there are no right or wrong answers. This is your 

chance to tell us about you.

 

Let’s get started.

A. Your School Experiences

First are some questions about things that may happen at school.

A01a. How many times did the following happen in the last month?

(Select one answer for each row.)

I was tardy for school.

1. 0 times

2. 1 or 2 times

3. 3 to 6 times

4. 7 to 9 times

5. 10 to 12 times

6. 13 or more times

A01b. How many times did the following happen in the last month?

I cut or skipped class.

1. 0 times

2. 1 or 2 times

3. 3 to 6 times

4. 7 to 9 times

5. 10 to 12 times

6. 13 or more times

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A02a. How often does the following happen at your school?

(Select one answer for each row.)

I feel like a real part of my school.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02b. How often does the following happen at your school?

People notice when I'm good at something.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02c. How often does the following happen at your school?

Other students take my opinions seriously.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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A02d. How often does the following happen at your school?

People are friendly to me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

A02e. How often does the following happen at your school?

I'm included in lots of activities.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

The next questions are about the students at your school.

A06a. How often did the following happen at your school in the last month?

(Select one answer for each row.)

Physical conflicts (fights) among students.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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A06b. How often did the following happen at your school in the last month?

Students bullied other students.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06c. How often did the following happen at your school in the last month?

Students yelled and screamed at the teachers.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06d. How often did the following happen at your school in the last month?

Students physically attacked teachers.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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A06e. How often did the following happen at your school in the last month?

Students used alcohol.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06f. How often did the following happen at your school in the last month?

Students used drugs.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A06g. How often did the following happen at your school in the last month?

Students brought in weapons.

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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A07a. During this school year, how often have other students...

(Select one answer for each row.)

Teased you, made fun of you, or called you names?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A07b. During this school year, how often have other students...

Told lies or untrue stories about you?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

A07c. During this school year, how often have other students...

Pushed, shoved, slapped, hit, or kicked you?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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A07d. During this school year, how often have other students...

Left you out when they were hanging out, sitting together, or doing other activities?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

C. Your Peers

The next questions are about your classmates this school year. Please think only about 

the students who are in your classes.

C01a. How often are the following statements true?

(Select one answer for each row.)

My classmates think it is important to be my friend.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01b. How often are the following statements true?

My classmates like me the way I am.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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C01c. How often are the following statements true?

My classmates care about my feelings.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01d. How often are the following statements true?

My classmates like me as much as they like others.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

C01e. How often are the following statements true?

My classmates really care about me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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Next are a few questions about people your age who you hang out with, including those 

who you know from school or from somewhere else.

C02a. Of the people your age who you hang out with, how important is it to them that they...

(Select one answer for each row.)

Attend classes regularly?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

C02b. Of the people your age who you hang out with, how important is it to them that they...

Get good grades?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

C02c. Of the people your age who you hang out with, how important is it to them that they...

Work hard in school?

1. Not at all important

2. A little bit important

3. Somewhat important

4. Important

5. Very important

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C03a. Of the people your age who you hang out with, how many...

Are members of a gang?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03b. Of the people your age who you hang out with, how many...

Have ever used a weapon in a fight?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03c. Of the people your age who you hang out with, how many...

Have ever stolen things?

1. None

2. Some

3. About half

4. Most

5. All or almost all

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C03d. Of the people your age who you hang out with, how many...

Have ever hit someone, trying to seriously hurt them?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03e. Of the people your age who you hang out with, how many...

Have ever damaged property that didn't belong to them on purpose?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C03f. Of the people your age who you hang out with, how many...

Have been suspended from school at least once this year?

1. None

2. Some

3. About half

4. Most

5. All or almost all

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C03g. Of the people your age who you hang out with, how many...

Have skipped school at least once this year?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04a. Of the people your age who you hang out with, how many have ever pressured you to...

(Select one answer for each row.)

Try cigarettes?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04b. Of the people your age who you hang out with, how many have ever pressured you to...

Try marijuana or other drugs?

1. None

2. Some

3. About half

4. Most

5. All or almost all

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C04c. Of the people your age who you hang out with, how many have ever pressured you to...

Drink beer, wine, or liquor?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04d. Of the people your age who you hang out with, how many have ever pressured you to...

Skip school?

1. None

2. Some

3. About half

4. Most

5. All or almost all

C04e. Of the people your age who you hang out with, how many have ever pressured you to...

Commit a crime or do something violent?

1. None

2. Some

3. About half

4. Most

5. All or almost all

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D. Your Health

This item appears only in Version 2.2

Next are a few questions about your health.

D01a. In the last month, how often...

(Select one answer for each row.)

Did you have a headache?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

This item appears only in Version 2.2

D01b. In the last month, how often...

Did you have aches, pains, or soreness in your muscles or joints?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

This item appears only in Version 2.2

D01c. In the last month, how often...

Did you have a stomachache?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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This item appears only in Version 2.2

D01d. In the last month, how often...

Did you wake up feeling tired?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

This item appears only in Version 2.2

D01e. In the last month, how often...

Did you have trouble falling asleep or staying asleep?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

This item appears only in Version 2.2

D02. What time do you usually go to sleep on school nights?

Drop-down menus:

Hour: ___ (1-12)

Minute: _____ (00-55, in 5 minute intervals)

A.M. or P.M.

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This item appears only in Version 2.2

D03. What time do you usually wake up on school days?

Drop-down menus:

Hour: ___ (1-12)

Minute: _____ (00-55, in 5 minute intervals)

A.M. or P.M.

E. About Yourself

Now we’d like to know a little more about what you think and how you behave.

E01a. How often are the following statements true for you? I see myself as someone who...

(Select one answer for each row.)

Does things carefully and completely.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01b. How often are the following statements true for you? I see myself as someone who...

Can be somewhat careless.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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E01c. How often are the following statements true for you? I see myself as someone who...

Is a reliable worker.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01d. How often are the following statements true for you? I see myself as someone who...

Tends to be disorganized.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01e. How often are the following statements true for you? I see myself as someone who...

Tends to be lazy.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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E01f. How often are the following statements true for you? I see myself as someone who...

Keeps working until things are done.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01g. How often are the following statements true for you? I see myself as someone who...

Does things efficiently (quickly and correctly).

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01h. How often are the following statements true for you? I see myself as someone who...

Makes plans and sticks to them.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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E01i. How often are the following statements true for you? I see myself as someone who...

Is easily distracted.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E01j. How often are the following statements true for you? I see myself as someone who...

Has trouble paying attention.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

E02a. How often are the following statements true for you?

(Select one answer for each row.)

I think I am doing pretty well.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

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E02b. How often are the following statements true for you?

I can think of many ways to get the things in life that are most important to me.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02c. How often are the following statements true for you?

I am doing just as well as other people my age.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02d. How often are the following statements true for you?

When I have a problem, I can come up with lots of ways to solve it.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

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E02e. How often are the following statements true for you?

I think the things I have done in the past will help me in the future.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E02f. How often are the following statements true for you?

Even when others want me to quit, I know that I can find ways to solve the problem.

1. None of the time

2. A little of the time

3. Some of the time

4. A lot of the time

5. Most of the time

6. All of the time

E06a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You have a certain amount of intelligence and you can’t really do much to change it.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E06b. How much do you agree or disagree with the following statements?

Your intelligence is something about you that you can’t change very much.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06c. How much do you agree or disagree with the following statements?

No matter who you are, you can significantly change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06d. How much do you agree or disagree with the following statements?

You can learn new things, but you can’t really change your basic intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E06e. How much do you agree or disagree with the following statements?

You can always substantially change your intelligence.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E06f. How much do you agree or disagree with the following statements?

No matter how much intelligence you have, you can always change it quite a bit.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E07a. How true are the following statements for you?

(Select one answer for each row.)

When I become confused about something I’m learning at school, I go back and try to 

figure it out.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E07b. How true are the following statements for you?

I work my hardest to learn at school, even if I do not like the subject.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E07c. How true are the following statements for you?

When something I’m studying at school is difficult, I spend extra time and effort until I 

understand it.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E07d. How true are the following statements for you?

Even if it is boring, I try to learn as much as I can about what I am studying.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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Now we’d like you to tell us about how you’ve been feeling during the past week.

E08a. How often in the past week have you...

(Select one answer for each row.)

Felt bothered by things that usually don't bother you?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08b. How often in the past week have you...

Felt like not eating; your appetite was poor?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08c. How often in the past week have you...

Felt that you could not shake off the blues even with help from your family or friends?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08d. How often in the past week have you...

Felt that you had trouble keeping your mind on what you were doing?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08e. How often in the past week have you...

Felt depressed?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08f. How often in the past week have you...

Felt that everything you did was an effort?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08g. How often in the past week have you...

Felt fearful?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08h. How often in the past week have you...

Felt that your sleep was restless?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08i. How often in the past week have you...

Felt that you talked less than usual?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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E08j. How often in the past week have you...

Felt lonely?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08k. How often in the past week have you...

Felt sad?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

E08l. How often in the past week have you...

Felt that you could not get going?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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This item appears only in Version 2.2

E09a. How true are the following statements for you?

(Select one answer for each row.)

I like to explore strange places.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

This item appears only in Version 2.2

E09b. How true are the following statements for you?

I like to do frightening things.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

This item appears only in Version 2.2

E09c. How true are the following statements for you?

I like new and exciting experiences, even if I have to break the rules.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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This item appears only in Version 2.2

E09d. How true are the following statements for you?

I prefer friends who are exciting and unpredictable.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E10a. Imagine that this ladder pictures how American society is set up. 

[*NOTE: WE WILL VISUALLY REPRESENT A LADDER WITH 10 RUNGS, EACH OF WHICH 

WILL HAVE A CORRESPONDING RADIO BUTTON. THE STUDENT WILL SELECT THE RADIO 

BUTTON THAT MATCHES WHERE HE/SHE THINKS HIS/HER FAMILY WOULD BE ON THE 

LADDER.]

- At the top of the ladder are the people who are the best off--they have the most 

money, the most education, and the most respected jobs.

- At the bottom are the people who are the worst off--they have the least money, the 

least education, and the least respected jobs.

Now think about your family. Where would your family be on this ladder?

Select the place on the ladder that best represents where your family would be.

1 (top of the ladder) to 

10 (bottom of the ladder)

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E10b. Now assume that the ladder is a way of picturing your school.

[*NOTE: WE WILL VISUALLY REPRESENT A LADDER WITH 10 RUNGS, EACH OF WHICH 

WILL HAVE A CORRESPONDING RADIO BUTTON. THE STUDENT WILL SELECT THE RADIO 

BUTTON THAT MATCHES WHERE HE/SHE THINKS HE/SHE WOULD BE ON THE LADDER.]

- At the top of the ladder are the students in your school who have the most respect, 

receive the highest grades, and are the most popular.

- At the bottom are the students who have the least respect, receive the worst grades, 

and are the least popular. 

Where would you place yourself on this ladder?

Select the place on the ladder that best represents where you would be.

1 (top of the ladder) to 

10 (bottom of the ladder)

E11a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You feel close to others who share your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E11b. How much do you agree or disagree with the following statements?

Other people judge you based on your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E11c. How much do you agree or disagree with the following statements?

You get in fights with other people because of your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E11d. How much do you agree or disagree with the following statements?

People do not want to hang out with you because of your race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E12. How would you describe your gender? 

(Select all that apply.)

1. Male

2. Female

3. Transgender

4. Other: (specify)

G. Your Future

G02. As things stand now, how far in school do you think you will get?

1. Won’t finish high school. 

2. Will graduate from high school, but won’t go any further. 

3. Will go to a technical or trade school after high school. 

4. Will attend college. 

5. Will graduate from college. 

6. Will attend a higher level of school after graduating from college.

7. Don’t know.

G03a. How true are the following statements for you?

I will graduate from high school.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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G03b. How true are the following statements for you?

I will go to college.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

Thank you for taking the time to answer our questions!

Student Survey 

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Booklet 3: Version 3.1 

All items across Versions 3.1 and 3.2 are the same except for items marked “This item only appears in 

Version 3.1”

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Introduction

Next we are interested in learning about what your school, friends, and home life are 

like, activities that you do, and how you think about yourself and school. 

 

These questions ask for your opinion so there are no right or wrong answers. This is your 

chance to tell us about you.

 

Let’s get started.

A. Your School Experiences

First are some questions about things that may happen at school.

A03a. How much do you agree or disagree with the following statements about your school?

(Select one answer for each row.)

Students get along well with teachers.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03b. How much do you agree or disagree with the following statements about your school?

Students make friends with students from other racial and ethnic groups.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03c. How much do you agree or disagree with the following statements about your school?

I feel safe at this school.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03d. How much do you agree or disagree with the following statements about your school?

Disruptions by other students get in the way of my learning.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03e. How much do you agree or disagree with the following statements about your school?

The school rules are fair.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03f. How much do you agree or disagree with the following statements about your school?

The punishment for breaking school rules is the same no matter who you are.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03g. How much do you agree or disagree with the following statements about your school?

The school rules are strictly enforced.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03h. How much do you agree or disagree with the following statements about your school?

Students get along well with other students.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03i. How much do you agree or disagree with the following statements about your school?

Students are treated differently at school because of their race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03j. How much do you agree or disagree with the following statements about your school?

I feel comfortable to be myself at school.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

Now we’d like to know about teachers at your school. For these questions, think about 

all the teachers at your school, even if you don’t have a class with that teacher.

A04a. How often do the teachers at your school do the following?

(Select one answer for each row.)

Teachers praise students' efforts when they work hard.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A04b. How often do the teachers at your school do the following?

Teachers want students to get good grades.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04c. How often do the teachers at your school do the following?

Teachers put down students in class.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04d. How often do the teachers at your school do the following?

Teachers expect students to do their best.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A04e. How often do the teachers at your school do the following?

Teachers expect everyone to work hard.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04f. How often do the teachers at your school do the following?

Teachers encourage students to consider different solutions or points of view.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04g. How often do the teachers at your school do the following?

Teachers want students to become better thinkers, not just memorize things.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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Now we want you to answer these questions thinking only about teachers that you have 

class with.

A05a. How often does the following happen with your teachers?

(Select one answer for each row.)

I get along well with my teachers.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05b. How often does the following happen with your teachers?

My teachers listen to what I have to say.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05c. How often does the following happen with your teachers?

If I need extra help, I receive it from my teachers.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A05d. How often does the following happen with your teachers?

My teachers treat me fairly.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05e. How often does the following happen with your teachers?

My teachers care about my feelings.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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B. Your Activities

The next questions ask about how you spend your free time.

B03a. For the next questions think of a typical weekday in the last month. How many hours 

per day did you spend doing the following on a typical weekday?

(Select one answer for each row.)

Hanging out or socializing with your friends in person after school.

1. Less than 1 hour

2. 1 to 2 hours

3. 2 to 3 hours

4. 3 to 4 hours

5. 4 to 5 hours

6. 5 or more hours

B03b. For the next questions think of a typical weekday in the last month. How many hours 

per day did you spend doing the following on a typical weekday?

Working on homework and studying for class in school or after school.

1. Less than 1 hour

2. 1 to 2 hours

3. 2 to 3 hours

4. 3 to 4 hours

5. 4 to 5 hours

6. 5 or more hours

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B04. Some people your age get paid for work they do.

Have you ever been paid to do the following?

(Do not include chores, helping around the house, or an allowance you might receive.)

Select all that apply.

1. Lawn work

2. Waiter/waitress, dishwasher, or cleaning tables

3. Newspaper route

4. Babysitting or child care

5. Petsitting

6. Farm or agricultural work

7. Other manual labor

8. Store clerk, salesperson

9. Office or clerical work

10. Other work you do for pay (specify):

11. I have not done any work for pay.

The next questions ask about the activities you might do with technology.

 

B05a. How much time per day do you spend...

Watching movies or TV shows on live TV, DVR, on demand, or through a website or 

streaming service (such as Netflix, Hulu Plus, or HBO Go)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05b. How much time per day do you spend...

Watching shorter video clips for fun on YouTube, Vine, or other sites?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05c. How much time per day do you spend...

Looking up information online for schoolwork (for example, using Google, Wikipedia, or 

other sites)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05d. How much time per day do you spend...

Looking up information online for your own interests (for example, using Google, 

Wikipedia, or other sites)? 

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05e. How much time per day do you spend...

Listening to music through music downloading or streaming services (such as iTunes, 

iTube, SoundCloud, Google Play, or Pandora)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05f. How much time per day do you spend...

Playing on a gaming system (such as X-Box or Wii), computer, or apps on your phone or 

tablet?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05g. How much time per day do you spend...

Video chatting with friends through programs like Facetime, OoVoo, or Skype?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05h. How much time per day do you spend...

Messaging with friends using texting, KIK, iMessage, Snapchat, or some other app?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05i. How much time per day do you spend...

Looking at or commenting on other people's profiles, photos, updates, or posts on social 

media sites (such as Twitter, Instagram, Facebook, or Ask.fm)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05j. How much time per day do you spend...

Doing some other activity using a computer, tablet, phone, or similar device? (specify):

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

B06. How many times per day do you post photos or updates on social media sites (such as 

Twitter, Instagram, Facebook, or Ask.fm)?

On a typical week day: ____ posts/updates

On a typical weekend day: ____ posts/updates

B07. How many e-mails do you send per day to friends, family members, teachers or others?

On a typical week day: ____ e-mails

On a typical weekend day: ____ e-mails

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{If B07=0 FOR WEEK DAY AND WEEKEND DAY}

B07a. Do you ever send emails to friends, family members, teachers or others?

1. Yes

2. No

B08. How much time per day do you spend using all electronic devices (including phone, 

tablet, computer, video game systems, television, iPod, etc.) for any type of activity? 

Your best guess is fine.

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B09. Below is a list of talents, interests, or hobbies that students your age are sometimes 

excited about. Please select the talents, interests, or hobbies that are very important to 

you. If you do not see yours listed, select the "Other" area and type in that talent, 

interest, or hobby on the line provided.

What talents, interests, or hobbies are you excited about?

You can pick more than one.

1. Math or science

2. Writing or reading

3. Computers or electronics

4. Team sports or athletics (baseball, basketball, football, gymnastics, volleyball, 

etc.)

5. Physical activities (biking, running, martial arts, skateboarding, ice skating etc.)

6. Dance

7. Music

8. Singing or choir

9. Art

10. Drama

11. Volunteering, service, or activism

12. Being in nature, caring for animals, or participating in outdoor recreation

13. Doing construction, architecture, mechanics, or engineering

14. Collecting (trading cards, stamps, models, etc.)

15. Cooking or baking

16. Other talents, interests, or hobbies (specify):

17. I don’t have any talents, interests, or hobbies that I am excited about

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B10. Among the talents, interests, or hobbies you selected, which are you the most excited 

about?

Please pick only one.

 

[*NOTE: ONLY THOSE SELECTED IN THE PREVIOUS ITEM WILL BE DISPLAYED.]

1. Math or science

2. Writing or reading

3. Computers or electronics

4. Team sports or athletics (baseball, basketball, football, gymnastics, volleyball, 

etc.)

5. Physical activities (biking, running, martial arts, skateboarding, ice skating etc.)

6. Dance

7. Music

8. Singing or choir

9. Art

10. Drama

11. Volunteering, service, or activism

12. Being in nature, caring for animals, or participating in outdoor recreation

13. Doing construction, architecture, mechanics, or engineering

14. Collecting (trading cards, stamps, models, etc.)

15. Cooking or baking

16. Other talents, interests, or hobbies (specify):

B11. Do you have a parent, mentor, friend, or other adult who has done something to help 

you get better at the talents, interests, or hobbies you are excited about?

1. Yes

2. No

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{If B11 = 1}

B12. Who has done something to help you get better at the talents, interests, or hobbies you 

are excited about?

Choose all that apply.

1. My mother or female guardian

2. My father or male guardian

3. My sister or brother

4. My grandmother or grandfather

5. My aunt or uncle

6. My friend

7. My teacher

8. Other adult, not related to me

9. Someone else (specify): _____

B13. Some people your age have pets at home, like a dog, cat, fish, or something else.

Do you have a pet at home?

1. Yes

2. No

{If B13 = 1}

B14. Thinking about your pet, or your favorite pet if you have several.

How long have you had this pet?

1. Less than one year

2. 1–5 years

3. 6–10 years

4. More than 10 years

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{If B13 = 1}

B15. Thinking about your pet, or your favorite pet if you have several.

How often do you have your pet near you when you do homework, study, read, or watch 

TV?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{If B13 = 1}

B16. Thinking about your pet, or your favorite pet if you have several.

When you feel bad or sad, how often do you go to your pet to help you feel better?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{If B13 = 1}

B17. Thinking about your pet, or your favorite pet if you have several.

Do you consider your pet to be a member of your family?

1. Yes, always

2. Yes, sometimes

3. No

4. I'm not sure

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E. About Yourself

Next are some questions about how you may feel about math. There are no right or 

wrong answers.

E03a. How true are the following statements for you?

(Select one answer for each row.)

I am certain I can learn everything taught in math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E03b. How true are the following statements for you?

I am sure I can do even the most difficult homework problems in math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E03c. How true are the following statements for you?

I am confident I can do all the work in math class if I don’t give up.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E03d. How true are the following statements for you?

I am confident I can do even the hardest work in my math class.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04a. How true are the following statements for you?

(Select one answer for each row.)

Math will be useful for me later in life.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04b. How true are the following statements for you?

Math helps me in my daily life outside of school.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E04c. How true are the following statements for you?

Being someone who is good at math is important to me.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04d. How true are the following statements for you?

I enjoy doing math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E05a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You have a certain amount of math ability, and you can’t really do much to change it.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E05b. How much do you agree or disagree with the following statements?

Your math ability is something about you that you can’t change very much.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05c. How much do you agree or disagree with the following statements?

No matter who you are, you can significantly change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05d. How much do you agree or disagree with the following statements?

You can learn new things, but you can’t really change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E05e. How much do you agree or disagree with the following statements?

You can always substantially change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05f. How much do you agree or disagree with the following statements?

No matter how good you are at math, you can always change it quite a bit.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

F. Your Home Life

Next are some questions about your family and home life.

F01a. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

(Select one answer for each row.)

Give me a reward, like a present or gift.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01b. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Give me money or increase my allowance.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01c. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Take me to some place special, like out to dinner, a movie, or an amusement park.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01d. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Give me more opportunities to make decisions for myself.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01e. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Encourage me to try harder.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01f. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Are less strict with me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01g. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Tell me I am a good student.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01h. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Tell me they are proud of me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01i. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Say I should have done even better.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01j. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Do something else when I get good grades (specify):

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02a. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

(Select one answer for each row.)

Reduce my allowance.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02b. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Give me fewer opportunities to make decisions for myself.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02c. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Are more strict with me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02d. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Punish or ground me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02e. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Encourage me to try harder.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02f. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer me a reward, such as money or a present, if I do better next time.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02g. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Make me feel bad.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02h. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer to help me with my school work.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02i. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer to find me a tutor.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02j. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Do something else when I get bad grades (specify):

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

This item appears only in Version 3.1

F03a. How often do your parents/guardians...

(Select one answer for each row.)

Tell you that they are right and that you should not question them?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F03b. How often do your parents/guardians...

Respect your privacy?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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This item appears only in Version 3.1

F03c. How often do your parents/guardians...

Give you a lot of freedom?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F03d. How often do your parents/guardians...

Make most of the decisions about what you can do?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F03e. How often do your parents/guardians...

Believe you have a right to your own point of view?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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This item appears only in Version 3.1

F04a. How often do your parents/guardians...

(Select one answer for each row.)

Know what you do during your free time?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F04b. How often do your parents/guardians...

Know how much homework you have?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F04c. How often do your parents/guardians...

Know what you spend your money on?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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This item appears only in Version 3.1

F04d. How often do your parents/guardians...

Know when you have an exam or paper due at school?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F04e. How often do your parents/guardians...

Know what your school grades are?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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This item appears only in Version 3.1

F05a. How often do you...

(Select one answer for each row.)

Tell your parents/guardians about your friends without them asking (for example, which 

friends you hang out with and how your friends feel about various things)?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

This item appears only in Version 3.1

F05b How often do you...

Tell your parents/guardians about school without them asking (for example, how each 

subject is going or your relationships with teachers)?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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This item appears only in Version 3.1

F05c. How often do you...

Keep a lot of secrets from your parents/guardians about what you do during your free 

time?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

The next questions are about where you live.

F06a. How true are the following statements for you?

(Select one answer for each row.)

There are a lot of adults in my neighborhood who I want to be like when I grow up.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

F06b. How true are the following statements for you?

I want to get away from my neighborhood as soon as I can.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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F06c. How true are the following statements for you?

I can count on people in my neighborhood to help me if I need it.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

F06d. How true are the following statements for you?

I feel very safe walking and playing in my neighborhood.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

Thank you for taking the time to answer our questions!

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Booklet 3: Version 3.2 

All items across Versions 3.1 and 3.2 are the same except for items marked “This item only appears in 

Version 3.2”

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Introduction

Next we are interested in learning about what your school, friends, and home life are 

like, activities that you do, and how you think about yourself and school. 

 

These questions ask for your opinion so there are no right or wrong answers. This is your 

chance to tell us about you.

 

Let’s get started.

A. Your School Experiences

First are some questions about things that may happen at school.

A03a. How much do you agree or disagree with the following statements about your school?

(Select one answer for each row.)

