Explanation

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**Worksheet Name Instrument**  App A Spring 4th Child Quex Spring Fourth-Grade Child Questionnaire, Appendix A App B Spring 4th Parent Interview Spring Fourth-Grade Parent Interview, Appendix B App C Spring 4th TQ Spring Fourth-Grade Teacher Questionnaire, Appendix C App D Spring 4th Reading TQC Spring Fourth-Grade Reading and Language Arts Teacher Questionanire, Appendix D App D Spring 4th Math TQC Spring Fourth-Grade Mathematics Teacher Questionnaire, Appendix D App D Spring 4th Science TQC Spring Fourth-Grade Science Teacher Questionnaire, Appendix D App E Spring 4th SpEd A Spring Fourth-Grade Special Education Teacher Questionnaire A, Appendix E App E Spring 4th SpEd B Spring Fourth-Grade Special Education Teacher Questionnaire B, Appendix E App F Spring 4th School Adm A Spring Fourth-Grade School Administrator Questionnaire A, Appendix F App F Spring 4th School Adm B Spring Fourth-Grade School Administrator Questionnaire B, Appendix F 

### This file contains a listing of every question asked of study children, parents, reading, math, and science teachers, special education teachers, and school administrators in the spring fourth grade data collection round (with the exception of the direct assessment items). For each question, the question wording is provided, along with the item source, the construct the item measures, and the specific research question in Part C of this OMB package for which the item is intended to provide information. Each worksheet in this file pertains to one instrument. The worksheet name notes the specific instrument, as well as the appendix within the OMB package in which the full instrument can be found. Below is a list of the worksheet name and a full description of the instrument to which the worksheet pertains.

Page 1 of 1**Section Item #** 

**Introduction** CLQ400

CLQ401

CLQ402 

## Spring Fourth-Grade Child Questionnaire, Appendix HCLQ403

**School Liking** CLQ405

CLQ410

CLQ415

CLQ420

CLQ425

**Peer Relationships** CLQ430

CLQ435, 450, 470CLQ440

CLQ445

CLQ455

CLQ460

CLQ465

CLQ475

CLQ480

CLQ485CLQ486

CLQ487

CLQ488

CLQ489

**Media Usage** CLQ490

CLQ495CLQ500

**Pet Relationships** CLQ505

CLQ510

CLQ515

CLQ520

CLQ525

CLQ530CLQ535

CLQ540

CLQ545

CLQ547

CLQ549

CLQ550

CLQ555**Item Stem**

PLUG HEADPHONES INTO THE COMPUTER. POSITION LAPTOP IN FRONT OF THE CHILD. Now, you are going to use the computer to tell us a little more about yourself. The computer will read some sentences while you listen on the headphones. [HOLD UP HEADPHONES] Then you will pick the answer that best describes you by touching your answer on the computer screen. [TOUCH THE MIDDLE OF THE COMPUTER SCREEN WITH ONE FINGER] You can change the volume by pressing this button [POINT TO THE RIGHT BUTTON ABOVE STICKER] to make it louder and this button [POINT TO THE LEFT BUTTON ABOVE STICKER] to make it softer. If you don't want the questions and answers read to you, just turn the volume all the way down. SHOW THE CHILD HOW TO ADJUST THE SIZE OF THE HEADPHONES. Okay, go ahead and put these headphones on and adjust them so they fit. Then, you will hear directions about what to do. TURN LAPTOP AROUND. ROTATE LAPTOP SCREEN TO FACE THE CHILD. Hello. Before you begin, please change the volume if this voice is too loud or too soft. In a minute, sentences will appear on the screen, and they will be read to you along with a list of answers. For these questions, there are no right or wrong answers, and all your answers are private. No one will be told the answers that you pick. To choose your answer, just touch it on the computer screen. You don't have to wait for the computer to finish reading all the answers before you choose your answer. If you want to change your answer, touch the "ERASE" button and then touch the new answer you want to pick. If you want to go back and change an answer, touch the "BACK" button to move to earlier screens. If you have any questions, or if you need help adjusting the volume or the size of your headphones, please ask for help now. When you're ready to move on, please touch the "NEXT" button to move to the next screen. Now let's practice. Touch the answer that best describes you, and then touch the "NEXT" button. How often do you watch TV? 

## Spring Fourth-Grade Child Questionnaire, Appendix HGreat, thanks for practicing.

One last thing before you begin. If there is a question you do not want to answer, just touch the "NEXT" button to skip over it. If you touch the "NEXT" button without answering, the computer will ask you if you want to skip the question, just make sure you didn't skip the question by accident. Please touch the "NEXT" button to move to the next screen. Think about yourself and your experiences this school year. How often do the following things happen? I try hard to do well in school. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. In class, I work as hard as I can. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. When I'm in class, I participate in class discussions. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. I pay attention in class. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. When I'm in class, I listen very carefully. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class make me feel better if I'm having a bad day**.** Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Social Distress. Items not included due to copyright restrictions (3 items total) question.I feel lonely at school.

Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class let me play with them. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. I feel left out at school. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class make me feel happy. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class would help me if I hurt myself on the playground. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class tell me that I'm their friend. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. I feel alone at school. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Kids in my class would help me if other kids were being mean to me. Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question.Next, please think about experiences that you have had with other students.

During this school year, how often have other students teased you, made fun of you, or called you names? Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. During this school year, how often have other students told lies or untrue stories about you? Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. During this school year, how often have other students pushed, shoved, slapped, hit, or kicked you? Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. During this school year, how often have other students left you out from playing with them on purpose? Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. How often do you send texts, messages, or emails using an app, cell phone, computer, iPad or tablet, or other electronic device?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Does your family have rules about **who**you can send texts, messages, or emails to?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question.Does your family have rules about **when**you can send texts, messages, or emails?

Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Do you have a pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Have you ever had a pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. How old were you when you got your first pet? If you can't remember exactly how old you were, please take your best guess.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. How many pets do you have right now?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. What kind of {pet/pets} do you have? You can choose more than one answer if you have more than one pet.
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Do you have a favorite pet?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question.Which pet is your favorite pet?

Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. How often do you spend time playing with {your pet/your favorite pet/any of your pets}?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. How often do you have {your pet/your favorite pet/any of your pets} near you when you do homework, study, read, or watch TV?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. When you feel bad or sad, how often do you go to {your pet/your favorite pet/any of your pets} to help you feel better?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Do you consider {your pet/your favorite pet/any of your pets} to be {a member/members} of your family?
Please pick an answer and then touch the "NEXT" button or just touch the "NEXT" button to skip this question. Thank you for working with me. You are done answering questions on the computer. Please take off the headphones now.

TAKE THE HEADPHONES FROM THE CHILD. UNPLUG HEADPHONES FROM COMPUTER. TAKE THE LAPTOP FROM THE CHILD AND PLACE THE LAPTOP DIRECTLY IN FRONT OF YOU. SAY: Thank you. Now we are going to do something else. TOUCH THE "NEXT" BUTTON TO CONTINUE.**Source Construct**  **Research Question**

ECLS-K:2011 3rd Grade CQ (modified) Introduction NA

ECLS-K:2011 3rd Grade CQ (modified) Introduction NA

ECLS-K:2011 3rd Grade CQ (modified) Introduction NAECLS-K:2011 3rd Grade CQ (modified) Introduction NA

Skinner, Ellen A., Kindermann, T. A., and Furrer, C. J. (In press). Behavior engagement C1

Skinner, Ellen A., Kindermann, T. A., and Furrer, C. J. (In press). Behavior engagement C1

Skinner, Ellen A., Kindermann, T. A., and Furrer, C. J. (In press). Behavior engagement C1

Skinner, Ellen A., Kindermann, T. A., and Furrer, C. J. (In press). Behavior engagement C1

Skinner, Ellen A., Kindermann, T. A., and Furrer, C. J. (In press). Behavior engagement C1

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2

LaGreca and Stone (1993) Also used in ECLS-K:2011 Spring 3rd grade CQ Social distress C2, C3Parker, J. G. and Asher, S. R. (1993). Loneliness C2, C3

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2

Parker, J. G. and Asher, S. R. (1993). Loneliness C2, C3

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2

Parker, J. G. and Asher, S. R. (1993). Loneliness C2, C3

SECCYD (Vandell, using Ladd items) "Kids in My Class at School" Peer social support C2Espelage and Holt (2001) (modified)

Also used in ECLS-K:2011 Spring 3rd grade CQ Peer victimization C4

Espelage and Holt (2001) (modified) Also used in ECLS-K:2011 Spring 3rd grade CQ Peer victimization C4

Espelage and Holt (2001) (modified) Also used in ECLS-K:2011 Spring 3rd grade CQ Peer victimization C4

Espelage and Holt (2001) (modified) Also used in ECLS-K:2011 Spring 3rd grade CQ Peer victimization C4

Adapted from the PEW September Tracking Survey (2009) (modified) Media usage C5

ECLS Media usage C5ECLS Media usage C5

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from Lexington Attachment to Pets Scale (LAPS) (John, Garrity, & Stallones 19922) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

Adapted from CENSHARE Pet Attachment Survey (Holcomb, Williams, & Richards, 1988) Pet relationships C6

ECLS-K:2011 3rd Grade CQ (modified) Closing NA

ECLS-K:2011 3rd Grade CQ (modified) Closing NAApp B Spring 4th Parent Intervi

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**Section Item #**  **Item Stem Source**  **Construct Research Question** 

**Introduction** INQ.005 {In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 2012/In the fall of 2012/In the spring of 2013/In the spring of 2014}, we spoke with {NAME OF RESPONDENT} who took part in the Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011on {DATE OF LAST INTERVIEW}. Am I talking to the same person? ECLS-K Introduction NA

INQ.010 May I please speak with {NAME OF PREVIOUS ROUND RESPONDENT}? ECLS-K Introduction NA INQ.015 Are you the parent or guardian in this household who knows the most about {CHILD}'s care,

education, and health? NHES:2007 (modified) Introduction NA

INQ.020 May I please speak with the parent or guardian in the household who knows the most about

{CHILD}'s care, education, and health? NHES:2007 (modified) Introduction NA INQ.025 May I please speak with a household member who is 18 or older and knows about {CHILD}'s care,

education, and health? NHES:2007 (modified) Introduction NA INQ.030 May I have your name please? ECLS-K Introduction NA INQ.060 [May I have your name, please?] ECLS-K Introduction NA INQ.070 [May I have your name, please?] ECLS-K Introduction NA INQ.080/080b (As I mentioned earlier), you and {CHILD} were selected to take part in the Early Childhood

Longitudinal Study Kindergarten Class of 2010-2011, which is sponsored by the U.S. Department of Education, National Center for Education Statistics. I have some questions for you that ask about {CHILD}’s school and home experiences. The information I collect in this interview will be extremely valuable in understanding the development of children and how their school experiences can be improved. All responses that relate to or describe identifiable characteristics of individuals 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. This call will be recorded for quality control purposes. ECLS-K Introduction NA 

### Spring Fourth-Grade Parent Interview, Appendix H

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INQ.090/090b {In the fall of 2010/In the spring of 2011/In the fall of 2011/In the spring of 2012/In the fall of

