1

First Semester 12

th

-Grade Facilitator Survey

INSTRUCTIONS

This survey asks about college and career instruction provided to your students as part of the Roads to Success 

program. The survey should take about 30 minutes. Your answers are very important to us and will not be 

shared with anyone at your school or community. 

SECTION A: TEACHER BACKGROUND

1. We would like to confirm your sex. Are you male or 

female?

1 Female

2 Male

2. Are you of Hispanic or [Latino/Latina] origin? 1 Yes

0 No

3. [In addition to learning about your Hispanic 

background, we would also like to know about your 

racial background.] Which of the following choices 

describe your race? You may choose more than one.

(Check all that apply.)

1 White

2 Black/African-American

3 Asian

4 Native Hawaiian or Other Pacific Islander

5 American Indian or Alaska Native

4. What is the highest degree you have earned? 1 Associate’s degree

2 Bachelor’s degree

3 Master’s degree

4 Ph.D., M.D., law degree, or other professional 

degree

5 You do not have a degree

5. Not including this school year, how many years have 

you taught a high school grade (9-12)?

Whole number

6. Not including this school year, how many years have 

you taught any grade?

Whole number

SECTION B: ROADS TO SUCCESS INSTRUCTION

In answering the following questions, please focus on instruction provided in the first half of the school year. 

7. Which of the following topic areas and modules have

you taught to your class so far this year?

(Check all that apply)

Topic area

Introduction to Roads to Success

Applying to College

Finding a Job

Financial Aid

Module

Introduction I

Introduction II

Completing a College Application

Essay Writing I

Essay Writing II

Essay Writing III

Essay Writing IV

Work and Values

Interest Inventory

Who Gets Jobs?

Your Network

Company Research I

Company Research II

Your Resume

Job Applications

Cover Letter I

Cover Letter II

The Interview

Follow-up

Financial Aid Options
2

Money Matters

Next Steps

Scholarship I

Scholarship II

FAFSA I

FAFSA II

Comparing Aid Packages

“Freshman Year” Budget

Big Ticket Expenses

Health Insurance

Budgeting Details

Freshman Year Survival Guide

Advice from the Experts

Getting Ahead at Work

8. For each of the modules you have taught, have you 

encountered any challenges difficulties in teaching 

students? If so, what kinds?

[List of each module checked in prior question. Teachers 

to provide a response for each module.]

1 No challenges

2 Lack of materials

3 Lack of student interest

4 Limited instructional time

5 Other (please specify): __________

9. About how minutes per week have you spent on 

Roads to Success instruction?

Whole number

10. Have you provided Roads to Success instruction each 

week of the school year so far?

[If yes, skip the next two questions]

1 Yes

0 No

11. About how many weeks, if any, have you not been 

able to provide Roads to Success instruction?

Whole number

12. Have you “doubled up” instruction in other weeks to 

catch up on Roads to Success material?

1 Yes

0 No

13. What obstacles or challenges have prevented you 

from providing Roads to Success instruction?

1 Lack of preparation time

2 Lack of training on module’s content

3 Competing classroom demands

4 Other (please specify): _____________

14. Have you graded student work produced as part of 

Roads to Success instruction?

1 Yes, Check/check minus or complete/incomplete

2 Yes, Letter or number grade

3 No

15. Do you plan on providing students a final grade for 

their Roads to Success participation?

1 Yes, Pass/fail or complete/incomplete

2 Yes, Letter or number grade

3 No

16. Which of the following specific activities, if any, have 

your students completed as part of your class?

1 Filled out a college application (real or simulated)

2 Completed a Free Application for Federal Student 

Aid (FAFSA)

3 Prepared a resume

4 Filled out a job application 

5 Participated in an internship

6 Participated in an apprenticeship 

7 Completed a career interest inventory

SECTION C: OTHER QUESTIONS
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17. Have you taught a specific college and career 

preparation curriculum before (either Roads to Success 

or another curriculum)?

1 Yes

0 No

18. Did you receive training in how to teach Roads to 

Success?

If no, skip the next two questions.

1 Yes

2 No

19. How would you rate the amount of training you 

received to teach Roads to Success?

1 Poor

2 Fair

3 Good

4 Excellent

20. How would you rate the quality of training you 

received to teach Roads to Success?

1 Poor

2 Fair

3 Good

4 Excellent

21. How would you rate the quality of Roads to Success 

materials and instruction guides?

1 Poor

2 Fair

3 Good

4 Excellent

22. To what extent have school staff (principal, 

counselors, or other teachers) supported you in 

implementing Roads to Success?

1 A great extent

2 Somewhat

3 A little

4 Not at all

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 1830-NEW. The time required to complete this information collection is estimated 

to average 30 minutes per respondent, including the time to review instructions, gather the data needed, and complete and review the information 

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

Department of Education, Washington, DC 20202. If you have comments or concerns regarding the status of your individual submission of this form, write 

directly to: U.S. Department of Education, Office of Career, Technical, and Adult Education, 400 Maryland Avenue, SW, Washington, DC 20202-7100.