Students get along well with teachers.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03b. How much do you agree or disagree with the following statements about your school?

Students make friends with students from other racial and ethnic groups.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03c. How much do you agree or disagree with the following statements about your school?

I feel safe at this school.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03d. How much do you agree or disagree with the following statements about your school?

Disruptions by other students get in the way of my learning.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03e. How much do you agree or disagree with the following statements about your school?

The school rules are fair.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03f. How much do you agree or disagree with the following statements about your school?

The punishment for breaking school rules is the same no matter who you are.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03g. How much do you agree or disagree with the following statements about your school?

The school rules are strictly enforced.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03h. How much do you agree or disagree with the following statements about your school?

Students get along well with other students.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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A03i. How much do you agree or disagree with the following statements about your school?

Students are treated differently at school because of their race/ethnicity.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

A03j. How much do you agree or disagree with the following statements about your school?

I feel comfortable to be myself at school.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

Now we’d like to know about teachers at your school. For these questions, think about 

all the teachers at your school, even if you don’t have a class with that teacher.

A04a. How often do the teachers at your school do the following?

(Select one answer for each row.)

Teachers praise students' efforts when they work hard.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A04b. How often do the teachers at your school do the following?

Teachers want students to get good grades.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04c. How often do the teachers at your school do the following?

Teachers put down students in class.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04d. How often do the teachers at your school do the following?

Teachers expect students to do their best.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A04e. How often do the teachers at your school do the following?

Teachers expect everyone to work hard.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04f. How often do the teachers at your school do the following?

Teachers encourage students to consider different solutions or points of view.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A04g. How often do the teachers at your school do the following?

Teachers want students to become better thinkers, not just memorize things.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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Now we want you to answer these questions thinking only about teachers that you have 

class with.

A05a. How often does the following happen with your teachers?

(Select one answer for each row.)

I get along well with my teachers.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05b. How often does the following happen with your teachers?

My teachers listen to what I have to say.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05c. How often does the following happen with your teachers?

If I need extra help, I receive it from my teachers.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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A05d. How often does the following happen with your teachers?

My teachers treat me fairly.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

A05e. How often does the following happen with your teachers?

My teachers care about my feelings.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

B. Your Activities

This item appears only in Version 3.2

The next few questions are about activities you do at school.

B01a. Have you participated in the following school-sponsored activities at any time during this 

school year?

(Select one answer for each row.)

School sports 

(for example, basketball, baseball, football, soccer, track/field, tennis)

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

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This item appears only in Version 3.2

B01b. Have you participated in the following school-sponsored activities at any time during this 

school year?

Math or science clubs 

(for example, math, robotics, science bowl, chess)

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

This item appears only in Version 3.2

B01c. Have you participated in the following school-sponsored activities at any time during this 

school year?

Other school clubs 

(for example, academic clubs, hobby clubs, service clubs, technical/trade education 

clubs, social justice/support networks, gaming, animation/drawing, yoga or marial arts)

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

This item appears only in Version 3.2

B01d. Have you participated in the following school-sponsored activities at any time during this 

school year?

Performing arts 

(for example, band, orchestra, chorus, choir, school play, or musical)

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

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This item appears only in Version 3.2

B01e. Have you participated in the following school-sponsored activities at any time during this 

school year?

Student government

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

This item appears only in Version 3.2

B01f. Have you participated in the following school-sponsored activities at any time during this 

school year?

School yearbook, newspaper, or literary magazine

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

This item appears only in Version 3.2

B01g. Have you participated in the following school-sponsored activities at any time during this 

school year?

Other activites you do at school (specify):

1. Did not participate

2. Participated

3. Participated as an officer, leader, or captain

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This item appears only in Version 3.2

The next questions ask about the activities you might do outside of school.

B02a. How often do you spend time...

(Select one answer for each row.)

Working on hobbies, arts, crafts, or playing a musical instrument outside of school?

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

This item appears only in Version 3.2

B02b. How often do you spend time...

Taking music, art, foreign language, or dance lessons outside of school?

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

This item appears only in Version 3.2

B02c. How often do you spend time...

Playing organized non-school sports (for example, Little League baseball/softball, 

community basketball, Pop Warner football, club soccer, gymnastics, martial arts)?

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

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This item appears only in Version 3.2

B02d. How often do you spend time...

Participating in a religious club or group?

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

This item appears only in Version 3.2

B02e. How often do you spend time...

Participating in a non-school, non-religious organized group activity (for example, scouts, 

4-H, volunteer group, community outreach, Big Brothers/Big Sisters)?

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

This item appears only in Version 3.2

B02f. How often do you spend time...

Doing other activites outside of school? (specify):

1. Never

2. Rarely 

3. Less than once a week

4. Once or twice a week

5. Everyday or almost everyday

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The next questions ask about how you spend your free time.

B03a. For the next questions think of a typical weekday in the last month. How many hours 

per day did you spend doing the following on a typical weekday?

(Select one answer for each row.)

Hanging out or socializing with your friends in person after school.

1. Less than 1 hour

2. 1 to 2 hours

3. 2 to 3 hours

4. 3 to 4 hours

5. 4 to 5 hours

6. 5 or more hours

B03b. For the next questions think of a typical weekday in the last month. How many hours 

per day did you spend doing the following on a typical weekday?

Working on homework and studying for class in school or after school.

1. Less than 1 hour

2. 1 to 2 hours

3. 2 to 3 hours

4. 3 to 4 hours

5. 4 to 5 hours

6. 5 or more hours

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B04. Some people your age get paid for work they do.

Have you ever been paid to do the following?

(Do not include chores, helping around the house, or an allowance you might receive.)

Select all that apply.

1. Lawn work

2. Waiter/waitress, dishwasher, or cleaning tables

3. Newspaper route

4. Babysitting or child care

5. Petsitting

6. Farm or agricultural work

7. Other manual labor

8. Store clerk, salesperson

9. Office or clerical work

10. Other work you do for pay (specify):

11. I have not done any work for pay.

The next questions ask about the activities you might do with technology.

 

B05a. How much time per day do you spend...

Watching movies or TV shows on live TV, DVR, on demand, or through a website or 

streaming service (such as Netflix, Hulu Plus, or HBO Go)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05b. How much time per day do you spend...

Watching shorter video clips for fun on YouTube, Vine, or other sites?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05c. How much time per day do you spend...

Looking up information online for schoolwork (for example, using Google, Wikipedia, or 

other sites)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05d. How much time per day do you spend...

Looking up information online for your own interests (for example, using Google, 

Wikipedia, or other sites)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05e. How much time per day do you spend...

Listening to music through music downloading or streaming services (such as iTunes, 

iTube, SoundCloud, Google Play, or Pandora)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05f. How much time per day do you spend...

Playing on a gaming system (such as X-Box or Wii), computer, or apps on your phone or 

tablet?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05g. How much time per day do you spend...

Video chatting with friends through programs like Facetime, OoVoo, or Skype?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05h. How much time per day do you spend...

Messaging with friends using texting, KIK, iMessage, Snapchat, or some other app?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B05i. How much time per day do you spend...

Looking at or commenting on other people's profiles, photos, updates, or posts on social 

media sites (such as Twitter, Instagram, Facebook, or Ask.fm)?

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

 

B05j. How much time per day do you spend...

Doing some other activity using a computer, tablet, phone, or similar device? (specify):

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

B06. How many times per day do you post photos or updates on social media sites (such as 

Twitter, Instagram, Facebook, or Ask.fm)?

On a typical week day: ____ posts/updates

On a typical weekend day: ____ posts/updates

B07. How many e-mails do you send per day to friends, family members, teachers or others?

On a typical week day: ____ e-mails

On a typical weekend day: ____ e-mails

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{If B07=0 FOR WEEK DAY AND WEEKEND DAY}

B07a. Do you ever send emails to friends, family members, teachers or others?

1. Yes

2. No

B08. How much time per day do you spend using all electronic devices (including phone, 

tablet, computer, video game systems, television, iPod, etc.) for any type of activity? 

Your best guess is fine.

On a typical week day: hrs ____ mins ____ 

On a typical weekend day: hrs ____ mins ____

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B09. Below is a list of talents, interests, or hobbies that students your age are sometimes 

excited about. Please select the talents, interests, or hobbies that are very important to 

you. If you do not see yours listed, select the "Other" area and type in that talent, 

interest, or hobby on the line provided.

What talents, interests, or hobbies are you excited about?

You can pick more than one.

1. Math or science

2. Writing or reading

3. Computers or electronics

4. Team sports or athletics (baseball, basketball, football, gymnastics, volleyball, 

etc.)

5. Physical activities (biking, running, martial arts, skateboarding, ice skating etc.)

6. Dance

7. Music

8. Singing or choir

9. Art

10. Drama

11. Volunteering, service, or activism 

12. Being in nature, caring for animals, or participating in outdoor recreation

13. Doing construction, architecture, mechanics, or engineering

14. Collecting (trading cards, stamps, models, etc.)

15. Cooking or baking

16. Other talents, interests, or hobbies (specify):

17. I don’t have any talents, interests, or hobbies that I am excited about

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B10. Among the talents, interests, or hobbies you selected, which are you the most excited 

about?

Please pick only one.

 

[*NOTE: ONLY THOSE SELECTED IN THE PREVIOUS ITEM WILL BE DISPLAYED.]

1. Math or science

2. Writing or reading

3. Computers or electronics

4. Team sports or athletics (baseball, basketball, football, gymnastics, volleyball, 

etc.)

5. Physical activities (biking, running, martial arts, skateboarding, ice skating etc.)

6. Dance

7. Music

8. Singing or choir

9. Art

10. Drama

11. Volunteering, service, or activism

12. Being in nature, caring for animals, or participating in outdoor recreation

13. Doing construction, architecture, mechanics, or engineering

14. Collecting (trading cards, stamps, models, etc.)

15. Cooking or baking

16. Other talents, interests, or hobbies (specify):

{If B08 = 1}

B11. Do you have a parent, mentor, friend, or other adult who has done something to help 

you get better at the talents, interests, or hobbies you are excited about?

1. Yes

2. No

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{If B11 = 1}

B12. Who has done something to help you get better at the talents, interests, or hobbies you 

are excited about?

Choose all that apply.

1. My mother or female guardian

2. My father or male guardian

3. My sister or brother

4. My grandmother or grandfather

5. My aunt or uncle

6. My friend

7. My teacher

8. Other adult, not related to me

9. Someone else (specify): _____

B13. Some people your age have pets at home, like a dog, cat, fish, or something else.

Do you have a pet at home?

1. Yes

2. No

{If B13 = 1}

B14. Thinking about your pet, or your favorite pet if you have several.

How long have you had this pet?

1. Less than one year

2. 1–5 years

3. 6–10 years

4. More than 10 years

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{If B13 = 1}

B15. Thinking about your pet, or your favorite pet if you have several.

How often do you have your pet near you when you do homework, study, read, or watch 

TV?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{If B13 = 1}

B16. Thinking about your pet, or your favorite pet if you have several.

When you feel bad or sad, how often do you go to your pet to help you feel better?

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{If B13 = 1}

B17. Thinking about your pet, or your favorite pet if you have several.

Do you consider your pet to be a member of your family?

1. Yes, always

2. Yes, sometimes

3. No

4. I'm not sure

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E. About Yourself

Next are some questions about how you may feel about math. There are no right or 

wrong answers.

E03a. How true are the following statements for you?

(Select one answer for each row.)

I am certain I can learn everything taught in math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E03b. How true are the following statements for you?

I am sure I can do even the most difficult homework problems in math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E03c. How true are the following statements for you?

I am confident I can do all the work in math class if I don’t give up.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E03d. How true are the following statements for you?

I am confident I can do even the hardest work in my math class.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04a. How true are the following statements for you?

(Select one answer for each row.)

Math will be useful for me later in life.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04b. How true are the following statements for you?

Math helps me in my daily life outside of school.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E04c. How true are the following statements for you?

Being someone who is good at math is important to me.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E04d. How true are the following statements for you?

I enjoy doing math.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

E05a. How much do you agree or disagree with the following statements?

(Select one answer for each row.)

You have a certain amount of math ability, and you can’t really do much to change it.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E05b. How much do you agree or disagree with the following statements?

Your math ability is something about you that you can’t change very much.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05c. How much do you agree or disagree with the following statements?

No matter who you are, you can significantly change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05d. How much do you agree or disagree with the following statements?

You can learn new things, but you can’t really change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

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E05e. How much do you agree or disagree with the following statements?

You can always substantially change your math ability.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

E05f. How much do you agree or disagree with the following statements?

No matter how good you are at math, you can always change it quite a bit.

1. Strongly agree

2. Agree

3. Slightly agree

4. Slightly disagree 

5. Disagree

6. Strongly disagree

F. Your Home Life

Next are some questions about your family and home life.

F01a. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

(Select one answer for each row.)

Give me a reward, like a present or gift.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01b. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Give me money or increase my allowance.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01c. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Take me to some place special, like out to dinner, a movie, or an amusement park.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01d. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Give me more opportunities to make decisions for myself.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01e. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Encourage me to try harder.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01f. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Are less strict with me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01g. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Tell me I am a good student.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F01h. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Tell me they are proud of me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01i. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Say I should have done even better.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F01j. How often do your parents/guardians do the following things when you receive good 

grades in school? When I get good grades my parents/guardians...

Do something else when I get good grades (specify):

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02a. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

(Select one answer for each row.)

Reduce my allowance.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02b. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Give me fewer opportunities to make decisions for myself.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02c. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Are more strict with me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02d. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Punish or ground me.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02e. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Encourage me to try harder.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02f. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer me a reward, such as money or a present, if I do better next time.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02g. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Make me feel bad.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02h. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer to help me with my school work.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

F02i. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Offer to find me a tutor.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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F02j. How often do your parents/guardians do the following things when you receive bad 

grades in school? When I get bad grades my parents/guardians...

Do something else when I get bad grades (specify):

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

The next questions are about where you live.

F06a. How true are the following statements for you?

(Select one answer for each row.)

There are a lot of adults in my neighborhood who I want to be like when I grow up.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

F06b. How true are the following statements for you?

I want to get away from my neighborhood as soon as I can.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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F06c. How true are the following statements for you?

I can count on people in my neighborhood to help me if I need it.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

F06d. How true are the following statements for you?

I feel very safe walking and playing in my neighborhood.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

Thank you for taking the time to answer our questions!

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Middle Grades Longitudinal Study of 

2016-2017 (MGLS:2017) 

Parent Questionnaire

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Parent 

Questionnaire. Please refer to the instructions you received in your survey invitation letter 

to find your login ID and password. To begin the survey, enter your login ID and password 

in the fields below, and then click NEXT. If you do not have your login ID and password, 

please call First Last at 1-888-xxx-xxxx, or email us at xxxxxx@xxxxxxxx.com. 

Login ID: 

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. The time 

required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, 

search existing data resources, gather the data needed, and complete and review the information requested. If you have any comments 

concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or concerns regarding the status of your 

individual response to this survey, please write directly to: National Center for Education Statistics, Middle Grades Longitudinal Study (MGLS), 

1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

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A. Introduction

Survey Information

A01a. Thank you for allowing your child to participate in the Middle Grades Longitudinal Study

 of 2016-2017 (MGLS:2017) field test. This will help us learn about children's

 development during an important time in their lives.

 

 We also want to learn about family and school experiences that shape children's

 development. This is where we need your help. Your answers are very important to the

 study's success and we hope you will complete the survey. This survey is voluntary and

 you can skip questions you do not want to answer. [You will receive a ($20/$40) gift card

 or completing this survey.]

 

 Please click below to start the brief survey.

 

 Let's get started

The National Center for Education Statistics (NCES) of the U. S. Department of Education is authorized to conduct 

the MGLS:2017 by the Education Sciences Reform Act of 2002 (20 U.S. Code, Section 9543). All of the information 

you provide 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 U.S. Code, Section 9573).

A01b. Thank you very much for participating! Before you get started, here are a few helpful hints.

• To answer a question, click the box to choose your response.

• Press the "Next" button to move forward.

• Press the "Back" button to go back.

• The "Stop and Come Back Later" button can be used to save your responses and finish later (button is 

at the bottom of each page).

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• To protect your data, your responses will be automatically saved and you will be 

logged off if you are idle for more than 30 minutes. 

IF A05A.=1 FILL WILL ASK NEW RESPONDENT TO ENTER FULL NAME AND NO INSTRUCTIONS OR 

CURRENT INFO WILL BE DISPLAYED IN THE RESPONSE OPTIONS

A02. {Is this spelling of your full name correct?/Please enter your full name.}

Make corrections to name below or press enter to accept first/middle/last name.

Current Info: 

[FIRST NAME]

[MIDDLE NAME]

[LAST NAME]

1. First name: [___________________]

2. Middle name: [_________________ ]

3. Last name: [___________________ ]

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A03. Is this spelling of {CHILD}'s full name correct?

Make corrections to name below or press enter to accept first/middle/last name.

Current Info: 

[CHILD'S FIRST NAME][CHILD'S MIDDLE NAME]

[CHILD'S LAST NAME]

1. First name: [___________________]

2. Middle name: [_________________ ]

3. Last name: [___________________ ]

A04. Are you the parent or guardian in this household who knows the most about {CHILD}'s 

development, schooling, and home life?

1. Yes

2. No

{IF A04.=2}

A05a. Is the parent or guardian in this household who knows the most about {CHILD}'s 

development, schooling, and home life available to complete this questionnaire?

1. Yes

2. No

{IF A05A.=1} {IFA05B=1 GOTO A01A.}

A05b. Great! Please select Next to be taken back to the introductory page of this questionnaire 

and ask him or her to begin from there. Thank you very much!

1. Next

2. Exit survey

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{IF A05A.=2}

A06. The MGLS:2017 team would like to contact the parent or guardian in the household who 

knows the most about {CHILD}'s development, schooling, and home life. Please enter 

the contact information for this person now and a team member will be in touch soon.

1. First Name: [___________________]

2. Last Name: [___________________]

3. Phone: [___________________]

4. Email: [___________________]

{IF A04.=1}

A07. What is {CHILD}'s sex?

1. Male

2. Female

A08. What is {CHILD}’s date of birth?

1. Month: ____ (January to December)

2. Day: ____ (1 to 31)

3. Year: ____ (2000 to 2009)

A09. Is the following home address for {CHILD} correct?

Make corrections to address below or press enter to accept it. 

1. Street address1: [___________________]

2. Street address2: [___________________]

3. City: [___________________]

4. State: [___________________]

5. Zip code: [___________________]

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B. Family Roster

Now, we have a few questions about you and the other members of your household. 

The following set of questions asks about the name, age, sex, ethnicity, race, and 

relationship to {CHILD} of all the people who normally live in your household. Please do 

not include anyone staying there temporarily, such as someone visiting the household 

who usually lives somewhere else.

QUESTIONS B01A-F. WILL APPEAR AS A TABLE WITH A ROW FOR RESPONDENT AND A ROW BELOW 

WITH CHILD'S INFORMATION.

B01a. First, we would like to know about you and your relationship to {CHILD}.

Please enter your name, sex, ethnicity, race, and relationship to {CHILD}?

1. First Name

___________ [ENTER TEXT]

 

2. Last Name

___________ [ENTER TEXT]

B01b. Please enter your name, sex, ethnicity, race, and relationship to {CHILD}.

Age [SELECT FROM DROP DOWN R=1-100]

B01c. Please enter your name, sex, ethnicity, race, and relationship to {CHILD}.

Sex

[SELECT FROM DROP DOWN]

1. Male

2. Female

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B01d. Please enter your name, sex, ethnicity, race, and relationship to {CHILD}.

Ethnicity 

[SELECT FROM DROP DOWN]

1. Hispanic or Latino/Latina

2. Non-Hispanic or Latino/Latina

B01e. Please enter your name, sex, ethnicity, race, and relationship to {CHILD}.

Race

You may select more than one.

[SELECT FROM DROP DOWN]

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

B01f. Please enter your name, sex, ethnicity, race, and relationship to {CHILD}.

Relationship to {CHILD} [SELECT FROM DROP DOWN]

1. Mother/Female guardian

2. Father/Male guardian

3. Sister

4. Brother

5. Girlfriend or partner of {CHILD}'s Parent/Guardian

6. Boyfriend or partner of {CHILD}'s Parent/Guardian

7. Grandmother

8. Grandfather

9. Aunt

10. Uncle

11. Cousin

12. Other relative or non-relative

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Next, we would like to know about other household members and their relationship to 

{CHILD}.

B02. Is there anyone else living in your household? For example, a boyfriend or girlfriend, 

husband/wife, younger/older sibling, extended family such as a 

grandmother/grandfather, aunt/uncle, cousins, or a new addition to the household, like 

a young baby?

1. Yes, there is another household member to add.

2. No, this table is complete.

{IFB02.=1 OR B04=2} QUESTIONS B03A-F. WILL APPEAR AS NEW ROWS TO THE B01. TABLE WITH A 

NEW QUSTION TEXT ASKING FOR INFORMATION ABOUT ADDITIONAL FAMILY MEMBERS, IF ANY, UNTIL 

B04=2}

B03a. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

1. First Name

___________ [ENTER TEXT]

 

2. Last Name

___________ [ENTER TEXT]

B03b. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

Age [SELECT FROM DROP DOWN: 1-100]

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B03c. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

Sex

[SELECT FROM DROP DOWN]

1. Male

2. Female

B03d. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

Ethnicity [SELECT FROM DROP DOWN]

1. Hispanic or Latino/Latina

2. Non-Hispanic or Latino/Latina

B03e. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

Race

You may select more than one.

[SELECT FROM DROP DOWN]

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

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B03f. Please enter each person's name, sex, ethnicity, race, and relationship to {CHILD}.

Relationship to {CHILD} [SELECT FROM DROP DOWN]

1. Mother/Female guardian

2. Father/Male guardian

3. Sister

4. Brother

5. Girlfriend or partner of {CHILD}'s Parent/Guardian

6. Boyfriend or partner of {CHILD}'s Parent/Guardian

7. Grandmother

8. Grandfather

9. Aunt

10. Uncle

11. Cousin

12. Other relative or non-relative

{IF B04=2 GOTO B03a.}

B04. Is this everyone in the household, or have we missed anyone who usually lives here but 

may be temporarily away from home on business or living in a dorm at school, or any 

babies or small children?

1. Yes, this is everyone who lives in the household.

2. No, there is another household member to add.

{IF B01D. OR B03D. =1} THIS ITEM WILL BE ASKED FOR ALL HOUSEHOLD MEMBERS IDENTIFIED AS 

ETHNICITY = 1 IN B01D. OR B03D IMMEDIATELY AFTER B01F OR B03F IS SELECTED FOR THAT PERSON.

B05. Which of the following best describes {you/{NAME}}?

Select all that apply.

1. Mexican, Mexican-American, or Chicano 

2. Cuban 

3. Dominican 

4. Puerto Rican 

5. Central American such as Guatemalan, Salvadoran, Nicaraguan, Costa Rican, 

Panamanian, or Honduran 

6. South American such as Colombian, Argentine, or Peruvian 

7. Other Hispanic or Latino/Latina (Specify)

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{IF B01E. OR B03E.= 3} THIS ITEM WILL BE ASKED FOR ALL HOUSEHOLD MEMBERS IDENTIFIED AS RACE 

= 3 IN B01E. OR B03E IMMEDIATELY AFTER B01F OR B03F IS SELECTED FOR THAT PERSON.

B06. Which of the following best describes {your/{NAME}'s} Asian race?

Select all that apply.

1. Asian Indian

2. Chinese

3. Filipino 

4. Japanese

5. Korean 

6. Vietnamese

7. Other (Specify)

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Please indicate which of the following options best describes {your/{NAME}'s 

relationship to {CHILD}.

ITEMS B07-B11 WILL APPEAR FOR EACH PERSON IN THE HOUSEHOLD IMMEDIATELY AFTER B01F OR 

B03F IS SELECTED. 

{IF B01F. OR B03F.= 1}

B07. {Are you/Is {NAME}} {CHILD}’s ...

1. Birth mother

2. Adoptive mother

3. Step mother

4. Foster mother or female guardian 

5. Other female parent or guardian

HELP TEXT AVAILABLE:

Biological or Birth Mother: Child's female biological parent. This may be the birth 

mother, but could also apply to a mother who used a surrogate mother to have her 

biological child.

 

Adoptive Mother: The female who has taken the child into her own family by legal 

process to raise as her own child.

 

Step Mother: The female other than the child's mother who is married to the 

child's father.

 

Foster Mother: The female with whom the child is placed temporarily, usually 

through a social service agency and/or a court.

 

Female Guardian: The female legally placed in charge of the affairs of the child.

 

Other Female Parent or Guardian: This person acts as the mother of the child, but 

does not fit into one of the other categories. For example, in a household with two 

mothers, one of the mothers may not classify herself as biologically related and she 

may not be legally in charge of the affairs of the child even though she is another 

parent to the child. This category may also be used if a mother has a child through 

a surrogate mother, or with a donated egg, and does not classify the child as 

biologically related or adopted through a legal process.

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Please indicate which of the following options best describes {your/{NAME}'s 

relationship to {CHILD}.

{IF B01F. or B03F.= 2}

B08. {Are you/Is {NAME}} {CHILD}'s ...

1. Birth father

2. Adoptive father 

3. Step father

4. Foster father or male guardian 

5. Other male parent or guardian

HELP TEXT AVAILABLE:

Biological or Birth Father: Child's male biological parent. This could also apply to a 

father who used a surrogate mother to have his biological child.