2012/In the spring of 2013/In the spring of 2014}, you took part in the Early Childhood Longitudinal Study Kindergarten Class of 2010-2011, which is sponsored by the U.S. Department of Education, National Center for Education Statistics. I have some questions for you that ask about {CHILD}’s school and home experiences since our last interview. The information I collect in this interview will be extremely valuable in understanding the development of young children and how their early school experiences can be improved. All responses that relate to or describe identifiable characteristics of individuals 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. This call will be recorded for quality control purposes. ECLS-K Introduction NA

INQ.130 Before we begin the interview, I would like to verify some information. I have recorded {CHILD's

FIRST, MIDDLE, AND LAST NAME} as {CHILD}'s full name. Is this correct? ECLS-K Introduction NA
INQ180 I have recorded that {CHILD}'s home address is...Is this still correct? ECLS-K Introduction NA INQ190 What is {CHILD}'s home address? Introduction NA INQ.200 I have recorded that {PHONE NUMBER} is {CHILD}'s family's current home phone number. Is this

correct? ECLS-K Introduction NA INQ.205 {What is {CHILD}'s family's current home phone number?} ECLS-K Introduction NA INQ.300 Next, I have a few questions about {CHILD}'s background. Was {CHILD} born in this country, that

is, in any of the fifty states or the District of Columbia? ECLS-K Country of origin for sample child PQ1, PQ3 INQ.310/312OS In what country or territory was {CHILD} born? ECLS-K Country of origin for sample child PQ1, PQ3 INQ.320 In what year did {CHILD} come to the United States to stay? ECLS-K Length of residence in U.S. for sample child PQ1, PQ3
INQ.330 Is {CHILD} a U.S. citizen? ECLS-K Citizenship of child PQ1, PQ3 PIQ.130 Since the beginning of this school year, have you or the other adultsin your household attended

an open house or a back-to-school night? ECLS-K Parent participation in school activities PQ5
PIQ.140 [Since the beginning of this school year, have you or the other adults in your household...]

Attended a meeting of a PTA, PTO, or Parent-Teacher Organization? ECLS-K Parent participation in school activities PQ5

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PIQ.150 [Since the beginning of this school year, have you or the other adults in your household...] Gone

to a regularly-scheduled parent-teacher conference with {CHILD}'s teacher or meeting with {CHILD}'s teacher? ECLS-K Parent attendance at parent-teacher conferences and meetings PQ5

PIQ.160 [Since the beginning of this school year, have you or the other adults in your household...]

Attended a school or class event, such as a play, sports event, or science fair? ECLS-K Parent participation in school activities PQ5
PIQ.170 [Since the beginning of this school year, have you or the other adults in your household...] Served

as a volunteer in {CHILD}’s classroom or elsewhere in the school? NHES:2007 Parent participation in school activities PQ5

PIQ.185 During this school year, how many times have you or other adults in your household gone to

meetings or participated in activities at {CHILD}'s school? ECLS-K Parent participation in school activities PQ5
PIQ.495 Do you {or your spouse/partner} use a computer or any other electronic device to communicate

with or get information from {CHILD}'s school? ELS:2002 (modified) Parent involvement online PQ5 PIQ.496a/b/c How often do you {or your spouse/partner} use a computer or any other electronic device in the

following ways? Would you say never, less than once a year, once or twice a year, several times a year, at lease once a month, or weekly? a. To communicate with {CHILD}'s teachers and administrative staff by email about {CHILD}, for example, about how {he/she} is performing, or about absences or tardiness? b. To find out about homework and other school assignments and projects? c. To find out about {CHILD}'s grades? ELS:2002 (modified)

Parent involvement online PQ5 PIQ.510 How often does {CHILD} do homework at home? Would you say...

Never, Less than once a week, 1 to 2 times a week, 3 to 4 times a week, or 5 or more times a week? ECLS-K Frequency child does homework at home PQ4, PQ5

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PIQ.520 During this school year, how often did you or someone else help {CHILD} with {CHILD}'s

homework? Would you say... Never, Less than once a week, 1 to 2 times a week, 3 to 4 times a week, or 5 or more times a week? ECLS-K:2011 Homework monitoring by parents PQ4, PQ5

PIQ.550 How often do you check that {CHILD} has completed all homework? Would you say never, rarely,

sometimes, or always? ECLS-K Homework monitoring by parents PQ4, PQ5
PIQ.560 Now I would like to ask you about {his/her} grades during this school year. Overall, across all

subjects {{he/she} takes at school, does {he/she} get... Mostly A's, Mostly B's, Mostly C's, Mostly D's and lower, or Does {his/her} school not give those grades? NHES Grades received at school PQ1, PQ2

PIQ.570 Would you describe {CHILD}'s work at school as...

Excellent, Above average, Average, Below average, or Failing? NHES Grades received at school PQ1, PQ2

PIQ.585 How often would you say that {CHILD}...

a. Makes up reasons to stay home from school? b. Seems to dread going to school? c. Becomes upset when it's time to go to school in the morning? d. Asks to stay home from school? e. Complains about going to school? Would you say almost never, rarely, sometimes, a lot, or almost always? The School Liking and Avoidance Questionnaire (SLAQ) School avoidance PQ1, PQ2

**Family Structure** FSQ.010 Now I have a few questions about your household. We have listed that (READ NAMES FROM MATRIX) lived in this household at the time of our last interview. As I read each person's name again, please tell me if he or she stilllives in this household. Does {NAME} stilllive in this household? ECLS-K Household roster: current PQ1, PQ3

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FSQ.015/015OS Why is {NAME} no longer living in this household? ECLS-K Household roster: former household member's status PQ1, PQ3
FSQ020 {Other than the people I just asked about, is there anyone else currently living in this household?

For example, anyone who has moved in or any babies born since our last interview? Please tell me the names and ages of all the other people who normally live here. Please do not include anyone staying here temporarily who usually lives somewhere else.} {Now I have a few questions about your household. We have noted that you and {CHILD} currently live in this household. First I’d like to ask you some questions about yourself, then I’d like you to please tell me the names and ages of all the other people who normally live here. Please do not include anyone staying here temporarily who usually lives somewhere else.} ECLS-K Household roster: current PQ1, PQ3

FSQ.025 ENTER LAST NAME OF {NAME}. ECLS-K Household roster: current PQ1, PQ3 FSQ.030 How old {are you/is {NAME}}? ECLS-K Household roster: current PQ1, PQ3

FSQ.040 CODE IF OBVIOUS. OTHERWISE, ASK: {Are you/Is {NAME} male or female?} ECLS-K Household roster: current PQ1, PQ3 FSQ.045 CHECK HOUSEHOLD MATRIX. ECLS-K Household roster: current PQ1, PQ3 FSQ.060 Have we missed anyone who usually lives here who is temporarily away from home or living in a

dorm at school, or any babies or small children? ECLS-K Household roster: current PQ1, PQ3 FSQ.110 Do you have a spouse or partner who lives in this household? ECLS-K Marital status of the primary caretakers PQ1, PQ3
FSQ.120 Who in the household is your spouse or partner? ECLS-K Marital status of the primary caretakers PQ1, PQ3
FSQ.121 During our last interview with this household (or family), it was reported that you were {the

girlfriend or female partner of {CHILD}’s parent or guardian}/the boyfriend or male partner of {CHILD}’s parent or guardian/the female guardian of {CHILD}/the male guardian of {CHILD}/{CHILD}’s relative, but not a guardian/not related to {CHILD}/{CHILD}'s {RELATIONSHIP}}. Has there been a change in your relationship to {CHILD}? ECLS-K Change in family relationship of respondent to child PQ1, PQ3

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FSQ.122 During our last interview with this household (or family), it was reported that {NAME OF

SPOUSE/PARTNER} was {the girlfriend or female partner of {CHILD}’s parent or guardian/the boyfriend or male partner of {CHILD}’s parent or guardian/{CHILD}’s relative, but not a guardian/the female guardian of {CHILD}/the male guardian of {CHILD}/not related to {CHILD}/{CHILD}'s {RELATIONSHIP}}. Has there been a change in the relationship of {NAME OF SPOUSE/PARTNER} to {CHILD}? ECLS-K Change in family relationship of spouse/partner to child PQ1, PQ3

FSQ.130 What is {your/{NAME}'s} relationship to {CHILD}? ECLS-K Relationship of household member to child PQ1, PQ3
FSQ.140 {Are you/Is {NAME}} {CHILD}'s...

Biological or birth mother, Adoptive mother, Step mother, Foster mother or female guardian, or Other female parent or guardian? ECLS-K Relationship of household member to child PQ1, PQ3

FSQ.150 {Are you/Is {NAME}} {CHILD}'s...

Biological or birth father, Adoptive father, Step father, Foster father or male guardian, or Other male parent or guardian? ECLS-K Relationship of household member to child PQ1, PQ3

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FSQ.160 {Are you/Is {NAME}} {CHILD}'s...

Full sister, Half sister, Step sister, Adoptive sister, or Foster sister? ECLS-K Relationship of household member to child PQ1, PQ3

FSQ.170 {Are you/Is {NAME}} {CHILD}'s...

Full brother, Half brother, Step brother, Adoptive brother, or Foster brother? ECLS-K Relationship of household member to child PQ1, PQ3

FSQ.180/181 {Are you/Is {NAME}} {CHILD}'s...

CODE NON-RELATIVE RELATIONSHIP BELOW IF MORE DESCRIPTIVE. ECLS-K Relationship of household member to child PQ1, PQ3

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FSQ.190 {Are you/Is {NAME}} Hispanic or Latino? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.195 What is {your/{NAME}'s} race? You may name one or more races to indicate what {you/NAME}

{consider/considers} {yourself/himself/herself} to be. ECLS-K Race of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.196a Though we may have asked you about {CHILD}'s ethnicity and race in the past, I do have a few

more questions I'd like to ask about that now. Is {CHILD} a member of a Spanish, Hispanic, or Latino group? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.196b Which of the following Spanish, Hispanic, or Latino groups best describes {CHILD}'s origin? Is

{he/she}... Mexican, Mexican American or Chicano, Puerto Rican, Cuban, or Other Spanish/Hispanic/Latino group? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.197a Is {CHILD} a member of an Asian group? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

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FSQ.197b Which of the following Asian groups best describes {CHILD}'s origin? Is {he/she}...

Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong, or Other Asian? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.198a Is {CHILD} a member of a Pacific Islander group? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.198b Which of the following Pacific Islander groups best describes {CHILD}'s origin? Is {he/she}...