 

Adoptive Father: The male who has taken the child into his own family by legal 

process to raise as his own child.

 

Step Father: The male other than the child's father who is married to the child's 

mother.

 

Foster Father: The male with whom the child is placed temporarily, usually through 

a social service agency and/or a court.

 

Male Guardian: The male legally placed in charge of the affairs of the child.

 

Other Male Parent or Guardian: This person acts as the father of the child, but does 

not fit into one of the other categories. For example, in a household with two 

fathers, one of the fathers may not classify himself as biologically related and he 

may not be legally in charge of the affairs of the child even though he is another

parent to the child. This category may also be used if a father has a child through a 

surrogate mother, or with donated sperm, and does not classify the child as 

biologically related or adopted through a legal process.

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Please indicate which of the following options best describes {your/{NAME}'s 

relationship to {CHILD}.

{IF B01F. or B03F.= 3}

B09. {Are you/Is {NAME}} {CHILD}’s ...

1. Full sister

2. Half sister 

3. Step sister 

4. Adoptive sister 

5. Foster sister

HELP TEXT AVAILABLE:

Full Sister: A female with whom the child shares the same biological parents.

 

Half Sister: A female with whom the child shares one biological parent.

 

Step Sister: A female to whom the child is unrelated except by the marriage of one 

biological parent.

 

Adoptive Sister: A female to whom the child is unrelated except that they are in the 

same family in which she or the child has been legally adopted by the family.

 

Foster Sister: A female to whom the child is unrelated except that they are in the 

same family in which she or the child have been taken into the home on a 

temporary basis and the parents have legal responsibility for the child.

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Please indicate which of the following options best describes {your/{NAME}'s 

relationship to {CHILD}.

{IF B01F. or B03F.= 4}

B10. {Are you/Is {NAME}} {CHILD}’s ...

1. Full brother

2. Half brother 

3. Step brother 

4. Adoptive brother 

5. Foster brother

HELP TEXT AVAILABLE:

Full Brother: A male with whom the child shares the same biological parents.

 

Half Brother: A male with whom the child shares one biological parent.

 

Step Brother: A male to whom the child is unrelated except by the marriage of one 

biological parent.

 

Adoptive Brother: A male to whom the child is unrelated except that they are in 

the same family in which he or the child has been legally adopted by the family.

 

Foster Brother: A male to whom the child is unrelated except that they are in the 

same family in which he or the child have been taken into the home on a 

temporary basis and the parents have legal responsibility for the child.

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Please indicate which of the following options best describes {your/{NAME}'s 

relationship to {CHILD}.

{IF B01F. or B03F.= 12}

B11. {Are you/Is {NAME}} {CHILD}’s ...

1. Girlfriend or partner of {CHILD}'s parent/guardian

2. Boyfriend or partner of {CHILD}'s parent/guardian

3. Female guardian

4. Male guardian

5. Daughter/Son of {CHILD}'s parent's partner

6. Other relative of {CHILD}'s parent's partner

7. Other non-relative (Specify)

HELP TEXT AVAILABLE:

Girlfriend or Female Partner of CHILD's Parent/Guardian: The female who has a 

"partner-like" relationship with one of the child's parents or guardians. "Living as 

married" is another way of describing the relationship.

 

Boyfriend or Male Partner of CHILD's Parent/Guardian: The male who has a 

"partner-like" relationship with one of the child's parents or guardians. "Living as 

married" is another way of describing the relationship.

 

Female Guardian: The female legally placed in charge of the affairs of the child.

 

Male Guardian: The male legally placed in charge of the affairs of the child.

 

Daughter/son of CHILD's Parent's Partner: The child of the person who has a 

"partner-like" relationship with one of the child's parents or guardians.

 

Other Relative of CHILD's Parent's Partner: Some other relative of the person who 

has a "partner-like" relationship with one of the child's parents or guardians.

 

Other Non-relative: If one of the codes for non-relative above does not better 

describe the relationship of the person to the child, and there is no family 

relationship through blood, marriage, adoption, or partnership

(i.e., living together as married), use this code.

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{FILL WILL ASK ABOUT CHILD’S PARENTS IF B01F. (RESPONDENT) NE 1 OR 2 AND B03F.(OTHER 

RESPONDENT) = 1 OR 2}

B12. {Are you/Are {CHILD}'s parents or guardians} married, separated, divorced, widowed, in 

a domestic partnership or a civil union, or have {you/they} never been married?

1. Married

2. Separated

3. Divorced

4. Widowed

5. In a domestic partnership or a civil union

6. Never been married

{IF B012. = 1 or 5} {FILL WILL ASK ABOUT CHILD’S PARENTS IF B01F. (RESPONDENT) NE 1 OR 2 AND 

B03F.(OTHER RESPONDENT) = 1 OR 2}

B13. Does {your/{CHILD}'s mother's/father's} spouse or partner live in this household?

1. Please indicate which household member in the table is {your/{CHILD}'s 

mother's/father's} spouse or partner

2. None of the household members are {my/{CHILD}'s mother's/father's} spouse or 

partner

C. Family and Parent Background

Thank you for letting us know about the people in your household. Now we have a few 

additional questions about them. First, we would like to know about languages used in 

your home.

C01. Is English the primary language used in your home?

1. Yes

2. No

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C02a. Is any other language used in your home?

1. Yes

2. No

{C02a=1}

C02b. Please select the language(s) other than English that are used in your home from the 

alphabetical list below. You may select more than one.

Select all that apply.

1. Arabic

2. Chinese language/dialect

3. Farsi 

4. Filipino language

5. French

6. German

7. Greek

8. Hmong 

9.Italian

10. Japanese

11. Korean

12. Polish

13. Portuguese

14. Sign Language 

15. Spanish

16. Vietnamese

91. Some other language (specify)

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{IF C01.=2 and C02a.=1}

C03. What is the primary language used in your home?

1. Arabic

2. Chinese language/dialect

3. Farsi 

4. Filipino language

5. French

6. German

7. Greek

8. Hmong 

9.Italian

10. Japanese

11. Korean

12. Polish

13. Portuguese

14. Sign Language 

15. Spanish

16. Vietnamese

91. Some other language (specify)

THIS ITEM WILL BE ASKED FOR EACH WAVE UNTIL ANSWERED

C04. In which country were you born?

DROP DOWN [a list will be available that can be searched by typing in the country 

name and having matching responses narrowed down until the correct country is 

identified. The United States of America will be item 1 in this list. One of the 

response options should be Country not in list, at which point, the individual will be 

given a text field where they can write in their response.]

THIS ITEM WILL BE ASKED FOR EACH WAVE UNTIL ANSWERED

C05. In which country was {CHILD} born?

DROP DOWN [a list will be available that can be searched by typing in the country 

name and having matching responses narrowed down until the correct country is 

identified. The United States of America will be item 1 in this list. One of the 

response options should be Country not in list, at which point, the individual will be 

given a text field where they can write in their response.]

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{IF C05.>1}THIS ITEM WILL BE ASKED FOR EACH WAVE UNTIL ANSWERED

C06. In what year did {he/she} come to the United States to stay permanently?

DROP DOWN [Include a list of years beginning with child's birth year leading up to 

the current year]

{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 1 AND ABOUT CHILD’S MOTHER IF B01F. NE 1 AND 

B03F. = 1}

C07. What is the highest level of education {you/{CHILD}'s mother} completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

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{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 1 AND ABOUT CHILD’S MOTHER IF B01F. NE 1 AND 

B03F. = 1}

C08. What is the highest level of education {your/{CHILD}'s mother's} mother completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 1 AND ABOUT CHILD’S MOTHER IF B01F. NE 1 AND 

B03F. = 1}

C09. What is the highest level of education {your/{CHILD}'s mother's} father completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

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{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 2 AND ABOUT CHILD’S FATHER IF B01F. NE 2 AND 

B03F. = 2}

C10. What is the highest level of education {you/{CHILD}'s father} completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 2 AND ABOUT CHILD’S FATHER IF B01F. NE 2 AND 

B03F. = 2}

C11. What is the highest level of education {your/{CHILD}'s father's} mother completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

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{FILL WILL ASK RESPONDENT DIRECTLY IF B01F. = 2 AND ABOUT CHILD’S FATHER IF B01F. NE 2 AND 

B03F. = 2}

C12. What is the highest level of education {your/{CHILD}'s father}'s father completed?

1. 8th grade or lower

2. 9th to 11th grade

3. 12th grade but no diploma

4. High school diploma or equivalent

5. Vocational/technical program after high school but no vocational/technical 

diploma

6. Vocational/technical diploma after high school

7. Some college but no degree

8. Associate’s degree

9. Bachelor’s degree

10. Graduate or professional school but no degree

11. Master’s degree (MA, MS)

12. Doctorate degree (Ph.D, Ed.D)

13. Professional degree after bachelor’s degree (medicine/MD; dentistry/DDS; 

law/JD/LLB; etc.)

14. Do not know

D. Home Life

Great! We really appreciate you taking the time to answer all of our questions about 

people living in your household. The study doesn’t happen without you. Let’s keep 

moving right along. Now we have some questions about how much parents and 

guardians keep an eye on children around this age.

D01a. How often do you:

Know what {CHILD} does during {his/her} free time?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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D01b. How often do you:

Know what type of homework {CHILD} has?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

D01c. How often do you:

Know what {CHILD} spends {his/her} money on?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

D01d. How often do you:

Know when {CHILD} has an exam or paper due at school?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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D01e. How often do you:

Know what {CHILD}'s grades are in different subjects at school?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

D01f. How often do you:

Know where {CHILD} goes after school?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

D01g. How often does {CHILD} tell you about:

{His/Her} friends without you asking (for example, which friends {he/she} hangs out with 

and how {his/her} friends feel about various things)?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

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D01h. How often does {CHILD} tell you about:

School without you asking (for example, how each subject is going; {his/her} 

relationships with teachers)?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

D01i. How often does {CHILD}:

Keep secrets from you about what {he/she} does during {his/her} free time?

Select one per row.

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

6. Always

Next, we’d like to ask you some questions about things children sometimes do around 

this age.

D02a. Have any of the following things happened to {CHILD}? Has {he/she}...

gotten involved with the wrong kinds of people {his/her} age?

1. Yes

2. No

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D02b. Have any of the following things happened to {CHILD}? Has {he/she}...

ever used drugs (e.g., marijuana, cocaine, ecstasy, or 'bath salts')?

1. Yes

2. No

D02c. Have any of the following things happened to {CHILD}? Has {he/she}...

ever used alcohol?

1. Yes

2. No

D02d. Have any of the following things happened to {CHILD}? Has {he/she}...

gotten in trouble with the police?

1. Yes

2. No

D02e. Have any of the following things happened to {CHILD}? Has {he/she}...

beaten up other people {his/her} age?

1. Yes

2. No

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D02f. Have any of the following things happened to {CHILD}? Has {he/she}...

been beaten up by other people {his/her} age?

1. Yes

2. No

D02g. Have any of the following things happened to {CHILD}? Has {he/she}...

run away?

1. Yes

2. No

The next set of questions is about the neighborhood in which you live.

D03a. How true are the following statements about your neighborhood?

I worry about people with guns and knives in my neighborhood.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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D03b. How true are the following statements about your neighborhood?

People in this neighborhood do not get along with each other.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

D03c. How true are the following statements about your neighborhood?

Drug dealers are a problem in my neighborhood.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

D03d. How true are the following statements about your neighborhood?

I worry about the kind of people my children will meet in this neighborhood.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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D03e. How true are the following statements about your neighborhood?

My neighborhood is safe for children during the daytime.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

D03f. How true are the following statements about your neighborhood?

My neighborhood is safe for children during the nighttime.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

D03g. How true are the following statements about your neighborhood?

There are lots of run down homes in our neighborhood.

Select one per row.

1. Not at all true

2. A little bit true

3. Somewhat true

4. True

5. Very true

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E. Child's School Experiences

The information you have provided so far is extremely helpful. Thanks! The next set of 

questions is about your involvement with {CHILD}'s school and contact you may have had 

with the school about {CHILD}'s behavior or performance.

E01a. Indicate how much you disagree or agree with each of the following statements. Please 

think about the current school year as you consider each statement.

I make it my business to stay on top of things at school.

Select one per row.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Slightly Agree

5. Agree

6. Strongly Agree

E01b. Indicate how much you disagree or agree with each of the following statements. Please 

think about the current school year as you consider each statement.

I like to spend time at {CHILD}'s school when I can.

Select one per row.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Slightly Agree

5. Agree

6. Strongly Agree

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E01c. Indicate how much you disagree or agree with each of the following statements. Please 

think about the current school year as you consider each statement.

It's important that I let the teacher know about things that concern {CHILD}.

Select one per row.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Slightly Agree

5. Agree

6. Strongly Agree

E01d. Indicate how much you disagree or agree with each of the following statements. Please 

think about the current school year as you consider each statement.

I find it helpful to talk with {CHILD}'s teacher.

Select one per row.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Slightly Agree

5. Agree

6. Strongly Agree

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E01e. Indicate how much you disagree or agree with each of the following statements. Please 

think about the current school year as you consider each statement.

{CHILD}'s teacher(s) know(s) me.

Select one per row.

1. Strongly Disagree

2. Disagree

3. Slightly Disagree

4. Slightly Agree

5. Agree

6. Strongly Agree

E02a. Indicate how often you have done the following during this school year.

I contacted {CHILD}'s teacher with questions about schoolwork.

1. Never

2. Once so far this year

3. About once a month

4. Once every two weeks

5. Once a week

6. Daily

E02b. Indicate how often you have done the following during this school year.

I exchanged phone calls or notes with {CHILD}'s teacher.

1. Never

2. Once so far this year

3. About once a month

4. Once every two weeks

5. Once a week

6. Daily

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E03a. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

{CHILD}'s school schedule for this year?

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

E03b. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

{CHILD} missing too many days of school? 

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

E03c. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

{CHILD}'s positive or good behavior in school?

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

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E03d. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

Information on how to help {CHILD} at home with specific skills or homework?

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

E03e. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

{CHILD}'s plans after leaving high school?

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

E03f. Since the start of the school year, how many times have {you or your spouse/partner} 

had contact with the school about...

{CHILD}'s course selection for entry into college, vocational, or technical school after 

completing high school?

Select one per row.

1. None

2. Once or twice

3. Three or four times

4. More than four times

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The next questions are about disciplinary actions {CHILD}'s school may have taken.

E04. Since starting kindergarten, how many times has {CHILD} ever been suspended or 

expelled from school? Do not count detentions.

1. Please select the number of times. [DROP DOWN: 0-10 or more]

{IF E04. >0}

E05.

What was the reason for the {(IF E04>1) most recent} suspension or expulsion?

Select all that apply.

1. Repeated violation of the school rules

2. Use of profanity (swearing)

3. Threatening students or teachers

4. Defacing or destroying school property

5. Bringing a weapon to school

6. Fighting with another student

7. Ganging up (with one or more other students) on another student

8. Threatening to use or making a false report of the use of an explosive device at 

school

9. Assaulting a teacher, principal, or other school personnel

10. Other (specify)

{IF E04. >0}

E06. How many days was the {(IF E04>1) most recent} suspension?

 

1. __________ Enter number of days suspended

2. {CHILD} was expelled.

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The next questions are about grades your child may have repeated or skipped.

E07. What grades, if any, has {CHILD} repeated since starting school?

Select all that apply.

1. Has not repeated any grades 

2. Kindergarten

3. 1st grade

4. 2nd grade 

5. 3rd grade

6. 4th grade

7. 5th grade 

8. 6th grade 

9. 7th grade

10. 8th grade

E08. What grades, if any, has {CHILD} skipped since starting school?

Select all that apply.

1. Has not skipped any grades 

2. Kindergarten

3. 1st grade

4. 2nd grade 

5. 3rd grade

6. 4th grade

7. 5th grade 

8. 6th grade 

9. 7th grade

10. 8th grade

The following questions are about programs {CHILD} may participate in at school.

E09. Has {CHILD} ever been enrolled in a program for English language learners (ELLs) such as 

English as a Second Language (ESL), English immersion, or bilingual education?

1. Yes

2. No

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{IF E09. = 1}

E10.

Is {he/she} currently enrolled in an English as a Second Language (ESL), English 

immersion, or bilingual education program?

1. Yes

2. No

E11. Does {CHILD} receive free or reduced price lunches at school?

1. Yes

2. No

{IF E11. = 1}

E12. Are these lunches free or reduced price?

1. Free

2. Reduced price

F. Child Health and Well Being

Thank you for answering all of our questions about {CHILD}'s educational experiences. 

Now, we would like to ask you about {CHILD}'s health.

F01. In general, would you say that {CHILD}'s health is...

1. Excellent

2. Very good

3. Good

4. Fair

5. Poor

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F02a. Has a doctor, health care provider, teacher, or school official ever told you that {CHILD} 

has...

Hearing problems that cannot be corrected with a hearing aid?

1. Yes

2. No

F02b. Has a doctor, health care provider, teacher, or school official ever told you that {CHILD} 

has...

Vision problems that cannot be corrected with glasses or contact lenses?

1. Yes

2. No

F03. Has a doctor, nurse, or other medical professional ever told you that {CHILD} has had a 

concussion?

1. Yes

2. No

{IF F03. = 1}

F04. How many times has {CHILD} been diagnosed by a doctor as having had a concussion?

|_|_| Enter Number of Times

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F05. Has a doctor, nurse, or other medical professional ever told you that {CHILD} has 

asthma?

1. Yes

2. No

{IF F05. = 1}

F06. Has {CHILD} ever been taken to an emergency room or hospitalized for at least one night 

because of asthma?

1. Yes

2. No

The next set of questions is about professional evaluations {CHILD} may have had in the 

past.

F07a. Has {CHILD} ever been evaluated by a professional because of an issue with...

independence and taking care of {himself/herself}

1. Yes

2. No

HELP TEXT AVAILABLE:

Professional: This includes health professionals such as doctors, pediatricians, and 

other licensed persons, including nurses or nurse practitioners, optometrists, 

ophthalmologists, ear-nose-throat (ENT) doctors, audiologists, school or other 

psychologists, school or other psychiatrists, psychiatric social workers, speechlanguage pathologists, etc. Do not include teachers or some other non-health 

professional.

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F07b. Has {CHILD} ever been evaluated by a professional because of an issue with...

paying attention

1. Yes

2. No

F07c. Has {CHILD} ever been evaluated by a professional because of an issue with...

learning, thinking, and solving problems

1. Yes

2. No

F07d. Has {CHILD} ever been evaluated by a professional because of an issue with...

coordination in moving {his/her} arms and legs

1. Yes

2. No

F07e. Has {CHILD} ever been evaluated by a professional because of an issue with...

behaving and relating to other children

1. Yes

2. No

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F07f. Has {CHILD} ever been evaluated by a professional because of an issue with...

behaving and relating to adults

1. Yes

2. No

F07g. Has {CHILD} ever been evaluated by a professional because of an issue with...

{his/her} overall activity level

1. Yes

2. No

F07h. Has {CHILD} ever been evaluated by a professional because of an issue with...

{his/her} emotional or psychological difficulties?

1. Yes

2. No

{IF ANY OF F07.A-H = 1} THIS ITEM WILL BE ASKED FOR EACH ITEM IN THE F07 SERIES WITH A 

RESPONSE OF 1 AND QUESTION FILL WILL SHOW QUESTION TEXT FOR EACH.

F08. Have you obtained a diagnosis or diagnoses for {CHILD}'s issue with {QUESTION TEXT 

FROM F07A-H} from a professional?

1. Yes

2. No

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{IF F08.=1}

F09. What {was the diagnosis/were the diagnoses}?

Select all that apply.

1. Learning disability

2. Attention Deficit Disorder (ADD)

3. Attention Deficit Hyperactivity Disorder (ADHD)

4. Developmental Delay

5. Autistic Disorder/Asperger’s Disorder/Childhood Disintegrative 

Disorder/Pervasive Developmental Disorder (PDD)/other Autism Spectrum 

Disorder

6. Dyslexia

7. Dyscalculia

8. Intellectual disability/severe cognitive disability/mental retardation

9. Orthopedic impairment

10. Serious emotional disturbance

11. Traumatic brain injury

12. Panic disorder

13. Separation anxiety disorder

14. Obsessive compulsive disorder

15. Generalized anxiety disorder

16. Other anxiety disorder

17. Bipolar disorder

18. Depression

19. Speech problems (such as articulation problems; communication problems; 

phonological problems; voice disorders; or stuttering)

20. Sensory deficit disorder (such as sensory deprivation problems; sensory 

processing problems; sensory integration problems; or sensory organization 

problems)

91. Other (Specify)

HELP TEXT AVAILABLE:

Learning disability: This is a disorder in one or more of the basic psychological 

processes involved in understanding or in using language, spoken or written, which 

shows up as difficulty to listen, think, speak, read, write, spell, or do mathematical 

calculations. In some cases the child can perform at grade level, but only with 

special help. Some names of learning disabilities are dyslexia, dyscalculia, 

developmental aphasia, minimal brain dysfunction, brain injury, and perceptual 

disabilities. The term does not include learning problems that are primarily the 

result of problems with seeing, hearing, or walking (or visual, hearing or motor 

disabilities); mental retardation; emotional disturbance; or environmental, cultural, 

or economic disadvantage. A commonly used acronym is "LD."

 

Attention Deficit Disorder (ADD): A childhood syndrome characterized by short 

attention span that is inappropriate for his/her age group.

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Attention Deficit Hyperactivity Disorder (ADHD): The child displays signs of 

inattention, impulsivity, and hyperactivity that are inappropriate for his or her 

mental and chronological age. Adults in the child’s environment, such as parents 

and teachers must report the signs. Inattention means difficulty concentrating, 

easily distracted, and not finishing things started. Impulsivity means often acts 

before thinking, shifts excessively from one activity to another, needs a lot of 

supervision. Hyperactivity means runs about or climbs on things excessively, has 

difficulty staying seated, always on the go, as if driven by a motor. Onset is typically 

before age seven and condition lasts at least six months.

 

Developmental delay: A condition in which a young child falls significantly behind 

his/her age-mates in physical, mental (cognitive), speech (communication), 

social/emotional, adaptive (behavioral) development. It does not simply mean that 

the child talked somewhat later than some children talked or was smaller than 

average. It is not to be confused with autism or pervasive developmental delay. If 

the child's social behavior and relationships with other people are generally 

consistent with his or her delayed cognitive development, then the classification of 

the condition as developmental delay is probably appropriate. If this is not the 

case, see the definitions of autism and pervasive developmental disorder or delay.

 

Autism is a developmental disability significantly affecting verbal and nonverbal 

communication as well as social interaction, generally evident before age three. 

Other characteristics often associated with autism are a pervasive lack of 

responsiveness to other people, and engagement in repetitive activities and 

stereotyped movements (such as hand-flapping or rocking). There is also often an 

insistence on sameness, as shown by stereotyped play, abnormal preoccupations, 

or resistance to change. With autism, the impaired social development and delayed 

or deviant language development are not merely predictable from the child's 

cognitive retardation. Some children with autism are actually advanced in their 

reading skills, memory skills, or musical abilities. The term autism does not apply if 

the child’s educational performance is negatively affected primarily because the 

child has an emotional disturbance. Asperger's Disorder, Pervasive Developmental 

Disorder (PDD), or any other autism spectrum disorder may be coded here; the 

subtype will be captured in the next question. Pervasive developmental disorder or 

delay is also characterized by gross and sustained impairment in social 

relationships, but typically has an onset after 30 months of age. Other 

characteristics are sudden excessive anxiety, inappropriate affect or emotions, 

resistance to change in the environment, oddities of motor movement, 

abnormalities of speech, hypersensitivity to sensory stimuli, and self-mutilation. 

This condition generally does not involve delusions, hallucinations, incoherence, or 

bizarre associations.

 

Dyslexia: A learning disability (see above definition) marked by impairment of the 

ability to recognize and comprehend the written word.

 

Dyscalculia: A learning disability (see above definition) marked by impairment in 

the ability to perform and remember calculations in mathematics.

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Intellectual or Severe cognitive disability/Mental Retardation: The child's mental 

development is significantly and noticeably behind what would ordinarily be 

expected for a child of his or her age. This significantly below average general 

intellectual functioning exists at the same time as problems in adaptive behavior, 

and negatively affects the child’s educational performance.

 

Orthopedic impairment: A bodily (or physical) impairment that is severe enough to 

negatively affect a child’s educational performance. Disabling physical problems 

such as those resulting from poliomyelitis (often called polio or infantile paralysis), 

bone tuberculosis, cerebral palsy, amputations, and fractures or contractures 

(shortening of tissue) from burns would be considered as orthopedic impairments.

 

Serious Emotional Disturbance or SED: A condition that has one or more of the 

following characteristics over a long period of time that negatively affect a child's 

educational performance: (a) an inability to learn that cannot be explained by 

other factors; (b) an inability to build or maintain satisfactory interpersonal 

relationships with peers and teachers; (c) inappropriate behavior or feelings; d) a 

general mood of unhappiness or depression; or (e) a tendency to develop physical 

symptoms or fears associated with personal or school problems. The term includes 

schizophrenia but does not apply to children who are socially maladjusted, unless it 

is determined that they have a serious emotional disturbance.