Native Hawaiian, Guamanian or Chamarro, Samoan, or Other Pacific Islander? ECLS-K Ethnicity of child, parent figures, respondent and respondent's spouse (if no mother or father figures) PQ1, PQ3

FSQ.200a {FILL 1} currently married, separated, divorced, widowed, in a domestic partnership, or {FILL 2}

never been married {FILL 3}? ECLS-K Marital status of the primary caretakers PQ1, PQ3
FSQ.200b See matrix. ECLS-K Marital status of the primary caretakers NA

**Home Environment,**  **Activities, and Cognitive**  **Stimulation** HEQ.010a/b/c/d/e

/f Now I'd like to talk with you about {CHILD}'s activities with family members. In a typical week,

how often do you or any other family members do the following things with {CHILD}? a. Tell stories to {CHILD}? b. Help {CHILD} to do arts and crafts? c. Play games or do puzzles with {CHILD}? d. Talk about nature or do science projects with {CHILD}? e. Play a sport or exercise together? f. Practice reading, writing or working with numbers? Would you say not at all, once or twice a week, 3-6 times a week, or every day? ECLS-K:2011 Frequency of home activities with child PQ4, PQ5

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HEQ.210 In the past week, how often did {CHILD} read to {himself/herself} or to others outside of school?

Would you say... Never, Once or twice a week, 3 to 6 times a week, or Every day? ECLS-K Frequency of reading activities with child PQ2, PQ4

HEQ.215 Generally, how many minutes did {CHILD} read at each of these times? ECLS-K Frequency of reading activities with child PQ2, PQ4
HEQ.225 In an average week, how often does {CHILD} use a home computer or other electronic device to

play with programs that teach {him/her} something, like math or reading skills? Would you say... Never, Once or twice a week, 3 to 6 times a week, or Every day? ECLS-K:2011 (modified) Use of electronic/computer devices PQ4

HEQ.226 Do you monitor how many hours {CHILD} spends online? ECLS-K:2011 Parental monitoring child's use of electronic/computer devices PQ4

HEQ.227 Do you monitor what {CHILD} looks at online, or what websites and accounts {CHILD} can join

online? Include everything the child may look at online, such as websites, email, videos, movies, television shows, online games, chat rooms, and picture or social media sites such as Instagram, Vine, Snapchat, YouTube, Twitter, and Facebook. ECLS-K:2011 Parental monitoring child's use of electronic/computer devices PQ4

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HEQ.228 How many close friends does {CHILD} have? Robert Crosnoe from the ECLS-K:2011 Technical Review Panel (TRP) Child's friends PQ1, PQ2
HEQ.229 What kind of influence is {CHILD}'s {best} friend? Would you say always a good influence, usually

a good influence, neither a good nor a bad influence, usually a bad influence, or always a bad influence? The National Longitudinal Study of Adolescent Health (Ad Health) (adapted) Child's friends PQ1, PQ2

HEQ.280 Is {CHILD} tutored on a regular basis, by someone other than you or a family member, in a

specific subject, such as reading, math, science, or a foreign language? ECLS-K Tutoring PQ5
HEQ.290/290OS What is {CHILD} tutored in? ECLS-K Tutoring PQ5 HEQ300 Outside of school hours in the past year, has {CHILD} participated in: Academic activities, like

science, computers, math lab, or taking a class to learn a language other than English? NHES 2007 (modified) Child activities outside of school hours PQ4
HEQ.301 Did {he/she} specifically learn about math, science, or technology in any of those academic

activities? High School Longitudinal Study of 2009 (HSLS:2009) (adapted) Child activities outside of school hours: STEM related PQ4

HEQ305 As part of {CHILD}’s participation in that activity, did {he/she} ever take a field trip focused on

science activities, for example to a science museum or center, a science lab, a planetarium, or a nature center? NCES Child activities outside of school hours: science related field trips PQ4

HEQ310 Outside of school hours in the past year, has {CHILD} participated in organized athletic activities,

like basketball, soccer, baseball, or gymnastics? ECLS-K Child activities outside of school hours PQ4

HEQ320 [Outside of school hours in the past year, has {CHILD} participated in:] Organized clubs or

recreational programs, like scouts? ECLS-K Child activities outside of school hours PQ4
HEQ325 As part of {CHILD}’s participation in that program, did {he/she} ever take a field trip focused on

science activities, for example to a science museum or center, a science lab, a planetarium, or a nature center? NCES Child activities outside of school hours: science related field trips PQ4

HEQ330 Outside of school hours in the past year, has {CHILD} participated in music lessons, for example,

piano, instrumental music, or singing lessons? ECLS-K Child activities outside of school hours PQ4

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HEQ340 [Outside of school hours in the pastyear, has {CHILD} participated in:] Drama classes? ECLS-K Child activities outside of school hours PQ4
HEQ350 [Outside of school hours in the past year, has {CHILD} participated in:] Art classes or lessons, for

example, painting, drawing, or sculpture? ECLS-K Child activities outside of school hours PQ4
HEQ370 [Outside of school hours in the past year, has {CHILD} participated in:] Organized performing arts

programs, such as children's choirs, dance programs, or theater performances? ECLS-K Child activities outside of school hours PQ4
HEQ.391 [Outside of school hours in the past year, has {CHILD} participated in:] Religious activities or

instruction? ECLS-K Child activities outside of school hours PQ4
HEQ.393 Did {CHILD}’s participation in {academic activities/organized athletic activities/ organized clubs or

recreational programs/music lessons/drama classes /art classes or lessons/organized performing arts programs/ religious activities or instruction/any of these activities} help to cover the hours when you needed adult supervision for {him/her}? ECLS-K Whether child activities serve as child care PQ6

HEQ.400 Now, I have a question about your neighborhood. How safe is it for children to play outside

during the day in your neighborhood? Would you say it's... Not at all safe, Somewhat safe, or Very safe? ECLS-K:2011 Neighborhood safety PQ4

HEQ.600a/b On an average school night, how many hours of sleep does {CHILD} get? Youth Risk Behavior Survey (YRBS) Amount of sleep PQ4

**Social Skills, Problem**  **Behaviors, and Approaches**  **Toward Learning** SSQ020 a/b/c/d (Copyrighted item) a. (copyrighted item) b. (copyrighted item) c. (copyrighted item) d. (copyrighted item) Behavior Rating Inventory of Executive Function (BRIEF) Child's working memory PQ1, PQ2