 

Traumatic Brain Injury: An acquired injury to the brain caused by an external force, 

resulting in total or partial functional disability or psychosocial impairment, or 

both, that adversely affects a child's educational performance. The term applies to 

open or closed head injuries resulting in impairments in one or more areas, such as 

cognition; language; memory; attention; reasoning; abstract thinking; judgment; 

problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; 

physical functions; information processing; and speech. The term does not apply to 

brain injuries that are congenital (there at birth ) or degenerative (problem that 

grows worse over time), or to brain injuries brought on by birth trauma (injuries 

during birth). The term is used when an external force has caused the injury.

 

Panic Disorder: A disorder in which there is the sudden onset of several different 

physical signs, such as rapid heart rate, shaking, sweating, nausea, dizziness, and 

difficulty breathing. A panic disorder may make a child think that something 

horrible is about to happen.

 

Separation Anxiety Disorder: This is the fear a child has of being separated from 

his/her parents which is far more than would be expected for the child’s 

developmental stage.

 

Obsessive Compulsive Disorder: A child must have obsessions or compulsions or 

both to have this disorder, and these obsessions and/or compulsions must be 

disabling to the child. Obsessions are thoughts that aren’t visible to others but 

cause the child distress. The thoughts occur over and over and the child spends so 

much time on them that they have a hard time taking care of themselves or 

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relating to others. Compulsions are mental acts that a child feels driven to perform 

in response to an obsession.

 

Generalized Anxiety Disorder: Children who have this disorder worry all the time 

over nothing, themselves, other’s safety, their health, and/or the world to a far 

greater extent than average. They often have many physical signs of anxiety such 

as headache, abdominal pain, cramps, diarrhea, vomiting, and dizziness.

{IF F09.=91}

F10. What {was the diagnosis/were the diagnoses}?

Specify Diagnosis/Diagnoses.

__________________ [ENTER TEXT]

{IF F09.= 5}

F11. What type of Autism Spectrum Disorder does {CHILD} have? Is it Autistic Disorder, 

Asperger's Disorder, Childhood Disintegrative Disorder, Pervasive Developmental 

Disorder, or something else?

1. Autistic Disorder 

2. Asperger's Disorder 

3. Childhood Disintegrative Disorder

4. Pervasive Developmental Disorder (PDD)

91. Other (Specify)

{IF F11. = 91}

F12. Specify the type of Autism Spectrum Disorder.

_________ [Enter text]

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{IF F09.=1-91} REPEAT FOR EACH SELECTION MADE IN F09.

F13a. What month and year was the diagnosis of {RESPONSE FROM F09. OR TEXT FROM F10. IF 

F09.=91} made? If {CHILD} was diagnosed more than once, please indicate the first 

diagnosis.

1. |___|___| Month

2. |___|___|___|___| Year

3. Do not know

{IF F13a.=3}

F13b. If you do not know the month and year the diagnosis of {RESPONSE FROM F09. OR TEXT 

FROM F10. IF F09.=91} was made, please enter {CHILD}'s age at that time. Your best 

guess is fine. If {CHILD} was diagnosed more than once, please indicate {his/her} age at 

the time of the first diagnosis.

1. |___|___| Enter age

2. Do not know

{IF F09.=1-91} REPEAT FOR EACH SELECTION MADE IN F09.

F14. Is {CHILD} now taking any prescription medicine for the condition related to {his/her} 

{RESPONSE FROM F09. OR TEXT FROM F10. IF F09.=91}?

1. Yes

2. No

{IF F09. = 2 or 3} AND {IF F14.= 1}

F15. Is {CHILD} medicated for ADD or ADHD at school, at home, or both?

1. At school

2. At home

3. Both at school and at home

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Now we would like to ask about the experience {CHILD} and your family may have had 

with a 504 Plan or an Individualized Education Program (IEP).

F16. Does {CHILD} currently have a 504 plan based on section 504 of the Rehabilitation Act 

that describes accommodations to support {his/her} learning?

1. Yes

2. No 

3. Don't know

HELP TEXT AVAILABLE:

Section 504 plan: A written plan to provide appropriate services to a child with a 

disability, whether or not the disability is judged to affect the child’s educational 

performance. Speech therapy services may often be specified as part of a Section 

504 plan.

F17. Has {CHILD} ever had an Individualized Education Program (IEP)?

1. Yes

2. No 

3. Don't know

HELP TEXT AVAILABLE:

Individualized Education Program (IEP) is a written statement for each student with 

a disability that sets goals for the student in school, says how progress will be 

measured, describes the special education and related services the school will 

provide, how much the student will be in the regular class with nondisabled 

students, and lists accommodations or modifications needed to measure what the 

student knows through tests.

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{IF F17.=1}

F18. Does {CHILD} still have an IEP?

1. Yes

2. No 

3. Don't know

{IF F18.=2}

F19. Why does {he/she} no longer have an IEP?

Select all that apply.

1. {CHILD} no longer needs special services 

2. {CHILD} met IEP goals 

3. {CHILD} was declassified, school says {he/she} no longer needs services 

4. {CHILD} no longer eligible, doesn’t qualify 

5. School doesn’t have the programs {CHILD} needs 

6. I don't want {CHILD} in special education 

7. {CHILD} did not want to be in special education 

8. {CHILD} now has a 504 Plan 

9. Other (specify)

{IF F18.=1}

F20. In the last 12 months, has there been an IEP meeting about {CHILD}'s special education 

program or services?

1.Yes

2.No

3.Don't know

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{IF F20.=1}

F21. Did you or another adult in the household go to the meeting?

1.Yes 

2.No 

3. Don't know

{IF F20.=1}

F22. Did {CHILD} go to the meeting?

1.Yes

2.No

3.Don't know

{IF F18.=1}

F23. Who came up with the goals on {CHILD}'s IEP?

 

Check all that apply.

1.School staff

2.Me or other parent/family member 

3.{CHILD}

4. Another person

{IF F18.=1}

F24. Of the people who came up with the IEP goals, who came up with the most goals?

Select one only.

1. School staff

2. Me or another parent/family member

3. {CHILD}

4. Another person

5. Not applicable; everyone came up with the same number of goals.

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{IF F18.=1}

F25. How active was {CHILD} in developing {his/her} IEP? For example, did {CHILD} 

participate in discussions about their disability, their strengths, their needs, the 

accommodations that would help them achieve in class, their goals for the future, and 

the goals they feel are most important for them to work on?

1. Very active; took a leadership role in IEP development

2. Active; participated regularly in IEP development 

3. Somewhat active; participated occasionally in IEP development

4. Not active; did not participate in IEP development

{IF F18.=1}

F26. Overall, how satisfied are you with the progress {CHILD} has made towards {his/her} IEP 

goals this year? Are you...

1. Completely satisfied

2. Very satisfied

3. Fairly satisfied

4. Somewhat dissatisfied

5. Very dissatisfied

{IF F18.=1}

F27. Have you had any discussions with {CHILD}'s IEP team about {his/her} transition to high 

school?

1. Yes

2. No

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{IF F18.=1}

F28a. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

develop self-determination and self advocacy skills

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{IF F18.=1}

F28b. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

expand social and community support networks

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{IF F18.=1}

F28c. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

learn “soft” employment skills (such as appropriate dress, working well in a group, 

following instructions)

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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{IF F18.=1}

F28d. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

practice money management skills

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{IF F18.=1}

F28e. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

connect with adult service providers

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

{IF F18.=1}

F28f. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

plan for health care needs

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

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{IF F18.=1}

F28g. How often have you discussed the following topics with staff at {CHILD}'s school about 

how {CHILD} can...

prepare for change

1. Never

2. Rarely

3. Sometimes

4. Often 

5. Very often

The next set of questions asks about the types of accommodations and services that 

{CHILD} receives, either at school or outside of school. Let’s begin by looking at 

accommodations and services that {CHILD} might receive for {his/her} academic 

performance.

{IF F16.OR F18=1}

F29a. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Catch-up courses or double-dosing of classes during the regular school day

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

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{IF F16.OR F18=1}

F29b. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Supplemental instruction or tutoring in academic subjects before or after school

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F16.OR F18=1}

F29c. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Supplemental instruction or tutoring in academic subjects on weekends

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know 

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{IF F16.OR F18=1}

F29d. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Help connecting students to outside academic transition services, supports, or activities 

(e.g., tutoring, mentoring)

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F16.OR F18=1}

F29e. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Tutor

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

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{IF F16.OR F18=1}

F29f. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for {his/her} academic performance? For each accommodation or service 

listed, please select whether {he/she} received the service or accomodation through 

school or through outside community sources. 

Braille instruction or other related services for visually impaired (e.g., Nemeth code, 

abacus)

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

Now we would like to know how helpful you have found the services {CHILD} and your 

family have received from {his/her} school.

{IF F29a. =1}

F30a. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Catch-up courses or double-dosing of classes during the regular school day

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F29b. =1}

F30b. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Supplemental instruction or tutoring in academic subjects before or after school

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

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{IF F29c. =1}

F30c. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Supplemental instruction or tutoring in academic subjects on weekends

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F29d. =1}

F30d. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Help connecting students to outside academic transition services, supports, or activities 

(e.g., tutoring, mentoring)

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F29e. =1}

F30e. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Tutor

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

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{IF F29f. =1}

F30f. Overall, how helpful {are/were} each of the following services for academic performance 

{CHILD} and your family have received from the school?

Braille instruction or other related services for visually impaired (e.g., Nemeth code, 

abacus)

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F16.OR F18=1}

F31a. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Help developing capability to dress, clean, care for self

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F16.OR F18=1}

F31b. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Help connecting students to community skill- and behavior-related services, supports, or 

activities (e.g., assistive technology, networking)

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

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{IF F16.OR F18=1}

F31c. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Speech or language therapy, or communication services

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know 

{IF F16.OR F18=1}

F31d. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Psychological or mental health services or counseling

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

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{IF F16.OR F18=1}

F31e. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Physical or occupational therapy

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F16.OR F18=1}

F31f. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive skills and behaviors? For each accommodation or service listed, 

please select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Orientation and mobility services (to help individuals navigate their environment)

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F31a. =1}

F32a. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Help developing capability to dress, clean, care for self

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

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{IF F31b. =1}

F32b. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Help connecting students to community skill- and behavior-related services, supports, or 

activities (e.g., assistive technology, networking)

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F31c. =1}

F32c. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Speech or language therapy, or communication services

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F31d. =1}

F32d. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Psychological or mental health services or counseling

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

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{IF F31e. =1}

F32e. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Physical or occupational therapy

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F31f. =1}

F32f. Overall, how helpful {are/were} each of the following services for positive skills and 

behaviors {CHILD} and your family have received from the school?

Orientation and mobility services (to help individuals navigate their environment)

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F16.OR F18=1}

F33a. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive life functioning? For each accommodation or service listed, please 

select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Reader or interpreter, including sign language

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

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{IF F16.OR F18=1}

F33b. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive life functioning? For each accommodation or service listed, please 

select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Audiology services for hearing problems

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know 

{IF F16.OR F18=1}

F33c. During the past 12 months, has {CHILD} received any of the following accommodations 

or services for positive life functioning? For each accommodation or service listed, please 

select whether {he/she} received the accomodation or service through school or 

through outside community sources. 

Special transportation because of disability

1. Yes - Received through school

2. Yes - Received through outside source

3. No - Did not receive

4. Don't know

{IF F33a. =1}

F34a. Overall, how helpful {are/were} each of the following services for positive life functioning 

{CHILD} and your family have received from the school?

Reader or interpreter, including sign language

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

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{IF F33b. =1}

F34b. Overall, how helpful {are/were} each of the following services for positive life functioning 

{CHILD} and your family have received from the school?

Audiology services for hearing problems

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F33c. =1}

F34c. Overall, how helpful {are/were} each of the following services for positive life functioning 

{CHILD} and your family have received from the school?

Special transportation because of disability

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

{IF F16.OR F18=1}

F35. During the past 12 months, has {CHILD} received any other accommodations or services? 

For each accommodation or service listed, please select whether {he/she} received the 

accomodation or service through school or through outside community sources. 

Other accommodations or services (specify)

1. Yes - Received through school ____________ [ENTER TEXT]

2. Yes - Received through outside source ____________ [ENTER TEXT]

3. No - Did not receive

4. Don't know

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{IF F35.=1}

F36. Overall, how helpful {are/were} the services {CHILD} and your family have received from 

the school?

{TEXT FROM F35.}

1. Very helpful

2. Helpful

3. Not helpful

4. Not at all helpful

G. Employment and Income

Now we have a few questions about what {you and your spouse/partner or {CHILD}'s 

mother and father} do for a living.

SECTION G ITEMS WILL LOOP WITH SHIFTING FILLS TO CAPTURE RESPONDENT AND SPOUSE (IF 

PARENTS DO NOT LIVE IN HOUSEHOLD) OR CHILDS MOTHER AND FATHER (IF THEY LIVE IN THE 

HOUSEHOLD) BASED ON RESPONSES TO B01f, B03f, B12, AND B13

G01. During the past week, did {you/{NAME}} work at a job for pay?

1. Yes

2. No

{IF G01. = 2}

G02. {Were you/Was {NAME}} on leave or vacation from a job?

1. Yes

2. No

{IF G01. = 2}

G03. {Have you/Has {NAME}} been actively looking for work in the past 4 weeks?

1. Yes

2. No

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{IF G01. = 2}

G04. Have {you/ {NAME}} worked at a job for pay in the last 5 years?

1. Yes

2. No

{IF G01. = 2}

G05. What {were you/was {NAME}} doing most of last week? Would you say ...

1. Keeping house or caring for children

2. Going to school

3. Retired

4. Unable to work

91. Something else? (Specify)

{IF G05. = 91}

G06. Please enter what {you were/{NAME} was} doing most of last week.

 

______________ Enter description

{IF G01. = 1}

G07. How many jobs {do you/does {NAME}} have now?

|___|___| Enter number of jobs

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{IF G01. = 1}

G08. About how many total hours per week {do you/does {NAME}} usually work for pay?

1. |___|___| Enter number of weekly hours between 1 and 80 {Range 1-80} 

2. More than 80 hours per week

{IF G01. = 1 OR IF G04. NE 2}

G09. For whom {do/does/did} {you/{NAME}} work {when {you/{he/she}} last worked}?

_________ Enter employer name

{IF G01. = 1 OR IF G04. NE 2}

G10. What kind of business or industry {is/was} this?

1. Construction (Buildings, alterations and public works)

2. Governments (Local, state and Federal agencies)

3. Foreign Trade (Exports, imports and participants)

4. Manufacturing (Companies, operations and shipments, products)

5. Mining (Minerals, gases and initial processing)

6. Retail (Merchandise for personal or home use)

7. Services (Personal, business and transport services)

8. Wholesale (Merchandise for business use)

9. Other (Specify)

{IF G01. = 1 OR IF G04. NE 2}

G11. What kind of work {are/is/were/was} {you/{NAME}} doing?

___________Enter job title

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{IF G01. = 1 OR IF G04. NE 2}

G12. What {are/is/were/was} {your/{NAME}'s} most important activities or duties on this job? 

What {do/does/did} {you/{NAME}} actually do at this job?

__________ Enter job duties

In studies like this, households are sometimes grouped according to income. 

G13. What was the total income of all persons in your household over the past year, including 

salaries or other earnings, interest, retirement, and so on for all household members?

1. $5,000 or less

2. $5,001 to $10,000

3. $10,001 to $15,000

4. $15,001 to $20,000

5. $20,001 to $25,000

2. $25,001 to $30,000 

3. $30,001 to $35,000

4. $35,001 to $40,000

5. $40,001 to $45,000 

6. $45,001 to $50,000

7. $50,001 to $55,000

8. $55,001 to $60,000

9. $60,001 to $ 65,000

10.$65,001 to $70,000

11. $70,001 to $75,000

12. $75,001 to $80,000

13. $80,001 to $85,000

14. $85,001 to $90,000

15. $90,001 to $95,000

16. $95,001 to $100,000

17. $100,001 to $110,000

18. $110,001 t0 $120,000

19. $120,001 to $130,000

20. $130,001 to $140,000

21. $140,001 to $150,000

22. $150,001 to $160,000

23. $160,001 to $170,000

24. $170,001 to $180,000

25. $180,001 to $190,000

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26. $190,001 to $200,000

27. $200,001 to $225,000

28. $225,001 to $250,000

29. $250,001 to $275,000

30. $275,001 to $300,000

31. $300,001 to $325,000

32. $325,001 to $350,000

33. $350,001 to $375,000

34. $375,001 to $400,000

35. $400,001 to $425,000

36. $425,001 to $450,000

37. $450,001 to $475,000

38. $475,001 to $500,000

39. $500,001 or more

G14. Which of the following have you or members of your household done to financially 

prepare for {CHILD}'s education after high school?

Select all that apply

1. Started a savings account

2. Bought an insurance policy

3. Bought U.S. savings bonds

4. Made investments in stocks or real estate

5. Set up a college investment fund (such as a mutual fund)

6. Started working another job and/or more hours

7. Established another form of savings

8. Reduced other expenses in some way (e.g., pay off car, put off vacations or other 

expenses)

9. Planned to reduce other expenses in some way

10. Re-mortgaged your property or took out a home equity loan

11. Planned to re-mortgage your property or take out a home equity loan

12. Had your child put aside earnings

13. Participated in a state-sponsored college savings program 

14. Nothing

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{IFG14.<14}

G15. About how much money has been set aside for {his/her} future educational needs?

1. None

2. $2,000 or less

3. $2,001-$5,000

4. $5,001-$10,000

5. $10,001-$15,000

6. $15,001-$25,000

7. $25,001-$35,000

8. $35,001-$60,000

9. More than $60,000

H. Mobility

The next questions ask about how often you and {CHILD} have moved since {CHILD} 

started kindergarten.

H01. How long has {CHILD} lived in {his/her} current residence?

Select number of years

[DROP DOWN R: <1 year->15 years]

H02. In the last 5 years how many different places has {CHILD} lived for four months or more?

|___|___| Enter number of places

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H03a. How many times has {CHILD} changed schools since {he/she} entered kindergarten as a 

result of grade promotion?

1. |___|___| Enter number of times

HELP TEXT AVAILABLE:

Grade promotion would include moving to a different school because of the prior 

school not serving more advanced levels, such as a move from an elementary 

school to a middle school or from a middle school to a junior high school in the 

same district.

H03b. How many times has {CHILD} changed schools since {he/she} entered kindergarten for a 

reason other than grade promotion?

1. |___|___| Enter number of times 

H04. Is {CHILD} attending a different school this year than the one {he/she} had attended last 

school year?

1. Yes

2. No

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I. Parent Involvement

The final section asks about your expectations for {CHILD}'s future and conversations you 

may have had with {CHILD} about school or {his/her} future plans.

I01a. Since the start of this school year, how often have you discussed the following with 

{CHILD}?

Selecting a math course to take next school year

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

I01b. Since the start of this school year, how often have you discussed the following with 

{CHILD}?

Selecting courses other than math to take next school year

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

I01c. Since the start of this school year, how often have you discussed the following with 

{CHILD}?

Preparing for college entrance exams such as ACT, SAT, or ASVAB

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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I01d. Since the start of this school year, how often have you discussed the following with 

{CHILD}?

Applying to college or other schools after high school

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

I01e. Since the start of this school year, how often have you discussed the following with 

{CHILD}?

Careers {CHILD} might be interested in

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

I02. How far in school do you expect {CHILD} to go? Would you say you expect {he/she} ...

1. Won’t finish high school

2. Will graduate from high school, but won’t go any further

3. Will go to a technical or trade school after high school

4. Will attend college

5. Will graduate from college

6. Will attend a higher level of school after graduating from college 

7. Don’t know

I03. Thank you for your cooperation!

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Middle Grades Longitudinal Study of 2016-2017 

(MGLS:2017) 

Math Teacher Questionnaire 

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Math Teacher 

Questionnaire. Please refer to the instructions you received in your survey invitation letter to find your 

login ID and password. To begin the survey, enter your login ID and password in the fields below, and 

then click NEXT. If you do not have your login ID and password, please call First Last at 1-888-xxxxxxx, or email us at xxxxxx@xxxxxxxx.com. 

Login ID: 

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. 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 requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or 

concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle Grades 

Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

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A. Introduction

Survey Information

A00a. You have received an invitation to complete this questionnaire because you are a math

teacher in one of the schools participating in the MGLS:2017 field test. To enhance the

information we obtain from assessing your students and surveying their parents, we

need you to complete this brief two-part instrument.

The first part, the Math Teacher Questionnaire, asks you about your classroom and

mathematics instruction, as well as your thoughts about teaching and your school, and

some information about your background. The second portion, the Teacher Student

Report (TSR), asks you to report on the social skills, problem behaviors, and math skills

that you have observed in each of the students in the study who are from your class.

Taking part in the study is voluntary and you can skip questions you do not want to

answer. We realize you are very busy, but urge you to complete this questionnaire as

completely and accurately as possible. Your answers are very important to the study’s

success. You will receive a $20 gift card for completing the questionnaire and $10 for

each completed student report.

Please click below to start the survey.

Let's get started

The National Center for Education Statistics (NCES) of the U. S. Department of Education is authorized to conduct 

the MGLS:2017 by the Education Sciences Reform Act of 2002 (20 U.S. Code, Section 9543). All of the information 

you provide 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 U.S. Code, Section 9573).

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A00b. How to Complete the Survey

Thank you for taking the time to complete this survey. Before you get started, here 

are a few helpful hints. 

• Please record your answers by checking the box next to the appropriate answer or 

entering information as directed. Answer each question as accurately as possible; if 

you need to estimate an answer that is okay.

• Press the "Next" button to move forward. 

• Press the "Back" button to go back. 

• The "Stop and Come Back Later" button can be used to save your responses and 

finish later (button is at the bottom of each page). 

• To protect your data, your responses will be automatically saved and you will be 

logged off if you are idle for more than 30 minutes. 

A. Student and Classroom Characteristics

This section asks specific questions about your {FILL CLASS NAME} class.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A01. How many students are enrolled in this class?

____ students (enter a number)

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A01a. Please provide some information about your {CLASS NAME} class.

Which of the following best describes this mathematics course? 

 

Select one response.

1. Grade 6 general mathematics

2. Grade 6 honors mathematics

3. Grade 6 remedial mathematics

4. Grade 7 general mathematics

5. Grade 7 honors mathematics

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6. Grade 7 remedial mathematics

7. Grade 8 general mathematics

8. Grade 8 honors mathematics

9. Grade 8 remedial mathematics

10. Introduction to algebra/ pre-algebra

11. Algebra

12. Algebra II

13. Geometry

14. Other, specify __________

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A02a. What percentage of students in this {CLASS NAME} class ...

Are below grade level in their mathematics skills.

ENTER PERCENTAGE IN BOX. IF NONE, ENTER "0". ____%

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A02b. What percentage of students in this {CLASS NAME} class ...

Are about on grade level in their mathematics skills.

ENTER PERCENTAGE IN BOX. IF NONE, ENTER "0". ____%

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A02c. What percentage of students in this {CLASS NAME} class ...

Are above grade level in their mathematics skills.

ENTER PERCENTAGE IN BOX. IF NONE, ENTER "0". ____%

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

A03. At this point in the school year, how would you rate the behavior of the students in this 

class?

 

Select one response.

1. Group misbehaves very frequently and is almost always difficult to handle.

2. Group misbehaves frequently and is often difficult to handle.

3. Group misbehaves occasionally.

4. Group behaves well.

5. Group behaves exceptionally well.

B. Classroom Mathematics Instruction

This section focuses on the content you cover in this {CLASS NAME} class, as well as your 

teaching practices.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B01. The curriculum used for this class is...

1. Locally or district-designed

2. State-designed

3. Nationally-designed

4. Other, specify:_________

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B02. What do you use as your primary basis for instruction?

1. Textbook (Print) 

2. E-book 

3. District or state educational content repository 

4. Open educational resources, specify: __________________

5. Other, specify: __________

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT} {ASK IF B02 = 1 or = 2}

B03. Which one of the following textbooks or e-books do you use in this class as your primary 

source of instruction? Select only one.

1. Holt Mathematics Course 1; Holt, Rinehart & Winston 

2. Holt Mathematics Course 2; Holt, Rinehart & Winston

3. Holt Mathematics Course 3; Holt, Rinehart & Winston

4. Holt Pre-Algebra; Holt, McDougal

5. Holt Pre-Algebra; Holt, Littell

6. Holt Algebra I; Holt, McDougal

7. Saxon Math

8. Algebra 1; McDougal Littell / Houghton Mifflin

9. Algebra; Prentice Hall

10. Algebra 1; Glencoe / McGraw-Hill

11. Contemporary Mathematics in Context; Glencoe / McGraw-Hill

12. Integrated Mathematics; McDougal Littell / Houghton Mifflin

13. Everyday Mathematics (UCSMP); Everyday Learning

14. Math; Harcourt, Brace, Jovanovich

15. Math; Scott Foresman

16. Trailblazers: Kendall Hunt

17. Math Investigations; Pearson/TERC

18. Geometry; Holt

19. Pre-Algebra; Glencoe/McGraw Hill

20. Glencoe Math Course 1

21. Connected Mathematics Program (CMP) 2

22. Connected Mathematics Program (CMP) 3

23. Math Connects Common Core Edition Course 2

24. Glencoe Math Common Core Edition Course 2

25. Other, specify: __________________

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT} {IF B02 = 1 or 2}

B03a. Please indicate the publication year of your primary textbook, {FILL TEXTBOOK NAME 

from B03}.