**Child Care** CCQ.376 Sometimes children spend time caring for themselves, either at home or somewhere else, without an adult or older child responsible for them. Does {CHILD} spend time caring for {himself/herself} on a regular basisbefore or after school? ECLS-K Time child spends in self-care PQ6
CCQ.377 How many hoursper weekdoes {CHILD} take care of {himself/herself}? ECLS-K Time child spends in self-care PQ6

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**Non-Resident Parents**  NRQ.040 The next questions are about {CHILD}'s contact with {his/her} {biological/adoptive} {father/mother}. [We understand that some of these questions may be difficult {for adoptive parents} to answer; however, these are standard questions we ask when a child does not live with {his/her} biological parents. Any information you can provide will be helpful.] How long has it been since {CHILD} last had a visit, a phone call, a video call, an e-mail, a text or other electronic message, or received a card or letter from {his/her} {biological/adoptive} {father/mother}? Would you say... Less than one month, More than a month but less than a year, More than a year, or No contact since birth? ECLS-K (modified) Current contact and nature of relationship with biological/adoptive parents no longer living in household PQ1, PQ3, PQ4

NRQ.123 How many times have {CHILD} and {his/her} {biological/adoptive} {father/ mother} talked on the

telephone or in a video call to each other, e-mailed, texted, or had some other type of contact that was not in person in the past 4 weeks? ECLS-K (modified) Current contact and nature of relationship with biological/adoptive parents no longer living in household PQ1, PQ3, PQ4

**Country of Origin for Non**  **Resident Biological**  **Parents** COQ.005/OS Now we'd like to ask {another question} about {CHILD}'s bilogical mother. {I know you mentioned that {CHILD}'s biological mother is deceased, and I am sorry for this loss. We understand that it may be hard to talk about those who are no longer living, but I was hoping I could ask a couple quick background questions about where she was from.} In what country was {his/her} biological mother born? ECLS-K Country of origin for nonresident parents PQ1, PQ3

COQ.010 How old was {CHILD’}’s biological mother when she first moved to {any of the fifty states in the

United States or the District of Columbia /the United States}? ECLS-K Country of origin for nonresident parents PQ1, PQ3
COQ.020/OS Now we'd like to ask {another question} about {CHILD}'s bilogical father. {I know you mentioned

that {CHILD}'s biological father is deceased, and I am sorry for this loss. We understand that it may be hard to talk about those who are no longer living, but I was hoping I could ask a couple quick background questions about where he was from.} In what country was {his/her} biological father born? ECLS-K Country of origin for nonresident parents PQ1, PQ3

COQ025 How old was {CHILD’}’s biological father when he first moved to {any of the fifty states in the

United States or the District of Columbia /the United States}? ECLS-K Country of origin for nonresident parents PQ1, PQ3

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100 A B C D E F DWQ070a/b/c/d/ e/f Now I am going to read some additional statements. Please tell me whether each statement is

never true for you, sometimes true for you, often true for you, or very often true for you. a. Even if I am really busy, I make time to listen to {CHILD}. b. I discourage {CHILD} from talking about {his/her} worries because it upsets {him/her}. c. I encourage {CHILD} to talk about {his/her} troubles. d. I encourage {CHILD} to tell me about {his/her} friends and activities. e. I encourage {CHILD} to express {his/her} opinions. f. When I lose my patience with {CHILD}’s questions and demands, I just don’t listen to {CHILD} anymore. ECLS-K Parent-child relationship: communication PQ4

DWQ.075 How often do you argue with {CHILD}? Please include major arguments as well as minor

arguments, such as over homework or chores. Would you say never, almost never, sometimes, often, or always? NCES Time spent arguing with child PQ4
DWQ077a/b/c The following are a number of statements about your family. Please tell me how often each

typically occurs in your home. a. You threaten to punish {CHILD} and then do not actually punish {him/her}. Would you say this occurs never, almost never, sometimes, often, or always? b. {CHILD} talks you out of being punished after {he/she} has done something wrong. c. Y ou let {CHILD} out of punishment early , like li restricons earlier than you originally said? Short form of Alabama Parenting Questonnaire Inconsistent Discipline PQ4

DWQ.081a/b Now I’d like to ask some questions about the amount of time {CHILD} plays video games . We

want you to include games played on systems like Playstation, Wii, or Xbox, or on handheld devices such as a Nintendo DS, Sony PSP, iPod, iPad, or cellphone, or games played on the computer. On any given weekday, how much time does {CHILD} spend playing video games? Please do not include time {CHILD} spends on the computer doing educational activities or homework. ECLS-K (modified) Time child spent playing video games PQ4

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**Child's Health and Well-Being**  CHQ.010 Now we'd like to discuss {CHILD}'s health and well-being. How long has it been since {CHILD}'s last visit to a dentist or dental hygienist for dental care? ECLS-K:2011 Dental visits PQ1, PQ2

CHQ.020 How long has it been since {CHILD}'s last visit to a clinic, health center, hospital, doctor's office, or

other place for routine health care? ECLS-K:2011 Doctor visits PQ1, PQ2 CHQ.021 Has {CHILD} had an ear infection since last spring? ECLS-K:2011 (modified) Ear infections since last spring PQ1, PQ2 CHQ.022 Has {CHILD} had an ear ache since last spring? ECLS-K:2011 (modified) Ear aches since last spring PQ1, PQ2 CHQ.023 Since last spring, how many times did a doctor, nurse, or other medical professional tell you that