Year: _ _ _ _

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B03 = 14, 15, 17, 21, or 25}

B03b. Please indicate the grade level of {FILL TEXTBOOK NAME from B03} you use as your 

primary textbook.

Select only one.

 

1. Grade 5

2. Grade 6

3. Grade 7

4. Grade 8

5. Grade 9

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B04. Which of the following do you use to supplement your primary basis for instruction? 

 

Select all that apply.

1. Textbook (Print) 

2. E-book 

3. District or state educational content repository 

4. Open educational resources, specify: _______________

5. Other, specify: __________

6. I do not use additional resources to supplement instruction

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT} {IF B04 = 1 or = 2}

B05. What additional textbooks or e-books do you use to supplement your instruction?

Select all that apply.

 

1. Holt Mathematics Course 1; Holt, Rinehart & Winston 

2. Holt Mathematics Course 2; Holt, Rinehart & Winston

3. Holt Mathematics Course 3; Holt, Rinehart & Winston

4. Holt Pre-Algebra; Holt, McDougal

5. Holt Pre-Algebra; Holt, Littell

6. Holt Algebra I; Holt, McDougal

7. Saxon Math

8. Algebra 1; McDougal Littell / Houghton Mifflin

9. Algebra; Prentice Hall

10. Algebra 1; Glencoe / McGraw-Hill

11. Contemporary Mathematics in Context; Glencoe / McGraw-Hill

12. Integrated Mathematics; McDougal Littell / Houghton Mifflin

13. Everyday Mathematics (UCSMP); Everyday Learning

14. Math; Harcourt, Brace, Jovanovich

15. Math; Scott Foresman

16. Trailblazers: Kendall Hunt

17. Math Investigations; Pearson/TERC

18. Geometry; Holt

19. Pre-Algebra; Glencoe/McGraw Hill

20. Glencoe Math Course 1

21. Connected Mathematics Program (CMP) 2

22. Connected Mathematics Program (CMP) 3

23. Math Connects Common Core Edition Course 2

24. Glencoe Math Common Core Edition Course 2

25. Other, specify: __________________ 

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT} {IF B04 = 1 or = 2} {FOR EACH 

SELECTED IN B05}

B05a. Please indicate the publication year of any supplementary textbooks.

Year: _ _ _ _

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{ASK FOR EACH SELECTED RESPONSE IN 

B05 THAT IS 14, 15, 17, 21, or 25}

B05b. Please indicate the grade level of {FILL SUPPLEMENTAL TEXTBOOK NAME from B05} you 

use as a supplemental textbook.

1. Grade 5

2. Grade 6

3. Grade 7

4. Grade 8

5. Grade 9

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B06. These questions ask about how much time is scheduled for this class.

How many weeks per year is the class held?

____ weeks

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B07. How many days per week is the class typically held?

1. One day 

2. Two days 

3. Three days 

4. Four days 

5. Five days 

6. Six days

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B08. How many minutes per day is the class typically held?

____ minutes

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09a. The purpose of this item is to obtain a description of the specific mathematic content 

areas you covered or plan to cover in your course this academic year. 

Following is a list of content areas covering materials that may be taught in grades 6, 7 & 

8. Please respond to the entire list so that we may obtain an indication of the topics 

covered in your class that is as complete and accurate as possible. (Note: not all areas 

are necessarily appropriate for your class). 

For each listed content area, indicate the approximate number of class periods during 

this school year when the content area was or will be a primary focus for your class. 

To what extent have you or will you teach each of the following topics in this course 

during this school year? 

Indicate the number of class periods taught. Select one per row.

Understand ratio concepts and use ratio reasoning to solve problems.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09b. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Analyze proportional relationships and use them to solve real-world and mathematical 

problems.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09c. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Apply and extend previous understandings of multiplication and division to divide 

fractions by fractions. 

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09d. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Compute fluently with multi-digit numbers and find common factors and multiples.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09e. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Apply and extend previous understandings of numbers to the system of rational 

numbers.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09f. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Apply and extend previous understandings of operations with fractions to add, subtract, 

multiply, and divide rational numbers.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09g. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Know that there are numbers that are not rational and approximate them by rational 

numbers.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09h. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Define, evaluate and compare functions.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09i. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Use functions to model relationships between quantities.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09j. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Apply and extend previous understandings of arithmetic to algebraic expressions.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09k. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Reason about and solve one-variable equations and inequalities.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09l. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Represent and analyze quantitative relationships between dependent and independent 

variables.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09m. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Use properties of operations to generate equivalent expressions.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09n. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Solve real-life and mathematical problems using numerical and algebraic expressions and 

equations. 

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09o. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Work with radicals and integer exponents.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09p. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Understand the connections between proportional relationships, lines, and linear 

equations.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

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{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B09q. To what extent have you or will you teach each of the following topics in this course 

during this school year? Indicate the number of class periods taught. 

Analyze and solve linear equations and pairs of simultaneous linear equations.

1. None

2. One or less

3. 2 – 5 

4. 6 – 10

5. 11 – 15

6. > 15

These next questions ask about the teaching practices you use in this classroom.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B10a. How often do the students in this {CLASS NAME} class...

Select one per row.

Explain how to solve a mathematics problem (either verbally or in writing).

1. Almost every day

2. Once or twice a week

3. Once or twice a month

4. Never or hardly ever

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B10b. How often do the students in this {CLASS NAME} class...

Work on problems for which there is no immediate solution.

1. Almost every day

2. Once or twice a week

3. Once or twice a month

4. Never or hardly ever

Math Teacher Survey 

September 2014

252
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B10c. How often do the students in this {CLASS NAME} class...

Practice solving routine items to develop or maintain fluency.

1. Almost every day

2. Once or twice a week

3. Once or twice a month

4. Never or hardly ever

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11a. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

Select one per row.

I try to give students a lot of choices about classroom assignments. 

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11b. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

I have to lead students through their schoolwork step by step.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

Math Teacher Survey 

September 2014

253
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11c. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

I can't afford to let students decide too many things about schoolwork for themselves.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11d. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

I let students make a lot of their own decisions regarding schoolwork.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11e. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

It's better not to give too many choices to students.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

Math Teacher Survey 

September 2014

254
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11f. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

I find myself telling students every step to make when it comes to schoolwork.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11g. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

I can't let students do things their own way.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11h. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

When it comes to assignments, I'm always having to tell students what to do.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

Math Teacher Survey 

September 2014

255
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B11i. Please indicate the extent to which the following statements are true for students in this 

{CLASS NAME} class.

My general approach with students is to give them as few choices as possible.

1. Not at all true 

2. A little bit true 

3. Somewhat true 

4. Mostly true

5. Very true

Next we would like to know about how you use technology in your teaching.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B12. Please indicate if the following technology devices are available for your use in the 

classroom. Select all that apply.

1. Desktop or laptop

2. Tablet 

3. Smartboard, or interactive whiteboard 

4. Interactive TV monitor 

5. LCD or DLP projector 

6. Smartphone 

7. Apps 

8. Digital camera 

9. Digital video recorder 

10. Graphing calculators 

11. Student or audience response system for polling 

12. Other, specify: ______

Math Teacher Survey 

September 2014

256
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B13. Please indicate if the following technology devices are available for student use in the 

classroom. Select all that apply.

1. Desktop or laptop

2. Tablet 

3. Smartboard, or interactive whiteboard 

4. Interactive TV monitor 

5. LCD or DLP projector 

6. Smartphone 

7. Apps 

8. Digital camera 

9. Digital video recorder 

10. Graphing calculators 

11. Student or audience response system for polling 

12. Other, specify: ______

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14a. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following? 

Select one per row.

Practice or review mathematics topics.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

257
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14b. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Show work to the class in real time.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14c. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Research a mathematics topic.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

258
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14d. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Play games.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14e. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Create projects.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

259
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14f. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Collect and analyze data.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14g. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Conduct or watch simulations.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

260
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14h. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Submit assignments online.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14i. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Edit others' work or give others feedback.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

261
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14j. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Share or post their work for others to view at any time.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14k. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Extend mathematics learning with enrichment activities.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

262
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14l. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Participate in online discussions.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing}

B14m. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Fill free time.

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

263
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}{IF B13 is not missing} {LOOP B16n. 

UNTIL NO MORE OTHER, SPECIFY}

B14n. In your {CLASS NAME} class this year, how often do your students use technological 

resources to do each of the following?

Other, specify: ____________

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15a. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following? Select one per row.

Collaborate with other teachers

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

264
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15b. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Encourage student participation in class

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15c. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Collect and analyze data for classroom examples and activities

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

265
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15d. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Collect and analyze assessment data for grading

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15e. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Send reminders or class information to students

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

266
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15f. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Provide homework help or learning support outside of class

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15g. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Develop videos of classroom instruction

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

267
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15h. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Compile links to external resources

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT}

B15i. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Distribute study tools and self-assessments 

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

Math Teacher Survey 

September 2014

268
{ASK ONCE FOR EACH CLASSROOM WITH A SAMPLED STUDENT} {LOPP B17j. UNTIL NO MORE OTHER, 

SPECIFY}

B15j. In your {CLASS NAME} class this year, how often do you use technological resources to 

do each of the following?

Other, specify: _______

1. Never

2. Rarely

3. Monthly

4. Weekly

5. Daily

HELP TEXT: Examples of technological resources would be tablets, e-readers, 

computers, smartphones, digital cameras, Smartboards and interactive 

whiteboards, as well as websites such as Khan Academy, Moodle, Dropbox, or 

Study Island and apps such as Edmodo, Poll Everywhere, or Remind 101.

B16. Does this school lend or provide computers, tablets or similar devices to individual 

students?

1. Yes 

2. No

B17. Thinking about students, is this a bring your own device (BYOD) school?

1. Yes 

2. No

Math Teacher Survey 

September 2014

269
C. Views on Teaching and School Environment

This section asks questions about your school and your teaching.

C01. Which statement best describes the way your mathematics classes at this school are 

organized?

1. You instruct several classes of different students all or most of the day in one or 

more subjects (sometimes called departmentalized instruction).

2. You instruct the same group of students all or most of the day in multiple 

subjects (sometimes called a self-contained class).

3. You instruct a small number of selected students released from or in their 

regular classes in specific skills or to address specific needs (sometimes called a 

"pull-out" class or "push-in" instruction).

C02a. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Select one per row.

Counselor recommendation.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C02b. In this school, how important is each of the following factors in placing a typical {FILL

GRADES TAUGHT} student into a mathematics course?

Prior teacher recommendation.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

Math Teacher Survey 

September 2014

270
C02c. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Courses taken previously.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C02d. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Achievement in previous courses.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C02e. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Results of district or state end-of-year or end-of-course exams.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

Math Teacher Survey 

September 2014

271
C02f. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Results of placement tests.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C02g. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Results of standardized tests.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C02h. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Student career or education plan.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

Math Teacher Survey 

September 2014

272
C02i. In this school, how important is each of the following factors in placing a typical {FILL 

GRADES TAUGHT} student into a mathematics course?

Student and/or parent or guardian selection.

1. Not at all important 

2. A little important

3. Somewhat important

4. Very important

5. Not applicable

C03a. Please indicate how confident you are for each of the following statements about your 

teaching. 

I am confident that I can...

Select one per row.

Answer students’ mathematics-related questions.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

C03b. I am confident that I can...

Explain to students how to do complex mathematics problems.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

Math Teacher Survey 

September 2014

273
C03c. I am confident that I can...

Skillfully teach all the concepts covered in the mathematics curriculum.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

C03d. I am confident that I can...

Help students master difficult concepts in mathematics.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

C03e. I am confident that I can...

Help all students make significant improvements in mathematics.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

Math Teacher Survey 

September 2014

274
C03f. I am confident that I can...

Design lessons that enable all my students to master the material in mathematics.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

C03g. I am confident that I can...

Help students who have failed math in the past make significant progress.

1. Not at all confident 

2. A little confident

3. Somewhat confident

4. Mostly confident

5. Very confident

C04a. Next, we would like to know more about your school's principal or administrator. How 

much do you disagree or agree with each of the following statements? The principal at 

this school... 

Select one per row.

Makes clear to the staff his or her expectations for meeting instructional goals.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

Math Teacher Survey 

September 2014

275
C04b. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Communicates a clear vision for our school.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C04c. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Sets high standards for teaching.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

Math Teacher Survey 

September 2014

276
C04d. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Understands how students learn.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C04e. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Sets high standards for student learning.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

Math Teacher Survey 

September 2014

277
C04f. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Presses teachers to implement what they have learned in professional development.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C04g. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Carefully tracks student academic progress.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

Math Teacher Survey 

September 2014

278
C04h. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Knows what's going on in my classroom.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C04i. How much do you disagree or agree with each of the following statements? The principal 

at this school...

Actively monitors the quality of teaching in this school.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

Math Teacher Survey 

September 2014

279
The next set of questions asks about the teaching climate at your school.

C05a. How much do you disagree or agree with each of the following statements about math 

teachers at your school? Math teachers at your school... 

Select one per row.

Believe all students can do well.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C05b. How much do you disagree or agree with each of the following statements about math 

teachers at your school? Math teachers at your school... 

Have given up on their students.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C05c. How much do you disagree or agree with each of the following statements about math 

teachers at your school? Math teachers at your school... 

Care only about the smart students.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C05d. How much do you disagree or agree with each of the following statements about math 

teachers at your school? Math teachers at your school... 

Expect very little from students.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C05e. How much do you disagree or agree with each of the following statements about math 

teachers at your school? Math teachers at your school... 

Work hard to make sure all students are learning.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C06a. To what extent do you disagree or agree with the following statements about teaching at 

your school? 

Select one response per row.

Curriculum, instruction, and learning materials are well coordinated across the different 

grade levels at this school.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C06b. To what extent do you disagree or agree with the following about teaching at your 

school? 

There is consistency in curriculum, instruction, and learning materials among teachers in 

the same grade level at this school.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C07a. How much do you agree with each of the following statements about your school? 

Select one response per row.

The level of student misbehavior (for example, noise, horseplay, or fighting in the halls or 

cafeteria) in this school interferes with my teaching.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C07b. How much do you agree with each of the following statements about the teaching 

climate at your school?

Many of the students I teach are not capable of learning the material I am supposed to 

teach them.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C07c. How much do you agree with each of the following statements about the teaching 

climate at your school?

I feel accepted and respected as a colleague by most staff members.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C07d. How much do you agree with each of the following statements about the teaching 

climate at your school?

Teachers in this school are continually learning and seeking new ideas.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C07e. How much do you agree with each of the following statements about the teaching 

climate at your school?

Routine administrative duties and paperwork interfere with my job of teaching. 

Paperwork includes items associated with Response to Intervention, alignment with the 

Common Core State Standards, or other initiatives.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C08a. Indicate the extent to which you disagree or agree with each of the following statements 

about your school. 

Select one response per row.

I feel safe at this school.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

C08b. Indicate the extent to which you disagree or agree with each of the following statements 

about your school. 

This school's security policies and practices are sufficient.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

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C08c. Indicate the extent to which you disagree or agree with each of the following statements 

about your school. 

The students get along well with teachers.

1. Strongly disagree

2. Disagree

3. Slightly disagree

4. Slightly agree

5. Agree

6. Strongly agree

D. Teacher background

D01. The next several questions ask about your educational background.

What is the highest level of education you have completed?

Select one response. 

1. Did not complete high school

2. High school diploma or equivalent/GED

3. Some college or technical or vocational school

4. Associate's degree

5. Bachelor's degree

6. Master's degree

7. Advanced professional degree beyond a master's degree (for example, Ph.D., 

Ed.D.)

D02. In what year did you receive your {FILL WITH HIGHEST DEGREE LISTED IN D01}?

Year: _ _ _ _

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D03a. Did you have a major, minor, or special emphasis in any of the following subjects as part 

of your undergraduate or graduate coursework? 

Select one per row.

Elementary education.

1. Yes, a major 

2. Yes, a minor or special emphasis 

3. No

D03b. Did you have a major, minor, or special emphasis in any of the following subjects as part 

of your undergraduate or graduate coursework? 

Secondary education.

1. Yes, a major 

2. Yes, a minor or special emphasis 

3. No

D04a. How many college-level classes have you taken in the following branches of 

mathematics?

Select one response per row.

Algebra such as abstract algebra, linear algebra, or groups, rings, and fields.

1. None 

2. One or two 

3. Three or four

4. Five or more

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D04b. How many college-level classes have you taken in the following branches of 

mathematics?

Applied mathematics such as dynamical systems, game theory, information theory, 

mathematical modeling, or mathematical physics.

1. None 

2. One or two 

3. Three or four

4. Five or more

D04c. How many college-level classes have you taken in the following branches of 

mathematics?

Calculus, analysis, or differential equations.

1. None 

2. One or two 

3. Three or four

4. Five or more

D04d. How many college-level classes have you taken in the following branches of 

mathematics?

Discrete mathematics, combinatorics, or graph theory.

1. None 

2. One or two 

3. Three or four

4. Five or more

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D04e. How many college-level classes have you taken in the following branches of 

mathematics?

Foundations, philosophy, history of mathematics, or logic.

1. None 

2. One or two 

3. Three or four

4. Five or more

D04f. How many college-level classes have you taken in the following branches of 

mathematics?

Geometry, trigonometry, or topology.

1. None 

2. One or two 

3. Three or four

4. Five or more

D04g. How many college-level classes have you taken in the following branches of 

mathematics?

Number theory.

1. None 

2. One or two 

3. Three or four

4. Five or more

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D04h. How many college-level classes have you taken in the following branches of 

mathematics?

Probability or statistics.

1. None 

2. One or two 

3. Three or four

4. Five or more

D04i. How many college-level classes have you taken in the following branches of 

mathematics?

Teaching mathematics.

1. None 

2. One or two 

3. Three or four

4. Five or more

D05a. Including this school year, how many years have you taught the following grades at any 

school...

Please estimate to the nearest half year (for example, 4.5 years).

Grade K-12 in any subject?

Number of years:______._______

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D05b. Including this school year, how many years have you taught the following grades at any 

school...

Grade K-5 math?

 

Number of years:______._______

D05c. Including this school year, how many years have you taught the following grades at any 

school...

Grade 6-8 math?

Number of years:______._______

D05d. Including this school year, how many years have you taught the following grades at any 

school...

Grade 9-12 math?

Number of years:______._______

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D06. Which of the following best describes the math teaching certificate you currently hold in 

{FILL STATE}?

1. Regular or standard state certificate or advanced professional certificate 

2. Certificate issued after satisfying all requirements except the completion of a 

probationary teaching period 

3. Certificate that requires some additional coursework or passing a test 

4. Certificate issued to persons who must complete a certification program in order 

to continue teaching 

5. I do not hold any of these certifications in this state

6. Other, specify: _________

{IF D06 does not = 5}

D07. In which grades does this certificate allow you to teach math in {FILL STATE}?

Select all that apply. 

 

1. Kindergarten 

2. 1st grade

3. 2nd grade

4. 3rd grade

5. 4th grade

6. 5th grade

7. 6th grade

8. 7th grade

9. 8th grade

10. 9th grade

11. 10th grade

12. 11th grade

13. 12th grade

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D08. Have you taken the exam for National Board for Professional Teaching Standards 

certification?

1. Not taken 

2. Taken and passed 

3. Taken and have not yet passed 

4. Taken and awaiting results

{IF D08 = 2}

D09. In what content area(s) do you hold a National Board for Professional Teaching 

certificate? 

 

Select all that apply from the drop down list below.

1. Generalist, Early Childhood

2. Generalist, Middle Childhood

3. Mathematics, Early Adolescence

4. Mathematics, Adolescence and Young Adulthood

5. Other, specify: _____

D10. Did you enter teaching through an alternative certification program? An alternative 

certification program is a program that was designed to expedite the transition of nonteachers to a teaching career, for example, a state, district, or university alternative 

certification program.

1. Yes 

2. No

This set of questions asks about you and your background.

D11. In what year were you born?

Select year. 19[__]

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D12. What is your sex?

 

1. Male

2. Female 

D13. Are you of Hispanic or Latino/Latina origin?

1. Yes

2. No

D14. Which of the following best describes your race? You may choose more than one.

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or other Pacific Islander

5. White

E. Thank you

E01. Thank you for your cooperation.

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Middle Grades Longitudinal Study of 2016-2017 

(MGLS:2017) 

Math Teacher Student Report 

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Teacher Student Report. 

Please refer to the instructions you received in your survey invitation letter to find your login ID and 

password. To begin the survey, enter your login ID and password in the fields below, and then click 

NEXT. If you do not have your login ID and password, please call First Last at 1-888-xxx-xxxx, or email 

us at xxxxxx@xxxxxxxx.com. 

Login ID: 

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. The time required to complete this information collection 

is estimated to average 10 minutes for each student report, including the time to review instructions, search existing data resources, gather the data needed, and 

complete and review the information requested. If you have any comments concerning the accuracy of the time estimate or suggestions for improving the survey 

instrument, or concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle 

Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

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A00a. Welcome to the MGLS:2017 Teacher Student Report web site! 

The Teacher Student Report asks questions about the social skills, problem behaviors, 

and math skills that you have observed for each student in your class selected to 

participate in MGLS:2017.

Instructions: 

1. On the next screen, you'll see a list of students. 

2. Choose a student you wish to rate and press the "Next" button. 

3. If a student moved to another class, moved to another school, or was never in your 

class, choose the student’s name and you will be able to note why the student is not 

currently in your class.

Press the "Next" button to proceed.

A00b. Please select a student to rate. 

School: [SCHOOL]; Classroom: [CLASSROOM] 

 

Select a student then press the "Next" button. You may have to scroll down to see the 

buttons.

 

1. First Name Last Name 

2. First Name Last Name 

3. First Name Last Name

A00c. Are you still the math teacher for {FILL NAME from A00b.}?

1. Yes

2. No

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{If A00c = 2}

A00d. You indicated that {FILL NAME from A00b} is not currently in your math class. What is 

the main reason you are no longer {FILL NAME from A00b}'s math teacher?

1. {FILL NAME from A00b} moved to another class in the same school. 

2. {FILL NAME from A00b} moved to another school in the same district. 

3. {FILL NAME from A00b} left the district.

3. {FILL NAME from A00b} was never in my class/I don't know {FILL NAME from 

A00b}.

{IF A00c =1 Proceed}

A. Mathematical Thinking

This first set of questions asks about the skills and abilities {STUDENT NAME} 

demonstrates in class.

A01a. Please rate this student's skills in the following areas, as exhibited in your class. 

Select one per row.

Ability to apply mathematical concepts to "real world" problems.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

A01b. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to complete or conduct proofs or demonstrations of his or her mathematical 

reasoning.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

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A01c. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to talk about his or her reasoning or thinking in solving a problem.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

A01d. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to explain his or her reasoning in solving a problem in writing.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

A01e. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to use representations to model mathematical ideas.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

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A01f. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to use a calculator to solve problems.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

A01g. Please rate this student's skills in the following areas, as exhibited in your class.

Ability to fluently apply math facts and procedures.

1. Outstanding

2. Very good

3. Good

4. Fair

5. Poor

6. Not applicable or not observed

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B. Social Skills

This section asks about how {STUDENT NAME} behaves and manages him or herself in

class.

B01a. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Select one response per row.

Organizes work.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

B01b. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Appears motivated to learn new things.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

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B01c. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Works well independently.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

B01d. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Adapts to changes in plans, requirements or routines.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

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B01e. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Persists in completing tasks.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

B01f. For each item below, please think about this student's behavior during the past month. 

Decide how often the student demonstrates the behavior described. 

Pays attention well.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

6. No opportunity to observe this behavior

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B02a. The following are some statements that describe behaviors many students exhibit. For 

each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Select one per row.

Manipulates others or lies.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B02b. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Bullies or is cruel or mean to others.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B02c. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Disobeys rules.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

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B02d. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Has sudden changes in mood or feeling.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B02e. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Argues too much.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B02f. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Is stubborn, sullen, or irritable.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

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B02g. For each item below, please think about this student's behavior during the past three 

months. Describe how often this student demonstrates the behavior.

Has a strong temper or loses his or her temper easily.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

Next are some questions about {STUDENT NAME}'s interactions with other students.

B03a. During this school year, how often have other students...

Select one per row.

Teased, made fun of, or called this student names.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B03b. During this school year, how often have other students...

Pushed, shoved, slapped, hit, or kicked this student.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

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B03c. During this school year, how often have other students...

Told lies or untrue stories about this student.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B03d. During this school year, how often have other students...

Intentionally excluded or left out this student from socializing with them.

1. Never

2. Sometimes

3. Often

4. Very often

5. Always

B04a. Please rate each of the listed behaviors according to how well it describes this student.

Select one response per row.

Resolves peer problems on his or her own.

1. Not at all

2. A little

3. Moderately well

4. Well

5. Very well

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B04b. Please rate each of the listed behaviors according to how well it describes this student.

Is helpful to others.

1. Not at all

2. A little

3. Moderately well

4. Well

5. Very well

B04c. Please rate each of the listed behaviors according to how well it describes this student.

Can give suggestions and opinions without being bossy.

1. Not at all

2. A little

3. Moderately well

4. Well

5. Very well

B04d. Please rate each of the listed behaviors according to how well it describes this student.

Acts friendly toward others.

1. Not at all

2. A little

3. Moderately well

4. Well

5. Very well

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B04e. Please rate each of the listed behaviors according to how well it describes this student.

Understands others.

1. Not at all

2. A little

3. Moderately well

4. Well

5. Very well

C. Classroom Behaviors

These questions ask about how {STUEDNT NAME} behaves in your classroom.

C01a. Please indicate the extent to which each of the following statements is true for this 

student.

Select one per row.

In my class, this student works as hard as he or she can.

1. Not at all true

2. A little bit true

3. Somewhat true

4. Mostly true

5. Very true

C01b. Please indicate the extent to which each of the following statements is true for this 

student.

When working on classwork in my class, this student appears involved.

1. Not at all true

2. A little bit true

3. Somewhat true

4. Mostly true

5. Very true

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C01c. Please indicate the extent to which each of the following statements is true for this 

student.

When I explain new material, this student listens carefully.

1. Not at all true

2. A little bit true

3. Somewhat true

4. Mostly true

5. Very true

C01d. Please indicate the extent to which each of the following statements is true for this 

student.

In my class, this student does more than required.

1. Not at all true

2. A little bit true

3. Somewhat true

4. Mostly true

5. Very true

C01e. Please indicate the extent to which each of the following statements is true for this 

student.

When this student doesn't do well, he or she works harder.

1. Not at all true

2. A little bit true

3. Somewhat true

4. Mostly true

5. Very true

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C02a. Next are some questions about this student's attendance. Over the last month, how 

often has this student been...

Select one per row.

Late to your class.

1. 0 times

2. 1–2 times

3. 3–6 times

4. 7–9 times

5. 10-12 times

6. 13 or more times

C02b. Over the last month, how often has this student been...

Absent from your class.

1. 0 times

2. 1–2 times

3. 3–6 times

4. 7–9 times

5. 10-12 times

6. 13 or more times

C03a. Over the past month, how often did this student...

Select one per row.

Come to class without completing prior assignments or homework.

1. 0 times

2. 1–2 times

3. 3–6 times

4. 7–9 times

5. 10-12 times

6. 13 or more times

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C03b. Over the past month, how often did this student...

Come to class without class materials (such as pencils, paper, tablet, books, or 

calculator).

1. 0 times

2. 1–2 times

3. 3–6 times

4. 7–9 times

5. 10-12 times

6. 13 or more times

D. Student and Classroom Information

This last section asks about any special supports or opportunities {STUDENT NAME} 

receives at school.

D01a. How often does this student receive instruction and/or related services in any of the 

following types of programs in your school during the day?

Select one per row.

Individual tutoring in mathematics.

1. Daily

2. Two to four times per week

3. Weekly

4. Less than once a week

5. This student does not receive this service

6. Program or service not provided to students in this school

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D01b. How often does this student receive instruction and/or related services in any of the 

following types of programs in your school during the day? 

Small group pull-out in mathematics.

1. Daily

2. Two to four times per week

3. Weekly

4. Less than once a week

5. This student does not receive this service

6. Program or service not provided to students in this school

D01c. How often does this student receive instruction and/or related services in any of the 

following types of programs in your school during the day? 

Gifted and talented program in mathematics.

1. Daily

2. Two to four times per week

3. Weekly

4. Less than once a week

5. This student does not receive this service

6. Program or service not provided to students in this school

D02. Have you recommended this student for academic honors, advanced placement, or 

honors classes?

1. Yes

2. No

3. Not applicable (No such honor available)

E. Thank you

E01. Thank you for your cooperation.

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Middle Grades Longitudinal Study of 2016-2017 

(MGLS:2017) 

Special Education Teacher/Service Provider 

Questionnaire 

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Special Education 

Teacher/Service Provider Questionnaire. Please refer to the instructions you received in your survey 

invitation letter to find your login ID and password. To begin the survey, enter your login ID and 

password in the fields below, and then click NEXT. If you do not have your login ID and password, 

please call First Last at 1-888-xxx-xxxx, or email us at xxxxxx@xxxxxx.com. 

Login ID: 

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. The time required to complete this information collection 

is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete 

and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, 

or concerns regarding the status of your individual response to this survey, write directly to: National Center for Education Statistics, Middle Grades Longitudinal 

Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

Special Education Teacher 

September 2014

314
A. Introduction

Survey Information

A00a. You have received an invitation to complete this questionnaire because you are a special

education teacher/provider in one of the schools participating in the MGLS:2017 field

test. To enhance the information we obtain from assessing your students and surveying

their parents, we need you to complete this brief two-part instrument.

The first part, the Teacher Questionnaire, asks you about your background, your current

position, and your opinions about teaching. The second part, the Teacher Student Report

(TSR), asks you to report on the IEP and primary disability, special education services

received, and goals and expectations about each of the students in the study who are

from your class.

Taking part in the study is voluntary and you can skip questions you do not want to

answer. We realize you are very busy, but urge you to complete this questionnaire as

completely and accurately as possible. Your answers are very important to the study’s

success. You will receive a $20 gift card for completing the questionnaire and $10 for

each completed student report.

Please click below to start the survey.

Let's get started

The National Center for Education Statistics (NCES) of the U. S. Department of Education is authorized to conduct 

the MGLS:2017 by the Education Sciences Reform Act of 2002 (20 U.S. Code, Section 9543). All of the information 

you provide 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 U.S. Code, Section 9573).

Special Education Teacher 

September 2014

315
A00b. How to Complete the Survey

Thank you for taking the time to complete this survey. Before you get started, here 

are a few helpful hints. 

• Please record your answers by checking the box next to the appropriate answer or 

entering information as directed. Answer each question as accurately as possible; if 

you need to estimate an answer that is okay.

• Press the "Next" button to move forward. 

• Press the "Back" button to go back. 

• The "Stop and Come Back Later" button can be used to save your responses and 

finish later (button is at the bottom of each page). 

• To protect your data, your responses will be automatically saved and you will be 

logged off if you are idle for more than 30 minutes. 

Special Education Teacher 

September 2014

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A. Teacher Assignment or Position

First we would like to ask you some questions about your current position or assignment.

{ASK ONCE FOR EACH TEACHER}

A01. Which of the following best describes your current position in this school?

Select only one. 

1. Special education teacher 

2. Special education teacher consultant 

3. General education teacher 

4. Special education classroom aide/paraprofessional

5. Speech - language pathologist 

6. Physical therapist 

7. Physical therapy assistant or aide 

8. Occupational therapist 

9. Occupational therapy assistant or aide 

10. School psychologist 

11. School counselor

12. School social worker

13. Other (please specify)

{ASK ONCE FOR EACH TEACHER}

A02. How do you classify your main assignment at this school, that is, the activity at which you 

spend most of your time during this school year?

Select only one.

1. Regular full-time teacher

2. Regular full-time service provider 

3. Regular part-time teacher (at one school)

4. Regular part-time service provider (at one school)

5. Itinerant teacher (i.e., your assignment requires you to provide 

instruction/related services at more than one school) 

6. Itinerant related services consultant (e.g., speech and language therapist, social 

worker, psychologist, behavior specialist. Your assignment requires you to provide 

instruction/related services at more than one school). 

7. Long-term substitute 

8. Teacher aide or paraprofessional

9. Other (please specify)

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

A03. Do you co-teach with another teacher or professional educator?

Select one only.

1. Yes

2. No

{A03=1}

A04. Which of the following models best describes your current co-teaching arrangement? 

Select one only. 

1. One teach, one drift (one teacher leads the class and the other moves 

throughout the classroom to make sure everyone is on track). 

2. Station teaching (class divided into two or more stations; each teacher spends at 

least half of the period with one group, and then teachers switch). 

3. Alternative teaching (one teacher teaches the large group and the other teacher 

works with a smaller group of students to re-teach any necessary information). 

4. Parallel teaching (both teachers are teaching at the same time, and both lead 

discussion; class may be divided into groups).

5. Team teaching (both co-teachers balance the responsibilities of the class in such 

a way that both teach the same amount in front of the classroom).

6. Other (please specify):

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

A05. During this school year, where have you worked with students with IEPs?

A05a. In a general education classroom

A05b. In a special education classroom

A05c. In a non-classroom space (e.g. office, therapy room, small work space, mobile van, 

etc.)

A05d. Other (please specify)

A05e. I do not work directly with students who have IEPs

Select yes or no on each row.

1. Yes 

2. No

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

A06. Do you teach mathematics to students who have IEPs?

1. Yes

2. No

{A06=1}

A07. When teaching mathematics to students who have IEPs, how often do you use each of 

the following instructional strategies?

A07a. Have students discuss different ways to solve a problem

A07b. Have students generate new strategies

A07c. Have students work on an investigation, problem or project over an extended 

period of time

A07d. Have students solve problems using multiple methods

A07e. Begin instructional units with worked examples (explaining how work is 

completed, step by step, and what you think as you complete each step) 

A07f. Teach the most efficient solution strategy using simple, direct language

A07g. Have students explain solutions in their own words 

A07h. Have students practice solution strategies that you taught

A07i. Have students explain how taught strategies are efficient

A07j. Provide students with background knowledge and skills 

A07k. Provide practice for prescribed strategies 

A07l. Incorporate systematic cumulative reviews of skills and information 

A07m. Include self-regulation strategies that promote on-task thinking and hard work

A07n. Explicitly teach for transfer of skills and strategies

A07o. Use validated forms of progress monitoring of student responsiveness

A07p. Apply validated decision-making rules with progress monitoring tools to 

determine when to revise the program 

Select one for each row.

1. Never

2. Once a month or less

3. Two or three times a month

4. Once or twice a week

5. Three or four times a week

6. Every day

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

A08. Please indicate the extent to which you agree or disagree with each of the following 

statements on teaching.

A08a. I really enjoy my present job.

A08b. I am certain I am making a difference in the lives of the students I work with.

A08c. If I could start over, I would choose this career again.

A08d. I am satisfied with my class size/caseload.

A08e. I worry about the security of my job because of the performance of the students in 

my class(es) on state or local tests.

A08f. I get frustrated working with general education teachers.

A08g. I plan to continue to teach special education for at least the next five years.

A08h. The amount of paperwork that I need to complete for my students takes away 

from my ability to deliver high quality instruction.

Select one on each row.

1. Strongly disagree 

2. Disagree 

3. Neither disagree nor agree 

4. Agree 

5. Strongly agree

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

A09. During this school year, how many students with IEPs have you worked with or provided 

services for, on average, each week? 

 

Include students you work with directly, as well as students for whom you consult with 

the general education teacher and/or another special education teacher/service 

provider.

Select only one.

1. 1-10 

2. 11-20 

3. 21-40 

4. More than 40 

5. Don’t know

Special Education Teacher 

September 2014

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B. Teacher Background and Education

The next several questions ask about your background and education.

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B01. What is your sex?

1. Male

2. Female

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B02. In what year were you born?

Enter year.

19 [ ]

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B03. Are you Hispanic or Latino/Latina?

Select only one.

1. Yes 

2. No

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B04. Which of the following best describes your race?

You may choose more than one. 

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B05. What is the highest level of education you have completed?

Select only one.

1. Did not complete high school

2. High school diploma or equivalent/GED

3. Some college or technical or vocational school

4. Associate's degree

5. Bachelor's degree

6. Master's degree

7. An advanced professional degree beyond a master's degree (for example, Ph.D., 

MD)

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B06. Which of the following credentials, licenses, or certificates do you have for working with 

students with disabilities?

B06a. Emergency credential

B06b. Provisional or temporary credential

B06c. Disability-specific credential or endorsement

B06d. Special education credential or endorsement (for more than one disability 

category)

B06e. General education credential

B06f. Speech/language therapy state license or certification 

B06g. Physical therapy state license or certification

B06h. Occupational therapy state license or certification

B06i. Social work license or certification

B06j. School psychology license or certification

B06k. Clinical psychology license or certification

B06l. Certificate of Clinical Competence 

B06m. Other professional license, credential, or endorsement (please specify)

Select yes or no on each row.

1. Yes 

2. No

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B07. Which of the following describes the teaching certificate you currently hold in {FILL 

STATE}?

Select one response. 

1. Regular or standard state certificate or advanced professional certificate 

2. Certificate issued after satisfying all requirements except the completion of a 

probationary teaching period 

3. Certificate that requires some additional coursework or passing a test 

4. Certificate issued to persons who must complete a certification program in order 

to continue teaching 

5. I do not hold any of these certifications in this state

{B07=1, 2, 3, 4}

B08. In what subject(s) are you certified in {FILL STATE}?

Select all that apply from the drop down list below.

1. Early childhood or Pre-k, general

2. Elementary grades, general

3. Middle grades, general

4. Secondary grades, general

5. Special education, general

6. Specific area of disability (for example, autism, learning disabilities, etc.) 

(specify:_____)

7. ESL or bilingual education: General

8. ESL or bilingual education: Spanish

9. ESL or bilingual education: Other

10. English/Language arts

11. Reading

12. Speech

13. Mathematics

14. Science (including general science, biology or life sciences, earth science, and 

other natural sciences)

15. Social studies (including history, government or civics, geography)

16. Social or behavioral science (including psychology, sociology, anthropology, and 

other social sciences)

17. Other, specify: ___________________

Special Education Teacher 

September 2014

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[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

B09. Have you received any training related to Response to Intervention (RTI)?

Select all that apply

1. College courses

2. Professional development

3. Personal reading and study 

4. Other training (please specify)

5. I have not received any training on issues related to Response to Intervention

C. Teacher Experience

Next, we would like to ask about your years of experience.

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

C01. Counting this school year, how many years have you worked in your current school, 

including part time?

Enter the number of years and additional months, if applicable (for example, 2 

years and 5 months).

---_____Years ---_____Months

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

C02. Counting this school year, how many total years (including part-time) have you been 

working with students receiving special education or related services?

Enter the number of years and additional months, if applicable (for example, 2 

years and 5 months).

---_____Years ---_____Months

[{IF A01 IS NOT 4} OR {A02 IS NOT 8}]

C03. Counting this school year, how many total years (including part-time) have you been 

working with any students in any school? This would include both providing special 

education services as well as teaching in a regular classroom.

Enter the number of years and additional months, if applicable (for example, 2 

years and 5 months).

---_____Years ---_____Months

Special Education Teacher 

September 2014

324
Middle Grades Longitudinal Study of 2016-2017 

(MGLS:2017) 

Special Education Teacher Student Report 

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Special Education 

Teacher Student Report. Please refer to the instructions you received in your survey invitation letter to 

find your login ID and password. To begin the survey, enter your login ID and password in the fields 

below, and then click NEXT. If you do not have your login ID and password, please call First Last at 1-

888-xxx-xxxx, or email us at xxxxxx@xxxxxx.com. 

Login ID: 

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. The time required to complete this information collection 

is estimated to average 20 minutes for each student, including the time to review instructions, search existing data resources, gather the data needed, and 

complete and review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey 

instrument, or concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle 

Grades Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

Special Education Teacher 

September 2014

325
SC. Student Introduction and Confirmation

SC00a. Welcome to the MGLS:2017 Teacher Student Report web site! 

The Teacher Student Report asks questions about each of the students in the study who 

are in your class, including questions about IEP and primary disability, special education 

services received, and goals and expectations. 

Instructions: 

1. On the next screen, you'll see a list of students. 

2. Choose a student you wish to rate and press the "Next" button. 

3. If a student moved to another class, moved to another school, or was never in 

your class, choose the student’s name and you will be able to note why the student 

is not currently in your class.

 

 

Press the "Next" button to proceed.

SC00b. Please select a student to rate. 

School: [SCHOOL]; Classroom: [CLASSROOM] 

 

Select a student then press the "Next" button. You may have to scroll down to see the 

buttons.

 

1. First Name Last Name 

2. First Name Last Name 

3. First Name Last Name

SC01. Are you currently the teacher or special education provider for [STUDENT]?

1. Yes

2. No

Special Education Teacher 

September 2014

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{SC01=2}

SC02. You indicated that you are not currently the teacher or special education provider for 

[STUDENT]. What is the main reason you are no longer [STUDENT]’s teacher or service 

provider?

 

1. Student moved to another teacher or provider in the same school 

2. Student moved to another school in the same district 

3. Student left the district 

4. Student was never in my class / I was never [STUDENT]'s teacher or service 

provider/ I don’t know [STUDENT]

{SC02=1}

SC03. What is the name of the teacher or special education provider whose class [STUDENT] 

currently attends?

Enter name.

{SC02=2}

SC03a. What is the name of the school where [STUDENT] went?

Enter school.

{SC02=3}

SC04. Please record the last date [STUDENT] was in your class.

Enter date. 

_ _/_ _/_ _

Special Education Teacher 

September 2014

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{SCO02=4}

SC05. Thank you. These are all the questions we have about this student at this time. Please 

press the "next" button to continue.

NEXT

A. Student Grade and IEP Status

These first questions are about this student's IEP status and grade.

{SC01=1}

A01. Is {STUDENT NAME} currently receiving gifted/talented services or has {STUDENT NAME} 

received such services during this school year?

Select only one. 

1. Yes

2. No

{SC01=1}

A02. Is {STUDENT NAME} currently receiving special education services through an IEP, due to 

a disability, or has {STUDENT NAME} received such services during this school year?

Select only one. 

1. Yes

2. No

{A02=1}

A03. In what capacity or capacities do you teach or provide services to {STUDENT NAME}?

A03a. Provide instruction directly to the student

A03b. Provide related services directly to the student

A03c. Provide consultation services directly to the student

A03d. Provide indirect consultation services (e.g., consultation to the student's teacher)

A03e. Provide case management

A03f. Other (please specify)

Select yes or no on each row.

1. Yes

2. No

Special Education Teacher 

September 2014

328
{A02=1}

A04. In which grade is {STUDENT NAME} enrolled?

Select one response only.

1. Sixth grade 

2. Seventh grade 

3. Eighth grade 

4. Ninth grade

5. This is an ungraded classroom

{A02=1}

A05. When did {STUDENT NAME} first have an IEP?

Select one response only. 

1. Before sixth grade 

2. During sixth grade 

3. During seventh grade 

4. During eighth grade 

5. During ninth grade

6. Don’t know

{A02=1}

A06. Is this the student's first year enrolled at this school?

Select only one. 

1. Yes

2. No

3. Don't know

{A06=1}

A07. To what extent were you involved in planning the transition from the previous school's 

special education program for {STUDENT NAME}?

Select only one. 

1. Not at all

2. Somewhat

3. Extensively

Special Education Teacher 

September 2014

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{A07=2, 3}

A08. To what extent did you communicate with the person who provided special education 

for {STUDENT NAME} at his or her previous school?

 

Select only one. 

1. Not at all

2. Somewhat

3. Extensively

{A02=1}

A09. Have you reviewed {STUDENT NAME} ’s records related to special education services 

provided before this school year?

Select only one.

1. Yes 

2. No, I don’t have access to the records. 

3. No, I have access to the records, but have not reviewed them.

B. Student's Disability and Services

Next we would like to know about this student's disability and the services he or she may 

receive.

{A02=1}

B01. What is {STUDENT NAME} ’s primary disability as identified on {STUDENT NAME}’s IEP?

Please select the category below into which the student's primary disability fits 

best. Select only one. 

1. Speech or language impairments

2. Specific learning disabilities

3. Emotional disturbance

4. Intellectual disability

5. Visual impairments (including blindness)

6. Hearing impairments (including deafness)

7. Orthopedic impairments

8. Other health impairments (Specify)

9. Autism

10. Traumatic brain injury

11. Deaf-blindness

12. Multiple disabilities (students included in this category should be those who 

have more than one primary disability which does not include deaf-blindness) 

(Specify)

Special Education Teacher 

September 2014

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{A02=1}

B02. For which of the following disabilities has {STUDENT NAME} received special education 

or related services this school year, whether for {STUDENT NAME}'s primary disability or 

another of his/her disabilities?

B02a. Speech or language impairments

B02b. Specific learning disabilities

B02c. Emotional disturbance

B02d. Intellectual disability

B02e. Visual impairments (including blindness)

B02f. Hearing impairments (including deafness)

B02g. Orthopedic impairments

B02h. Other health impairments (specify: what are the other health impairments the 

student receives services for?)

B02i. Autism

B02j. Traumatic brain injury

B02k. Deaf-blindness

B02l. Multiple disabilities (students included in this category should be those who have 

more than one severe disability which does not include deaf-blindness) (specify: what 

are the multiple disabilities the student receives services for?)

Select yes or no on each row.

1. Yes

2. No

{A02=1}

B03. Has this student received any special education or related services because of Attention 

Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)?

Select only one. 

1. Yes

2. No

Special Education Teacher 

September 2014

331
{A02=1}

B04. Which of the following best describe(s) the IEP goals for {STUDENT NAME} during this 

school year?

Select all of the areas in which this student has IEP goals. 

Academics 

1. Reading 

2. Mathematics 

3. Language Arts 

4. Science 

5. Social Studies

 

Speech and Language

6. Auditory processing 

7. Listening comprehension 

8. Oral expression 

9. Voice/speech articulation, quality, or fluency 

10. Language pragmatics 

 

Social-Emotional

11. Social skills

12. Behavior regulation

13. Emotional or mood regulation

 

Life skills 

14. Adaptive behavior or self-help skills 

15. Transition and postsecondary goals 

16. Organizational and planning skills 

 

Physical/Mobility 

17. Fine motor skills 

18. Gross motor skills 

19. Orientation and mobility

 

Other (Please specify)

20. ________________

Special Education Teacher 

September 2014

332
{A02=1}

B05. Which of the following related services have been provided through the school to 

{STUDENT NAME} during this school year?

B05a. Audiology

B05b. Counseling services

B05c. Occupational therapy

B05d. Physical therapy

B05e. Psychological services

B05f. Health services

B05g. Social work services

B05h. Special transportation

B05i. Speech or language therapy 

B05j. Orientation services

B05k. Mobility services

B05l. Rehabilitation services

B05m. Other (please specify)

Select yes or no on each row. 

1. Yes 

2. No

Special Education Teacher 

September 2014

333
{A02=1}

B06. Has {STUDENT NAME} received any of the following?

B06a. Adaptive physical education 

B06b. Assistance from classroom aides or paraprofessionals (e.g., teacher aide, 

behavioral assistant, special education aide) 

B06c. Interpreter for the deaf or hard of hearing (oral or sign) 

B06d. Materials provided in Braille or Nemeth code to support learning/instruction 

B06e. Student was taught how to use Braille and/or the Nemeth code 

B06f. Instruction provided in American Sign Language 

B06g. Student was taught how to use American Sign Language 

B06h. Instruction provided in Manual English 

B06i. Student was taught how to use Manual English 

B06j. Instruction provided in Cued Speech 

B06k. Student was taught how to use Cued Speech 

B06l. Mental health services, personal/group counseling, therapy, or psychiatric care 

provided to the child 

B06m. Tutoring/remediation from special education teacher 

B06n. Training, counseling, and other supports/services provided to this child's family.

B06o. Assistive technology

Select yes or no on each row. 

1. Yes 

2. No

C. Student Instruction and Instructional Environment

Now we have a few questions about where and how this student receives instruction.

{A02=1}

C01. Which of the following best describes {STUDENT NAME}'s classroom placement?

Select only one. 

1. In general education classroom 80% of the time or more.

2. In general education classroom 40% to 79% of the time.

3. In general education classroom less than 40% of the time.

Special Education Teacher 

September 2014

334
{A02=1}

C02a. In what setting does {STUDENT NAME} primarily receive mathematics instruction?

Select one only. 

1. General education classroom

2. Special education classroom

3. Resource room

4. Some other setting (specify)

{A02=1}

C02b. In what additional setting or settings does {STUDENT NAME} receive mathematics 

instruction?

Select all that apply. 

1. General education classroom

2. Special education classroom

3. Resource room

4. Some other setting (specify)

{A02=1}

C03. Approximately how many hours per week of direct special education and related 

services has {STUDENT NAME} received this school year? 

 

Please include hours for any services in which you or another professional staff member 

at your school provided services directly to {STUDENT NAME}, and also hours for any 

services {STUDENT NAME} receives through a referral to another professional. Do not 

include paraprofessional services.

Select number in box

____hours per week

Special Education Teacher 

September 2014

335
{A02=1}

C04. Of the hours of direct special education and related services reported above, 

approximately how many of those hours per week were the instruction/services 

provided outside of a general education classroom but within the school setting?

Select number in box

____hours per week

{A02=1}

C05. What teaching practices and methods have you and/or other special education service 

providers used with {STUDENT NAME} ?

C05a. One-on-one instruction

C05b. Small-group instruction

C05c. Large-group instruction

C05d. Cooperative learning

C05e. Peer tutoring

C05f. Computer-based instruction

C05g. Direct instruction

C05h. Cognitive strategies

C05i. Self-management

C05j. Behavior management

C05k. Instruction received through a sign interpreter

C05l. Video-based instruction 

C05m. Audio-recorded texts or lessons

C05n. Use of visual organizers or visual models

C05o. Use of 3-dimensional materials and/or models (e.g., base ten blocks, fraction bars)

C05p. Student did not receive instruction from me and/or other special education service 

providers.

Select one on each row.

1. Yes 

2. No

3. Don't know

Special Education Teacher 

September 2014

336
{A02=1}

C06. Which of the following best describes the curriculum materials used with {STUDENT 

NAME} in the general education classroom?