{CHILD} had an ear infection? ECLS-K:2011 (modified) Ear infections since last spring PQ1, PQ2 CHQ.024/024OS How have {CHILD}’s {ear infections/ear aches} been treated by your doctor, nurse, or other

medical professional since last spring? ECLS-K:2011 (modified) Ear infections/aches treatment since last spring PQ1, PQ2

CHQ.025 Since last spring, have ear tubes been placed in the right ear, left ear, or both ears when your

child had surgery to place tubes in {his/her} ears? IF NEEDED: Please consider all surgeries since last spring if {CHILD} had more than one to place ear tubes. ECLS-K:2011 (modified) Ear tubes since last spring PQ1, PQ2

CHQ.026 Has a doctor, nurse, or other medical professional ever told you that {CHILD} has asthma? ECLS-K Asthma PQ1, PQ2 CHQ.027 Does {he/she} receive treatment for this condition? ECLS-K Asthma PQ1, PQ2 CHQ.060 In a typical week, on how many days does {CHILD} get exercise that causes rapid breathing,

perspiration, and a rapid heartbeat for 20 continuous minutes or more? ECLS-K Exercise/physical activities PQ1, PQ2 CHQ.095 For the next set of questions, please base your answer on how {CHILD} compares to other

children of the same age. {CHILD} is independent and takes care of {himself/herself} ... Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K Behavioral comparison to peers: Independence and ability to take care of him/herself PQ1, PQ2

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119 A B C D E F CHQ.100 Does {CHILD} pay attention...

Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K Behavioral comparison to peers: Attention PQ1, PQ2

CHQ.105 Does {CHILD} learn, think, and solve problems...

Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K Behavioral comparison to peers: Learn, think, solve problems PQ1, PQ2

CHQ.106 Does {CHILD} show good coordination in moving {his/her} arms and legs? Would you say

{he/she} does this... Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K Behavioral comparison to peers: Child's coordination PQ1, PQ2

CHQ.107 Would you say {CHILD} behaves and relates to other children...

Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K (modified) Behavioral comparison to peers: Relating to children PQ1, PQ2

CHQ.108 Would you say {CHILD} behaves and relates to adults
...

Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K:2011 Behavioral comparison to peers: Relating to adults PQ1, PQ2

CHQ.109 Thinking about {CHILD}'s overall activity level, would you say {he/she} is...

Less active than other children {his/her} age, About as active, Slightly more active, or A lot more active than other children {his/her} age? ECLS-K Behavioral comparison to peers: Overall activity level PQ1, PQ2

CHQ.110 Does {CHILD} have any emotional or psychological difficulties? ECLS-K:2011 Emotional and psychological difficulties PQ1, PQ2
CHQ.111 Do you think this is a mild problem, a moderate problem, or a severe problem? ECLS-K:2011 Emotional and psychological difficulties PQ1, PQ2

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126 A B C D E F CHQ.115 {Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of an

issue with {independence and taking care of {himself/herself} {or}/paying attention {or}/learning, thinking, and solving problems {or}/ coordination in moving {his/her} arms and legs {or}/behaving and relating to other children {or}/ behaving and relating to adults {or}/{his/her} overall activity level {or}/{his/her} emotional or psychological difficulties}? ECLS-K:2011 Evaluation of disabilities and health conditions PQ1, PQ2

CHQ.120 {Since last spring, have you obtained/Did you obtain} a diagnosis or diagnoses of a problem from

a professional? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ.125/125OS What was the diagnosis or were the diagnoses? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ126/126OS What type of autism spectrum disorder does {CHILD} have? Is it autism, Asperger's Disorder,

Pervasive Developmental Disorder, something else, or was it identified generally as Autism Spectrum Disorder? ECLS-K:2011 Diagnoses of disabilities and health conditions: Autism spectrum disorder PQ1, PQ2

CHQ.130/131 How old was {CHILD} when the first diagnosis of a problem related to {a learning

disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)/a developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder (PDD), or other autism spectrum disorder/dyslexia/dyscalculia/an intellectual disability, severe cognitive disability, or mental retardation/an orthopedic impairment/a serious emotional disturbance/a traumatic brain injury/a panic disorder/separation anxiety disorder/obsessive compulsive disorder/generalized anxiety disorder/an {other} anxiety disorder/bipolar disorder/depression/speech/a sensory deficit disorder/oppositional defiant disorder/{TEXT FROM OTHER SPECIFY}} was made? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2

CHQ.135a/b What was the month and year when the diagnosis was made? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ.140 Is {CHILD} now taking any prescription medicine for the condition related to {his/her} {learning

disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)/developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder (PDD), or other autism spectrum disorder/dyslexia/dyscalculia/intellectual disability, severe cognitive disability, or mental retardation/orthopedic impairment/serious emotional disturbance/traumatic brain injury/panic disorder/separation anxiety disorder/obsessive compulsive disorder/generalized anxiety disorder/{other} anxiety disorder/bipolar disorder/depression/speech problems/sensory deficit disorder/oppositional defiant disorder{TEXT FROM OTHER SPECIFY}}? ECLS-K:2011 Prescription medications PQ1, PQ2

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132 A B C D E F CHQ.155 Is {CHILD} medicated for ADD or ADHD at school, at home, or both? ECLS-K:2011 Prescription medications PQ1, PQ2 CHQ.173 How long has {CHILD} taken such prescription medicine for the condition related to {his/her} {a

learning disability/Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD)/a developmental delay/autism, Asperger’s disorder, Pervasive Developmental Disorder (PDD), or other autism spectrum disorder/dyslexia/dyscalculia/an intellectual disability, severe cognitive disability, or mental retardation/orthopedic impairment/ a serious emotional disturbance/a traumatic brain injury/a panic disorder/separation anxiety disorder/obsessive compulsive disorder/generalized anxiety disorder/an {other} anxiety disorder/bipolar disorder/depression/speech problems/a sensory deficit disorder/oppositional defiant disorder/{TEXT FROM OTHER SPECIFY}}, in total? Less than one month, Less than a year, 1 to 2 years, 3 to 4 years, or 5 years or more? ECLS-K:2011 Prescription medications PQ1, PQ2