C06a. General education curriculum materials were used without modification 

C06b. General education curriculum materials were used with some modifications 

C06c. General education curriculum materials were used with substantial modifications 

C06d. Specially--designed commercial materials were used 

C06e. Teacher- designed materials were used 

Select one per row. 

1. Yes

2. No

3. Don't know

4. Not applicable

{A02=1}

C07. Which of the following best describes the curriculum materials used with {STUDENT 

NAME} in the special education classroom/program?

C07a. General education curriculum materials were used without modification 

C07b. General education curriculum materials were used with some modifications 

C07c. General education curriculum materials were used with substantial modifications 

C07d. Specially--designed commercial materials were used 

C07e. Teacher- designed materials were used 

Select one per row. 

1. Yes

2. No

3. Don't know

4. Not applicable

Special Education Teacher 

September 2014

337
{A02=1}

C08. Which of the following assistive technologies and devices has {STUDENT NAME} used 

this school year?

Select all of the assistive technologies this student used. 

 

Mobility aids

1. Vans, vehicles 

2. Wheelchairs 

3. White canes 

 

Communication aids

4. Electronic with voice output (e.g., Touch Talker) 

5. Nonelectronic (e.g., manual printing board or picture exchange system) 

 

Hearing assistance

6. Hearing aids 

7. FM loops 

8. TTYs/TDDs 

9. Cochlear implants 

10. Real time captioning 

 

Visual aids

11. Braille texts 

12. Electronic Braille devices 

13. Digital texts 

14. Magnifying devices 

15. Close captioned television (CCTV) 

16. Screen readers

17. Talking calculators

18. Abacus 

 

Learning aids 

19. Tape recorder or digital recorder 

20. Calculators 

21. Electronic spelling devices

22. Dictation software

 

Computer hardware designed or adapted for students with disabilities (e.g., 

alternate keyboards, switch interface)

23. Used solely by individual student

24. Shared with other students

 

Computer software designed for students with disabilities

25. Reading

26. Writing

27. Mathematics

 

28. Other (please specify)

29. Student did not use any assistive technologies

Special Education Teacher 

September 2014

338
{A02=1}

C09. Does {STUDENT NAME} have a computer, laptop, tablet, or word processing device 

assigned to him/her for use full time?

Select only one. 

1. Yes

2. No

D. Communication About Student

The following questions ask about your communications with others regarding this 

student.

{A02=1}

D01. On average, how often have you met with general education teacher(s) to discuss 

{STUDENT NAME} ’s program or progress during this school year?

Select only one.

1. Every day or several times a week 

2. Once a week or several times a month 

3. Once a month 

4. A few times over the school year 

5. Once during this school year 

6. Never during this school year 

7. Not applicable to my work with this student 

8. Not applicable as student receives all instruction from me

{D01=1, 2, 3, 4, 5}

D02. On average, how long were the meetings with the general education teacher(s) to 

discuss {STUDENT NAME}’s program or progress?

Select only one. 

1. 1 to 15 minutes 

2. 16 to 30 minutes 

3. 31 to 45 minutes 

4. 46 to 60 minutes 

5. More than 60 minutes

Special Education Teacher 

September 2014

339
{A02=1}

D03. Approximately how often have you communicated with {STUDENT NAME} ’s parents 

during this school year about {STUDENT NAME}’s program or progress (by phone, in 

person, or in writing, including e-mail)?

Select only one. 

1. Every day or several times a week 

2. Once a week or several times a month 

3. Once a month 

4. A few times over the school year

5. Once during this school year 

6. Never during this school year

E. Student Goals, Performance and Expectations

{A02=1}

E01. During this school year, has {STUDENT NAME} received formal individual evaluations in 

any of the following areas for purposes of developing IEP goals?

E01a. Psychological

E01b. Social work services

E01c. Behavioral

E01d. Speech/language

E01e. Vision

E01f. Hearing

E01g. Learning style

E01h. Motor skills

E01i. Academics

E01j. Other (please specify)

Select yes or no on each row.

1. Yes 

2. No

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{A02=1}

E02. To what extent is {STUDENT NAME} expected to achieve the same general education 

goals as other students at his/her grade level?

Select only one.

1. Student is expected to attain grade level achievement for all of the academic 

content standards. 

2. Student is expected to attain grade level achievement for some of the academic 

content standards. 

3. Student is expected to attain grade level achievement for only a few of the 

academic content standards. 

4. Student is not expected to attain grade level achievement for any of the 

academic content standards. 

5. Don’t know

{A02=1}

E03. What percentage of {STUDENT NAME} ’s current IEP goals have been met or nearly met 

at this point in the school year?

Select only one.

1. 76 to 100 percent 

2. 51 to 75 percent 

3. 26 to 50 percent 

4. 1 to 25 percent 

5. Zero percent

{A02=1}

E04. Which of the following best expresses the likelihood that {STUDENT NAME} will continue 

to receive some level of special education services (through an IEP) in the next school 

year?

Select only one.

1. Definitely will continue in special education 

2. Very likely to continue in special education 

3. Rather likely to continue in special education 

4. Rather unlikely to continue in special education 

5. Very unlikely to continue in special education 

6. Definitely will not continue in special education (will be dismissed from services)

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{A02=1}

E05. To what extent has {STUDENT NAME} participated in any grade-level assessment 

administered as part of the school’s testing program during the current school year?

Select only one.

1. Student did not participate in the school’s testing or assessment program. 

2. Student participated in alternate assessments and no regular assessments. 

3. Student participated in some alternate assessments and some regular 

assessments. 

4. Student participated fully in the school’s regular testing or assessment program. 

5. There is no testing or assessment program at this grade level.

6. Don’t know

{A02=1}

E06. Overall, at what grade level is {STUDENT NAME} performing in each of the following 

areas?

E06a. Language and literacy skills

E06b. Mathematical skills

Mark one response in each row. 

1. Preschool to Grade 1

2. Grade 2

3. Grade 3

4. Grade 4

5. Grade 5

6. Grade 6

7. Grade 7

8. Grade 8

9. Grade 9

10. Grade 10 or Higher

F. Thank You.

F01.

Thank you for your cooperation.

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Middle Grades Longitudinal Study of 2016-2017 

(MGLS:2017) 

Special Educator Rating Scale 

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) Special Educator Rating 

Scale. Please refer to the instructions you received in your survey invitation letter to find your login ID 

and password. To begin the survey, enter your login ID and password in the fields below, and then 

click NEXT. If you do not have your login ID and password, please call First Last at 1-888-xxx-xxxx, or 

email us at xxxxxx@xxxxxx.com. 

Login ID:

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. The time required to complete this information collection 

is estimated to average 5 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and 

review the information requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or 

concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle Grades 

Longitudinal Study (MGLS) 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

Special Education Teacher 

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ntroduction

A00 Thank you for answering our questions about this student so far! We have just a few 

more questions, in which we ask you to rate his or her reading and mathematics skills as 

well as his or her functional abilities.

Please continue to answer these questions with this particular student in mind, as 

you did in the last section.

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A00a Sections A and B include questions about the following areas: (A) Language and Literacy 

and (B) Mathematical Thinking. Together these sections are known as the Academic 

Rating Scale. Please rate the student's skills, knowledge, and behaviors within each of 

these areas based on your experience with him or her. This is NOT a test and should not 

be administered directly to the student. Each question includes examples that are meant 

to help you think of the range of situations in which the student may demonstrate the 

identified skills and behaviors. The examples do not exhaust all the ways that a student 

may demonstrate what he/she knows or can do. The examples do, however, indicate a 

level of proficiency a child should have reached in order to receive the highest ratings. 

Some of these examples describe a very high level of performance (beyond what would 

be expected for students at this grade level) in order to evaluate achievement levels of 

the highest performing students. 

The following five-point scale is used for each of the questions. It reflects the 

degree to which a child has acquired and demonstrated the targeted skills, 

knowledge, and behaviors: 

• Not yet = Student has not yet demonstrated skill, knowledge, or behavior.

• Beginning = Student is just beginning to demonstrate skill, knowledge, or

behavior but does so very inconsistently.

• In progress = Student demonstrates skill, knowledge, or behavior with

some regularity but varies in level of competence.

• Intermediate = Student demonstrates skill, knowledge, or behavior with

increasing regularity and average competence but is not completely

proficient.

• Proficient = Student demonstrates skill, knowledge, or behavior

competently and consistently. 

Rate only the student's current skills, knowledge, and behaviors. Rate each student 

compared to other children of the same grade level, considering how students in 

this grade level will complete this skill, knowledge or behavior. Please consider the 

full range of ratings when answering. 

Student with Limited English Proficiency/English language learner: Please answer 

the questions based on your knowledge of this student's skills. If the student does 

not yet demonstrate skills in English but does demonstrate them in his/her native 

language, please answer the questions with the student's native language in mind. 

Student with Special Needs: It may be necessary to consider adaptations for some 

questions to make them more inclusive for this student's skills and/or use of 

adaptive equipment. Some students may utilize alternative forms of verbal 

communication (e.g., sign language, communication boards) or written 

communication (e.g., word processors, Braille, dictation). Please answer the 

questions with these adaptations in mind.

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A. Reading Skills and Abilities

In this section, we ask you to rate this student's reading-related abilities, including 

language, literacy and listening comprehension skills.

These first few questions ask you to rate student language.

A01 {STUDENT NAME} uses complex sentence structures - for example, says "If she had 

brought her umbrella, she wouldn't have gotten wet," or "Yesterday it was raining cats 

and dogs," or "Why can't we go on the field trip at the same time as the first grade?"

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A02 {STUDENT NAME} contributes relevant information to classroom discussions - for 

example, during a class discussion, can express an idea or a personal opinion on a topic 

and the reasons behind the opinion.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A03 {STUDENT NAME} conveys ideas clearly when speaking - for example, presents a wellorganized oral report, or uses precise language to express opinions, feelings, and ideas, 

or provides relevant answers to questions that summarize classmate’s concerns.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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The following questions focus on rating listening comprehension.

A04 {STUDENT NAME} understands and interprets a story or other text read to him/her -

for example, by retelling a story just read to the group, or telling about why a story 

ended as it did, or connecting part of the story to his/her own life.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A05 [Advanced comprehension] {STUDENT NAME} understands and interprets a story or 

other text read aloud - for example, identifies the author’s purpose, or relates how the 

story would be different if told from another point of view, or identifies techniques of 

persuasion.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

These next few questions focus on literacy, or breaking the code.

A06 {STUDENT NAME} uses different strategies to read unfamiliar words - for example, 

examines cues from pictures or context, or uses consonant sounds to read words, or 

uses prior knowledge in order to make predictions.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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A07 {STUDENT NAME} reads words with regular vowel sounds - for example, reads "coat", 

"junk", "lent", "chimp", "halt", or "bite."

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A08 {STUDENT NAME} reads words with irregular vowel sounds - for example, reads 

"through," "point," "enough," or "shower."

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A09 {STUDENT NAME} reads grade _____ (enter grade level) books fluently - for example, 

easily reads words in meaningful phrases rather than reading word by word

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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These final few questions ask you to rate this student's literacy with a focus on reading 

comprehension.

A10 {STUDENT NAME} reads grade ____ (enter grade level) books independently with 

comprehension - for example, reads most words correctly and answers questions about 

what was read, make predictions while reading, and retells story after reading.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

A11 {STUDENT NAME} reads and comprehends expository text - for example, after reading 

about how early colonists lived, creates a chart comparing life today with colonial life, or 

after reading a children’s news story about pollution, identifies cause and effect 

relationships, or summarizes main ideas and the supporting details in a science or social 

studies selection.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B. Mathematics Skills and Abilities

Now we would like to know about this student's mathematics skills and abilities.

B01 {STUDENT NAME} sorts, classifies, and compares math materials by various rules and 

attributes - for example, by creating a rule for sorting keys, such as "keys with numbers" 

in one pile and "keys without numbers" in another pile, or by sorting shapes by several 

attributes such as "large plastic shapes" and "small wooden shapes."

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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B02 {STUDENT NAME} creates and extends patterns - for example, extends an alternating 

pattern involving addition and subraction (+3, -1, +3, -1, +3... or +5, -3, +5, -3,... ) or 

creates a complex visual pattern (aabc).......

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B03 {STUDENT NAME} shows an understanding of the relationship between quantities - for 

example, knows that a group of ten small stones is the same quantity as a group of ten 

larger blocks.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B04 {STUDENT NAME} demonstrates an understanding of place Value [ to 100] - for 

example, by explaining that fourteen is ten plus four, or using two stacks often and five 

single cubes to represent the number 25..........

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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B05 {STUDENT NAME} shows understanding of place value with whole number - for 

example, correctly orders the numbers 19,321, 14,999, 9,900, and 20,101 from least to 

greatest, or correctly regroups when adding and subtracting.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B06 {STUDENT NAME} shows understanding of place values [decimals] - for example, 

compares decimals to the thousandths place (1.04 > 1.009).......

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B07 {STUDENT NAME} models, reads, writes, and compares fractions - for example, shows 

that 1⁄2 of the candy bar is 1⁄4 + 1⁄4, or shows that 1⁄4 of a set of 12 is 3.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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B08 {STUDENT NAME} reduces fractions to lowest denominator - for example, reduces 

27/63 to 3/7, or 4 1/6 to 6 5/6.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B09 {STUDENT NAME} solves problems involving numbers using concrete objects - for 

example, "Vera has six blocks, George has three, how many blocks are there in all?" or 

"How many do I need to give George so he will have the same number of blocks as 

Vera?"

1. Not Yet

2. Beginning 

3. In Progress

4. Intermediate

5. Proficient

B10 {STUDENT NAME} uses a variety of strategies to solve math problems - for example, 

using manipulative materials, using trial and error, making an organized list or table, 

drawing a diagram, looking for a pattern, acting out a problem, or talking with others.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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B11 {STUDENT NAME} subtracts numbers that require regrouping - for example, 1300 - 579, 

or 2302 - 947, or 2603 - 1594......

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B12 {STUDENT NAME} divides a 3 digit number by a 1 digit number - for example, 348÷4 or 

228÷6

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

B13 {STUDENT NAME} divides multi-digit problems with remainders in the quotient - for 

example, computes 536÷30 or 6,135÷7.....

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

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B14 {STUDENT NAME} demonstrates algebraic thinking - for example, solves for an 

unknown in an equation such as 16 x A = 48; or expresses a function as a general rule 

that enables them to determine any term in the sequence.

1. Not Yet

2. Beginning

3. In Progress

4. Intermediate

5. Proficient

C. Student Functional Abilities

These final few questions ask about this student's functional abilities. Please choose the 

description that best fits this student in each area.

C01 Expressive Communication (check the best description for {STUDENT NAME})

1. Uses symbolic language to communicate: Student uses verbal or written words, 

signs, Braille, or language-based augmentative systems to request, initiate, and 

respond to questions, describe things or events, and express refusal. 

2. Uses intentional communication, but not at a symbolic language level: Student 

uses understandable communication through such modes as gestures, pictures, 

objects/textures, points, etc., to clearly express a variety of intentions. 

3. Student communicates primarily through cries, facial expressions, change in

muscle tone, etc., but no clear use of objects/textures, regularized gestures, 

pictures, signs, etc., to communicate. 

C02 Does {STUDENT NAME} use an augmentative communication system in addition to or in 

place of oral speech?

1. Yes

2. No

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C03 Vision (check the best description for {STUDENT NAME})

1. Vision within normal limits.

2. Corrected vision within normal limits. 

3. Low vision; uses vision for some activities of daily living.

4. No functional use of vision for activities of daily living, or unable to determine 

functional use of vision.

C04 Hearing (check the best description for {STUDENT NAME})

1. Hearing within normal limits.

2. Corrected hearing loss within normal limits.

3. Hearing loss aided, but still with a significant loss.

4. Profound loss, even with aids.

5. Unable to determine functional use of hearing.

C05 Motor (check the best description for {STUDENT NAME})

1. No significant motor dysfunction that requires adaptations.

2. Requires adaptations to support motor functioning (e.g., walker, adapted 

utensils, and/or keyboard). 

3. Uses wheelchair, positioning equipment, and/or assistive devices for most 

activities. 

4. Needs personal assistance for most/all motor activities.

C06 Engagement (check the best description for {STUDENT NAME})

1. Initiates and sustains social interactions.

2. Responds with social interaction, but does not initiate or sustain social

interactions. 

3. Alerts to others. 

4. Does not alert to others.

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Middle Grades Longitudinal Study of 

2016-2017 (MGLS:2017) 

School Administrator Questionnaire

Welcome to the Middle Grades Longitudinal Study of 2016-2017 (MGLS:2017) School Administrator Questionnaire. 

Please refer to the instructions you received in your survey invitation letter to find your login ID and password. To 

begin the survey, enter your login ID and password in the fields below, and then click NEXT. If you do not have 

your login ID and password, please call First Last at 1-888-xxx-xxxx, or email us at xxxxxx@xxxxxxxx.com. 

Login ID:

Password: ____________________________

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 1850-0911. Approval expires XX/XX/20XX. 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 requested. If you have any comments concerning the accuracy of the time estimate, suggestions for improving the survey instrument, or 

concerns regarding the status of your individual response to this survey, please write directly to: National Center for Education Statistics, Middle Grades 

Longitudinal Study (MGLS), 1990 K Street, N.W., Room 9035, Washington, D.C. 20006-5650.

School Administrator 

September 2014

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A. Introduction

Survey Information

I01a You have received an invitation to complete this questionnaire because you are an

administrator in one of the schools participating in the MGLS:2017 field test.

To enhance the information we obtain from your students and their parents and

teachers, we need your input. The School Administrator Questionnaire asks you to

report on the characteristics and population of your school, courses offered, security

measures, teachers, and your own personal background.

Taking part in the study is voluntary and you can skip questions you do not want to

answer. We realize you are very busy, but urge you to complete this questionnaire as

completely and accurately as possible. Your answers are very important to the study’s

success.

Please click below to start the survey.

Let's get started

The National Center for Education Statistics (NCES) of the U. S. Department of Education is authorized to conduct 

the MGLS:2017 by the Education Sciences Reform Act of 2002 (20 U.S. Code, Section 9543). All of the information 

you provide 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 U.S. Code, Section 9573).

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I01b. Thank you very much for participating! Gathering the following information in advance 

will help you complete the questionnaire more quickly:

 

1. For the current school year:

 

 • Average daily attendance 

 • Math curriculum information

 • Matriculation information

 • Student- body demographic information, including the estimated percentage of 

students in each grade served who are:

 • Receiving free or reduced price lunch

 • English language learners

 • Alternative program attendees

 • Students with disabilities/Individualized Education Program (IEP)

 • In each racial/ethnic category

 •School personnel counts such as the number of: 

 • Teachers by subject taught

 • Security personnel

 

2. For the 2013-2014 school year:

 

 • State assessment scores by subject

 • Programs, services, and supports available for students with IEPs and the percentage 

of students who use them

HELP TEXT AVAILABLE:

English Language Learner (ELL): A student whose native language is one other than 

English and whose skills in listening, speaking, reading, or writing English are such 

that he or she has difficulty understanding school instruction in English.

 

Individualized Education Program (IEP): A written statement of the educational program 

designed to meet the individual needs of a school-aged child with a disability that is 

judged to affect the child’s educational performance. Children who receive special 

education services under the Individuals with Disabilities Education Act (IDEA) are 

expected to have an IEP or an Individualized Family Service Plan (IFSP)

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I01c. Before you get started, here are a few helpful hints. 

• Please record your answers by checking the box next to the appropriate answer or 

entering information as directed. Answer each question as accurately as possible; if 

you need to estimate an answer that is okay.

• Press the "Next" button to move forward. 

• Press the "Back" button to go back. 

• The "Stop and Come Back Later" button can be used to save your responses and 

finish later (button is at the bottom of each page). 

• To protect your data, your responses will be automatically saved and you will be 

logged off if you are idle for more than 30 minutes. 

I02a. Before you start the questionnaire, please confirm that you are the person at your 

school with the most knowledge about {6th/7th/8th} grade students, teachers, 

programs, and services.

1. Yes

2. No

{IF I02A.=2}

I02b. Please provide the name and contact information for the person at your school with the 

most knowledge about {6th/7th/8th} grade students, teachers, programs, and services.

1. Title: [___________________]

2. First Name: [___________________]

3. Last Name: [___________________]

4. Street address1: [___________________]

5. Street address2: [___________________]

6. City: [___________________]

7. State: [___________________]

8. Zip code: [___________________]

9. Phone: [___________________]

10. Email: [___________________]

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{IF I02A.=2} FILL WILL ASK ABOUT RESPONDENT IF NO INFORMATION IS ENTERED AT I02B.

I02c. Thank you ! The MGLS:2017 team will {contact you/contact {NAME FROM I02B}} very 

soon.

Press Next to close this survey.

I03. What is your title or position at this school?

1. Principal/Administrator

2. Vice Principal

3. Counselor

4. School administrative personnel

5. Other (please specify)

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A. School Characteristics

The following questions ask about characteristics of your school.

A01. Which of the following best describes your school?

1. Regular public school

2. Private

3. Charter school

4. Has a magnet program for part of the school

5. Exclusively a magnet school

6. Other (please specify)

A02. Which of the following grades are offered at your school?

Select all that apply

1. Pre-K 

2. Kindergarten

3. 1st Grade

4. 2nd Grade

5. 3rd Grade

6. 4th Grade

7. 5th Grade

8. 6th Grade

9. 7th Grade

10. 8th Grade

11. 9th Grade

12. 10th Grade

13. 11th Grade

14. 12th Grade

A03. What is the Average Daily Attendance (ADA) for your school this year?

________ % Average Daily Attendance

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{IF A01. = 2}

A04. What is the maximum yearly tuition to attend your school?

_________ Enter amount

Enter "0" if school does not charge tuition.

{IF A04. > 0}

A05. What percent of your students pay the maximum yearly tuition?

1. 0%-25% 

2. 26%-50% 

3. 51%-75% 

4. 76%-100%

The next set of questions are about your student population.

A06. Please indicate the percentage of male and female students at your school.

1. ____ Percentage of Male Students

2. ____ Percentage of Female Students

A07a. What percentage of the total student body in your school...

receives free or reduced-price lunch?

____ Percent

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A07b. What percentage of the total student body in your school...

are English language learners?

____ Percent

HELP TEXT AVAILABLE:

English Language Learner (ELL): A student whose native language is one other than 

English and whose skills in listening, speaking, reading, or writing English are such 

that he or she has difficulty understanding school instruction in English.

A07c. What percentage of the total student body in your school...

are enrolled in an alternative program either at your school or off-site? (For example, 

programs for students with disabilities or behavioral problems.)

____ Percent

The next set of questions are about additional supports your school provides for 

struggling students.

A08. Which of the following steps does this school take for {6th/7th/8th} graders who need 

extra assistance?

Select all that apply.

1. Tutoring during the regular school day

2. School staff work with classroom teachers to provide extra assistance

3. Pull-out instruction during the regular school day

4. Homework assistance program

5. Additional support outside the regular school day such as before-or after-school 

tutoring or special programs, or weekend or summer school programs

6. Your school takes other steps to assist struggling students

7. Your school does not have any programs for students who need extra assistance

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A09. Does your school offer any of the following programs to assist {6th/7th/8th} graders who 

are struggling academically?

Select all that apply.

1. Summer program prior to entry into the next grade that provides supplemental 

instruction in reading and math

2. Small learning communities for over-aged students who have not met promotion 

criteria 

3. Small {6th/7th/8th} grade learning communities separate from the rest of the 

school

4. Block scheduling, also called double-block or extended-block scheduling

5. Catch-up courses or “double-dosing” of classes

6. Specific professional development, coaches, or technical assistance for teachers 

working with struggling {6th/7th/8th} graders

7. Tutoring

8. Another program

9. There are no programs to assist {6th/7th/8th} graders who are struggling 

academically.

The next set of questions are about state assessment scores.

{IF A02.= 8}

A10. Based on recent state assessments, what percentage of 6th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Reading or verbal skills

1. ____Percentage of 6th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

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{IF A02.= 9}

A11. Based on recent state assessments, what percentage of 7th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Reading or verbal skills

1. ____Percentage of 7th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

{IF A02.= 10}

A12. Based on recent state assessments, what percentage of 8th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Reading or verbal skills

1. ____Percentage of 8th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

{IF A02.= 8}

A13. Based on recent state assessments, what percentage of 6th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Mathematics

1. ____Percentage of 6th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

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{IF A02.= 9}

A14. Based on recent state assessments, what percentage of 7th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Mathematics

1. ____Percentage of 7th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

{IF A02.= 10}

A15. Based on recent state assessments, what percentage of 8th grade students in your 

school scored "proficient" or above in the following subjects for 2013-2014? Please also 

indicate the percentage of students scoring proficient or above that was needed to meet 

your AYP (adequate yearly progress) goals for that school year.

Mathematics

1. ____Percentage of 8th grade students whose achievement level is “proficient” 

or above

2. ____Percentage required by AYP goals in 2013-2014

3. Not applicable, my district does not receive Title I funding.

The next set of questions are about instructional programs at your school.

{IF A02.= 8}

A16a. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

English as a second language

1. _______________ % of 6th Graders

School Administrator 

September 2014

366
The next set of questions are about instructional programs at your school.

{IF A02.= 8}

A16b. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Bilingual education (instruction in both English and another language) 

1. _______________ % of 6th Graders

{IF A02.= 8}

A16c. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Special education (with Individualized Education Program (IEP))

1. _______________ % of 6th Graders

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

{IF A02.= 9}

A17a. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

English as a second language

1. _______________ % of 7th Graders

School Administrator 

September 2014

367
{IF A02.= 9}

A17b. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Bilingual education (instruction in both English and another language) 

1. _______________ % of 7th Graders

{IF A02.= 9}

A17c. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Special education (with Individualized Education Program (IEP))

1. _______________ % of 7th Graders

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

{IF A02.= 10}

A18a. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

English as a second language

1. _______________ % of 8th Graders

School Administrator 

September 2014

368
{IF A02.= 10}

A18b. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Bilingual education (instruction in both English and another language) 

c. Special education (with Individualized Education Program (IEP))

1. _______________ % of 8th Graders

{IF A02.= 10}

A18c. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Special education (with Individualized Education Program (IEP))

1. _______________ % of 8th Graders

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

School Administrator 

September 2014

369
B. Services and Supports for Students with Disabilities

The next set of questions are about IEP placement options.

B01a. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

General education with services or supports

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

B01b. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

Classes co-taught by general and special education teachers

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

School Administrator 

September 2014

370
B01c. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

Part-time resource room for special education students

1. ______________ Percentage of students with IEPs receiving service

99. Service not available

B01d. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

Self-contained special education classrooms

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

B01e. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

Individual instruction such as home school or a residential, off site, incarceration or 

hospital program

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

School Administrator 

September 2014

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THIS QUESTION WILL CONTINUE TO BE ASKED UNTIL RESPONDENT SELECTS 99.

B01f. What percentage of students with IEPs at this school are served by each of the following 

placement options? If the service is available but no students currently receive it, enter 0 

for that service. If the service is not available, check the column labeled "service not 

available."

Other (please specify)

1. _______________ Percentage of students with IEPs receiving service

99. No additional service is available

The next questions are about services and supports schools can offer to teachers of 

students with IEPs.

B02a. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Consultation or technical assistance by special education or other staff with general 

special education training, not specific to child's disability (e.g., a school psyschologist, 

teacher trained in a related disability area)

1. Yes

2. No

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

School Administrator 

September 2014

372
B02b. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Special equipment or materials

1. Yes

2. No

B02c. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Professional development

1. Yes

2. No

B02d. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Teacher aides, instructional assistants, paraprofessionals, or aides for individual students

1. Yes

2. No

B02e. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Smaller student load or class size

1. Yes

2. No

School Administrator 

September 2014

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B02f. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Co-teaching with a special education teacher or related services provider (both teachers 

are in classroom together, but trade off instruction)

1. Yes

2. No

B02g. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes?

Team teaching with a special education teacher or related services provider (both 

teachers are NOT in classroom together, but alternate instruction and are responsible 

for teaching the same set of students)

1. Yes

2. No

B02h. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes? 

Team planning

1. Yes

2. No

School Administrator 

September 2014

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THIS QUESTION WILL CONTINUE TO BE ASKED UNTIL RESPONDENT SELECTS 99.

B02i. Which of the following are available to general education teachers in this school when 

students with IEPs are included in their classes? 

Other (please specify)

1. _______________ Enter text

99. There are no additional supports.

The next questions are about programs and supports schools can offer to students with 

IEPs.

B03a. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Referrals to Vocational Rehabilitation Services

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

HELP TEXT AVAILABLE:

Individualized Education Program (IEP): A written statement of the educational 

program designed to meet the individual needs of a school-aged child with a 

disability that is judged to affect the child’s educational performance. Children 

who receive special education services under the Individuals with Disabilities 

Education Act (IDEA) are expected to have an IEP or an Individualized Family 

Service Plan (IFSP)

School Administrator 

September 2014

375
B03b. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Help developing capability to dress, clean, care for self

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

B03c. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Learning self-determination and self-advocacy skills

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

School Administrator 

September 2014

376
B03d. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Peer buddy program

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

B03e. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Alternative placements for students who are expelled and/or suspended

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

B03f. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Helping students connect to outside transition services, supports, and activities (e.g., 

tutoring, mentoring, transportation, assistive technology, networking)

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

School Administrator 

September 2014

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B03g. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Helping students connect to adult residential providers and day services

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

B03h. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Information bank for parents or guardians with materials and resources relating to 

independent living

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

School Administrator 

September 2014

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B03i. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Instruction for parents or guardians on youth’s rights and responsibilities under 

disability-related laws

1. _______________ Percentage of students with IEPs receiving service

99. Service not available

This question will continue to be asked until respondent selects 99.

B03j. For each of the following programs and supports schools can offer to students with IEPs, 

please indicate what percentage of students with IEPs in your school receive this 

program or support during the current school year. Please include programs provided by 

alternate service providers. If a service is available but no students currently receive it, 

enter 0 for that service. If a service is not available, check the column labeled "service 

not available."

Other (please specify)

1. _______________ Percentage of students with IEPs receiving service

99. There are no additional services.

School Administrator 

September 2014

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C. School Programs and Practices

The following questions are about math courses at your school.

C01. Which of the following math courses are offered onsite at your school?

Select all that apply.

1. Grade 6 general math {SHOW IF A02.=8}

2. Grade 6 honors math {SHOW IF A02.=8}

3. Grade 6 remedial math {SHOW IF A02.=8}

4. Grade 7 general math {SHOW IF A02.=9}

5. Grade 7 honors math {SHOW IF A02.=9}

6. Grade 7 remedial math {SHOW IF A02.=9} 

7. Grade 8 general math {SHOW IF A02.=10}

8. Grade 8 honors math {SHOW IF A02.=10}

9. Grade 8 remedial math {SHOW IF A02.=10} 

10. Introduction to Algebra/PreAlgebra

11. Algebra I

12. Algebra II

13. Geometry

{DISPLAY FOR EACH COURSE IN C01.}

C02. Are there enough slots available for {COURSE TITLE FROM C01.} so that students who 

have the necessary prerequisites and interest can enroll?

1. Yes

2. No

School Administrator 

September 2014

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{IF A02. = 9}

C03. Please estimate the percentage of 7th grade students repeating the level of mathematics 

they took in 6th grade. If your school uses a semester or block course system, please 

indicate the percentage of 7th grade students repeating the last course section they took 

in 6th grade.

1. Less than 1 percent

2. 1 to 5 percent

3. 6 to 10 percent

4. 11 to 25 percent

5. More than 25 percent

6. Students are not grouped by ability

7. Do not know

{IF A02. = 10}

C04. Please estimate the percentage of 8th grade students repeating the level of mathematics 

they took in 7th grade. If your school uses a semester or block course system, please 

indicate the percentage of 7th grade students repeating the last course section they took 

in 6th grade.

1. Less than 1 percent

2. 1 to 5 percent

3. 6 to 10 percent

4. 11 to 25 percent

5. More than 25 percent

6. Students are not grouped by ability

7. Do not know

School Administrator 

September 2014

381
{IF A02. = 9}

C05. Please estimate the percentage of students demoted to a previous level in mathematics 

between 6th and 7th grade.

1. Less than 1 percent

2. 1 to 5 percent

3. 6 to 10 percent

4. 11 to 25 percent

5. More than 25 percent

6. Students are not grouped by ability

7. Do not know

{IF A02. = 10}

C06. Please estimate the percentage of students demoted to a previous level in mathematics 

between 7th and 8th grade.

1. Less than 1 percent

2. 1 to 5 percent

3. 6 to 10 percent

4. 11 to 25 percent

5. More than 25 percent

6. Students are not grouped by ability

7. Do not know

{IF A02. = 9}

C07. What math course are students who took {COURSE TITLE FROM C01.} in 6th grade 

expected to take the following year in 7th grade?

1. Grade 7 general math

2. Grade 7 honors math

3. Grade 7 remedial math 

4. Introduction to Algebra/PreAlgebra

5. Algebra I

6. Algebra II

7. Geometry

8. Other (please specify)

9. Do not know

School Administrator 

September 2014

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{IF A02. = 10}

C08. What math course are students who took {COURSE TITLE FROM C01.} in 7th grade 

expected to take the following year in 8th grade?

1. Grade 8 general math

2. Grade 8 honors math

3. Grade 8 remedial math 

4. Introduction to Algebra/PreAlgebra

5. Algebra I

6. Algebra II

7. Geometry

8. Other (please specify)

9. Do not know

The next questions are about courses other than math at your school.

{IF A02.=8}

C09a. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Reading instruction for students performing below grade level in reading

1. _______________ % of 6th Graders

The next questions are about courses other than math at your school.

{IF A02.=8}

C09b. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Additional instruction for students performing below grade level in other areas of English 

language arts

1. _______________ % of 6th Graders

School Administrator 

September 2014

383
The next questions are about courses other than math at your school.

{IF A02.=8}

C09c. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Instruction for students performing below grade level in mathematics

1. _______________ % of 6th Graders

The next questions are about courses other than math at your school.

{IF A02.=8}

C09d. Approximately what percentage of your 6th grade students is in each of the following 

instructional programs?

Gifted and talented or International Baccalaureate® (IB)

1. _______________ % of 6th Graders

{IF A02.=9}

C10a. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Reading instruction for students performing below grade level in reading

1. _______________ % of 7th Graders

{IF A02.=9}

C10b. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Additional instruction for students performing below grade level in other areas of English 

language arts

1. _______________ % of 7th Graders

School Administrator 

September 2014

384
{IF A02.=9}

C10c. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Instruction for students performing below grade level in mathematics

1. _______________ % of 7th Graders

{IF A02.=9}

C10d. Approximately what percentage of your 7th grade students is in each of the following 

instructional programs?

Gifted and talented or International Baccalaureate® (IB)

1. _______________ % of 7th Graders

{IF A02.=10}

C11a. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Reading instruction for students performing below grade level in reading

1. _______________ % of 8th Graders

{IF A02.=10}

C11b. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Additional instruction for students performing below grade level in other areas of English 

language arts

1. _______________ % of 8th Graders

School Administrator 

September 2014

385
{IF A02.=10}

C11c. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Instruction for students performing below grade level in mathematics

1. _______________ % of 8th Graders

{IF A02.=10}

C11d. Approximately what percentage of your 8th grade students is in each of the following 

instructional programs?

Gifted and talented or International Baccalaureate® (IB)

1. _______________ % of 8th Graders

The next questions are about assisting students in the transition from one grade to the 

next.

C12. Does your school organize the transition from {5th/6th/7th} grade to {6th/7th/8th} grade 

in the following ways?

 

Note: The fills in this question will populate with the lowest “middle” grade served at 

the school and the grade immediately preceding that grade.

Select all that apply to your present practices.

1. No transition—{6th/7th/8th} grade seamlessly continues directly from 

{5th/6th/7th} grade

2. No special activities until students enter {6th/7th/8th} grade

3. {6th/7th/8th} grade students share information with the {5th/6th/7th} grade 

students

4. {5th/6th/7th} grade students visit an assembly of {6th/7th/8th} grade students

5. {5th/6th/7th} grade students attend regular {6th/7th/8th} grade courses

6. Buddy programs that pair new students with an older student in the fall

7. Parents visit the school or {6th/7th/8th} grade section while students are still in 

{5th/6th/7th} grade

8. Parents can attend an orientation in the fall after students start {6th/7th/8th} 

grade

School Administrator 

September 2014

386
9. Meetings for {5th/6th/7th} grade students during the summer prior to beginning 

the {6th/7th/8th} grade

10. {6th/7th/8th} grade and {5th/6th/7th} grade teachers meet together on 

courses and requirements

11. {6th/7th/8th} grade and {5th/6th/7th} grade administrators meet together on 

articulation and programs

12. {5th/6th/7th} grade counselors* meet with {6th/7th/8th} grade counselors or 

staff

13. {6th/7th/8th} grade counselors meet with students while they are still in 

{5th/6th/7th} grade

14. {5th/6th/7th} grade counselors meet with {6th/7th/8th} grade counselors or 

staff 

15. {5th/6th/7th} grade counselors meet with individual {5th/6th/7th} grade 

students and assist them with selecting {6th/7th/8th} grade courses while they are 

still in {5th/6th/7th} grade

16. {5th/6th/7th} grade counselors present information to {5th/6th/7th} grade 

students' parents or guardians about {6th/7th/8th} grade courses and registration 

17. {5th/6th/7th} grade counselors place {5th/6th/7th} grade students into 

{6th/7th/8th} grade courses based on school or district placement policies 

18. {5th/6th/7th} grade counselors present information to {5th/6th/7th} grade 

students about {6th/7th/8th} courses and registration 

19. Other (describe)

* A counselor is an educator who works in schools to provide academic, career, 

college readiness, and personal/social competencies to all students through a 

school counseling program.

C13. Does your school provide additional assistance with the transition from {5th/6th/7th} 

grade to {6th/7th/8th} grade for students with disabilities? If so, please describe that 

assistance.

 

Note: The fills in this question will populate with the lowest “middle” grade served at 

the school and the grade immediately preceding that grade.

1. _________ Pleases describe the assistance offered.

2. No, my school does not provide additional assistance.

School Administrator 

September 2014

387
C14. Does your school organize the transition from {6th/7th/8th} grade to {7th/8th/9th} grade 

in the following ways?

 

Note: The fills in this question will populate with the highest “middle” grade served and 

the grade immediately following that grade.

Select all that apply to your present practices. 

1. No transition—{7th/8th/9th} grade seamlessly continues directly from 

{6th/7th/8th} grade 

2. No special activities until students enter {7th/8th/9th} grade

3. {7th/8th/9th} grade students share information with the {6th/7th/8th} grade 

students

4. {6th/7th/8th} grade students visit an assembly of {7th/8th/9th} grade students

5. {6th/7th/8th} grade students attend regular {7th/8th/9th} grade courses

6. Buddy programs that pair new students with an older student in the fall

7. Parents visit the {7th/8th/9th} grade section while students are still in 

{6th/7th/8th} grade 

8. Parents can attend an orientation in the fall after students start {7th/8th/9th} 

grade 

9. Meetings for {6th/7th/8th} grade students during the summer prior to beginning 

the {7th/8th/9th} grade 

10. {7th/8th/9th} grade and {6th/7th/8th} grade teachers meet together on 

courses and requirements

11. {7th/8th/9th} grade and {6th/7th/8th} grade administrators meet together on 

articulation and programs

12. {6th/7th/8th} grade counselors meet with {7th/8th/9th} grade counselors or 

staff

13. {7th/8th/9th} grade counselors meet with students while they are still in 

{6th/7th/8th} grade 

14. {6th/7th/8th} grade counselors meet with {7th/8th/9th} grade counselors or 

staff 

15. {6th/7th/8th} grade counselors meet with individual {6th/7th/8th} grade 

students and assist them with selecting {7th/8th/9th} grade courses while they are 

still in {6th/7th/8th} grade 

16. {6th/7th/8th} grade counselors present information to {6th/7th/8th} grade 

students' parents or guardians about {7th/8th/9th} grade courses and registration 

17. {6th/7th/8th} grade counselors place {6th/7th/8th} grade students into 

{7th/8th/9th} grade courses based on school or district placement policies.

18. {6th/7th/8th} grade counselors present information to {6th/7th/8th} grade 

students about {7th/8th/9th} grade courses and registration 

19. Other (describe)

* A counselor is an educator who works in schools to provide academic, career, 

college readiness, and personal/social competencies to all students through a 

school counseling program.

School Administrator 

September 2014

388
C15. Does your school provide additional assistance with the transition from {6th/7th/8th} 

grade to {7th/8th/9th} grade for students with disabilities? If so, please describe that 

assistance.

 

Note: The fills in this question will populate with the highest “middle” grade served and 

the grade immediately following that grade.

1. _________ Pleases describe the assistance offered.

2. No, my school does not provide additional assistance.

The next questions are about health instruction at your school.

C16a. Are students offered instruction on...

Nutrition and dietary behavior?

1. Yes

2. No

C16b. Are students offered instruction on...

Physical activity and fitness, that is classroom instruction, not a physical education 

period?

1. Yes

2. No

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C16c. Are students offered instruction on...

Alcohol or other drug use prevention?

1. Yes

2. No

C16d. Are students offered instruction on...

Tobacco use prevention?

1. Yes

2. No

C16e. Are students offered instruction on...

HIV (human immunodeficiency virus) prevention?

1. Yes

2. No

C16f. Are students offered instruction on...

STD (sexually transmitted disease) prevention?

1. Yes

2. No

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C16g. Are students offered instruction on...

Sexual health education?

1. Yes

2. No

D. School Environment

The following questions are about problems you may experience at your school.

D01a. To what degree is each of the following a problem at your school?

School tardiness

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01b. To what degree is each of the following a problem at your school?

School absenteeism

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

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D01c. To what degree is each of the following a problem at your school?

Student class cutting

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01d. To what degree is each of the following a problem at your school?

Teacher absenteeism

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01e. To what degree is each of the following a problem at your school?

Students dropping out

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

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D01f. To what degree is each of the following a problem at your school?

Student apathy

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01g. To what degree is each of the following a problem at your school?

Lack of parental involvement

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01h. To what degree is each of the following a problem at your school?

Students coming to school unprepared to learn

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

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D01i. To what degree is each of the following a problem at your school?

Poor student health

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01j. To what degree is each of the following a problem at your school?

Lack of resources and materials

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

D01k. To what degree is each of the following a problem at your school?

Student mobility

1. Not a problem

2. Minor problem

3. Moderate problem

4. Serious problem

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D02a. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Conflicts resulting from student racial/ethnic tensions

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02b. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Student bullying

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02c. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Student sexual harassment of other students

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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D02d. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Student harassment of other students based on sexual orientation or gender identity 

(i.e., lesbian, gay, bisexual, transgender, questioning)

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02e. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Widespread disorder in classrooms

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02f. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Students yelling and screaming at teachers

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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D02g. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Student acts of disrespect for teachers other than verbal abuse

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02h. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Gang activities

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

D02i. To the best of your knowledge, how often did the following types of problems occur in 

your school in the last month?

Cult or extremist group activities

1. Never

2. Rarely

3. Sometimes

4. Often

5. Very often

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The next questions are about school-level security at your school.

D03a. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require visitors to sign or check in

1. Yes

2. No

D03b. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Control access to school buildings during school hours (e.g., locked or monitored doors)

1. Yes

2. No

D03c. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Control access to school grounds during school hours (e.g., locked or monitored gates)

1. Yes

2. No

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D03d. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require students to pass through metal detectors each day

1. Yes

2. No

D03e. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require students to wear uniforms

1. Yes

2. No

{IF D03e. = 2}

D03f. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Enforce a strict dress code

1. Yes

2. No

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D03g. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Perform one or more random sweeps for contraband (e.g., drugs or weapons), including 

dog sniffs

1. Yes

2. No

D03h. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Provide school lockers to students

1. Yes

2. No

D03i. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require clear book bags or ban book bags on school grounds

1. Yes

2. No

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D03j. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require students to wear badges or picture IDs

1. Yes

2. No

D03k. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Require faculty and staff to wear badges or picture IDs

1. Yes

2. No

D03l. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Use one or more security cameras to monitor the school

1. Yes

2. No

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D03m. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Limit access to social networking websites (e.g., Facebook or Twitter) from school 

computers

1. Yes

2. No

D03n. During this school year, is it a practice of your school to do the following?

If your school changed its practices during the school year, please answer regarding your 

most recent practice.

Prohibit use of cell phones, smart phones, and text messaging devices during school 

hours

1. Yes

2. No

D04. During this school year, have you had any security guards, security personnel, or sworn 

law enforcement officers present at your school at least once a week?

1. Yes

2. No

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{IF D04. = 1}

D05. Are these security guards, security personnel, or sworn law enforcement officers used at 

least once a week in or around your school at the following times?

Select all that apply

1. At any time during school hours

2. While students are arriving or leaving

3. At selected school activities (e.g., athletic and social events, open houses, 

science fairs)

4. When school is out/school activities is not occurring

{IF D04. = 1}

D06. How many of the following are present in your school at least once a week?

If an officer works full-time across various schools in the district, please count this officer 

as "part-time" for your school. A full-time officer at your school should be counted as 

1.0 full-time equivalent (FTE) and a part-time officer should be counted as 0.5 (FTE).

Full-time equivalent security guards or security personnel (not law enforcement)

|__|__|__| Enter number

{IF D04. = 1}

D07. How many of the following are present in your school at least once a week?

If an officer works full-time across various schools in the district, please count this officer 

as "part-time" for your school. A full-time officer at your school should be counted as 

1.0 full-time equivalent (FTE) and a part-time officer should be counted as 0.5 (FTE).

Full-time equivalent school resource officers (Include all career law enforcement officers 

with arrest authority, who have specialized training and are assigned to work in 

collaboration with school organizations)

|__|__|__| Enter number

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{IF D04. = 1}

D08. How many of the following are present in your school at least once a week?

If an officer works full-time across various schools in the district, please count this officer 

as "part-time" for your school. A full-time officer at your school should be counted as 

1.0 full-time equivalent (FTE) and a part-time officer should be counted as 0.5 (FTE).

Full-time equivalent sworn law enforcement officers who are not school resource 

officers

|__|__|__| Enter number

The following questions are about the community around your school.

D09a. How would you describe the crime level in the area(s) in which your students live?

Select one response.

1. High level of crime

2. Moderate level of crime

3. Low level of crime

4. Students come from areas with very different levels of crime

D09b. How would you describe the crime level in the area where your school is located?

Select one response.

1. High level of crime

2. Moderate level of crime

3. Low level of crime

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E. School's Teachers

The following questions are about teachers at your school.

E01a. For each of the following subject areas, please indicate the number of full-time teachers 

and part-time teacher that instruct {6th/7th/8th} grade students in your school. Please 

give your best estimate. 

If a teacher works full-time in your school, but divides his or her time between subject 

areas or across grades, consider that teacher as part-time in each subject area or grade. 

A full-time teacher at your school should be counted as 1.0 full-time equivalent (FTE) and 

a part-time teacher should be counted as 0.5 FTE.

|___|___|___| Mathematics (full-time equivalent)

E01b. For each of the following subject areas, please indicate the number of full-time teachers 

and part-time teacher that instruct {6th/7th/8th} grade students in your school. Please 

give your best estimate. 

If a teacher works full-time in your school, but divides his or her time between subject 

areas or across grades, consider that teacher as part-time in each subject area or grade. 

A full-time teacher at your school should be counted as 1.0 full-time equivalent (FTE) and 

a part-time teacher should be counted as 0.5 FTE.

|___|___|___| English/Language Arts (full-time equivalent)

E01c. For each of the following subject areas, please indicate the number of full-time teachers 

and part-time teacher that instruct {6th/7th/8th} grade students in your school. Please 

give your best estimate. 

If a teacher works full-time in your school, but divides his or her time between subject 

areas or across grades, consider that teacher as part-time in each subject area or grade. 

A full-time teacher at your school should be counted as 1.0 full-time equivalent (FTE) and 

a part-time teacher should be counted as 0.5 FTE.

|___|___|___| Science (full-time equivalent)

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The following questions ask about teacher preparedness to teach specific subjects.

E02a. To what extent do you agree with the following statement?

English/Language Arts teachers at your school are adequately prepared to teach 

English/Language Arts.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

E02b. To what extent do you agree with the following statement?

General mathematics teachers at your school are adequately prepared to teach general 

mathematics.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

E02c. To what extent do you agree with the following statement?

Algebra teachers at your school are adequately prepared to teach Algebra.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

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E02d. To what extent do you agree with the following statement?

Algebra II teachers at your school are adequately prepared to teach Algebra II.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

The next questions ask about teacher preparedness to assist students who are 

experiencing difficulties in specific subjects.

E03a. To what extent do you agree with the following statement?

General mathematics teachers at your school are adequately prepared to assist students 

who are experiencing difficulties in general mathematics.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

E03b. To what extent do you agree with the following statement?

Algebra teachers at your school are adequately prepared to assist students who are 

experiencing difficulties in Algebra.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

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E03c. To what extent do you agree with the following statement?

Algebra II teachers at your school are adequately prepared to assist students who are 

experiencing difficulties in Algebra II.

1. Strongly disagree

2. Disagree

3. Neither agree nor disagree

4. Agree

5. Strongly agree

99. Subject not taught at this school

F. School Administrator Background

The next set of questions are about your background and experience.

F01. What is your sex?

1. Male

2. Female

F02. Are you of Hispanic or Latino/Latina origin?

1.Yes

2.No

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F03. Which of the following choices describes your race? You may choose more than one.

1. White

2. Black or African American

3. Asian

4. Native Hawaiian or other Pacific Islander

5. American Indian or Alaska Native

F04. What is the highest degree you have earned?

1. Associate's degree

2. Bachelor’s degree

3. Master’s degree

4. Educational Specialist degree

5. Ph.D.,Ed.D., M.D., law degree, or other high level professional degree

6. You do not have a degree

{IF F04 NE 6}

F05. What was your major field of study for your [highest degree earned]?

(Please type your major in the space below and click on 'Search for major.' Do not 

enter abbreviations.)

F06. Including this school year, how many years have you served as the {TEXT FROM I03.} of 

your school or any other school?

________Enter Number of Years

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F07. Including this school year, how many years have you served as the {TEXT FROM I03.} of 

your school?

________Enter Number of Years

F08. Including this school year, how many years of experience do you have teaching 6th, 7th, 

or 8th grade?

________Enter Number of Years

F09. Thank you for your cooperation!

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