CHQ.200 For the next question, please base your answer on how {CHILD} compares to other children of the

same age. Does {CHILD} pronounce words, communicate with and understand others... Better than other children {his/her} age, As well as other children, Slightly less well than other children, or Much less well than other children? ECLS-K:2011 Communication: comparison to peers PQ1, PQ2

CHQ.206e Since last spring, has {CHILD} had a problem with stuttering? ECLS-K:2011 Communication problems PQ1, PQ2 CHQ.210 {Since last spring has {CHILD}/Has {CHILD} ever} been evaluated by a professional because of

{his/her} ability to communicate? ECLS-K Evaluation of communication problems PQ1, PQ2
CHQ.215 Did you obtain a diagnosis or diagnoses of a problem related to {his/her} ability to communicate

from a professional? ECLS-K Diagnoses for communication problems PQ1, PQ2

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139 A B C D E F CHQ.216 Which best describes {CHILD}’s hearing? If {CHILD} has a hearing aid or other assistive device,

please consider {his/her} hearing without the hearing aid or assistive device. Would you say {CHILD} has... excellent hearing, good hearing, a little trouble hearing, moderate trouble hearing, a lot of trouble hearing, or is {CHILD} deaf? ECLS-K Hearing ability PQ1, PQ2

CHQ.217 Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a

hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or assistive device. {CHILD} can usually hear and understand what a person says without seeing his or her face if that person whispersto {him/her} from across a quiet room. ECLS-K Hearing ability PQ1, PQ2

CHQ.218 [Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a

hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or assistive device.] {CHILD} can usually hear and understand what a person says without seeing his or her face if that person talks in a normal voiceto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.219 [Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a

hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or assistive device.] {CHILD} can usually hear and understand what a person says without seeing his or her face if that person shoutsto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.220 [Please indicate whether the following statement describes {CHILD}'s hearing. If {CHILD} has a

hearing aid or other assistive device, please consider {his/her} hearing without the hearing aid or assistive device.] {CHILD} can usually hear and understand what a person says without seeing his or her face if that person speaks loudlyinto {his/her} ears or better ear. ECLS-K:2011 Hearing ability PQ1, PQ2

CHQ.221 Is {CHILD}’s hearing worse in one ear? ECLS-K:2011 Hearing ability PQ1, PQ2 CHQ.222 Which best describes {CHILD}'s hearing in {his/her} worseear? If {CHILD} has a hearing aid or

other assistive device, please consider {his/her} hearing without the hearing aid or assistive device. In {his/her} worse ear, would you say {CHILD} has... Excellent hearing, Good hearing, A little trouble hearing, Moderate trouble hearing, A lot of trouble hearing, or is {CHILD} Deaf? ECLS-K:2011 Hearing ability PQ1, PQ2

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147 A B C D E F CHQ.235 {Besides the ECLS-K:2011 hearing evaluation done for this study, {Since last spring, has/Since the

spring of 2013, has/Since the fall of 2012, has/has}} / {Since last spring, has/Since the spring of 2013, has/Since the fall of 2012, has/Has}} {CHILD}'s hearing {ever} been evaluated by a professional?
. ECLS-K (modified) Evaluated for hearing ability PQ1, PQ2

CHQ.245 Did you obtain a diagnosis of a problem from a professional? ECLS-K Diagnoses for hearing ability PQ1, PQ2 CHQ.246/246OS What was the diagnosis? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ250a/b/c How old was {CHILD} when the first diagnosis of a problem related to {his/her} {ability to

communicate/hearing} was made? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ.255a/b What was the month and year the problem with {CHILD}'s {ability to communicate/hearing} was

diagnosed? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ.256a Since last spring, has {CHILD} worn a hearing aid? ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.256b Has {CHILD} ever worn a hearing aid? ECLS-K:2011 (modified) Use of hearing aid PQ1, PQ2
CHQ.257a/b At what age was the recommendation that {CHILD} wear a hearing aid first made? ECLS-K:2011 Use of hearing aid PQ1, PQ2

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160 161 A B C D E F CHQ.258 How often does {CHILD} use the hearing aid(s) in school? Would you say...

All of the time, Most of the time, Sometimes, Rarely, or Never? ECLS-K:2011 Use of hearing aid PQ1, PQ2

CHQ.259 Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} hearing aid(s) . {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person whispersto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with hearing aid PQ1, PQ2

CHQ.260 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} hearing aid(s) . ] {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person talks in a normal voiceto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with hearing aid PQ1, PQ2

CHQ.261 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} hearing aid(s) . ] {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person shoutsto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with hearing aid PQ1, PQ2

CHQ.262 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} hearing aid(s) .] {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person speaks loudlyinto {his/her} {better} ear. ECLS-K:2011 Hearing ability: with hearing aid PQ1, PQ2

CHQ.263 {Since last spring has/Has} a doctor or other health care professional {ever} recommended that

{CHILD} wear a hearing aid? ECLS-K:2011 Use of hearing aid PQ1, PQ2 CHQ.264a/b At what age was the recommendation that {CHILD} wear a hearing aid first made? ECLS-K:2011 Use of hearing aid PQ1, PQ2 CHQ.270 Does {CHILD} have a cochlear implant? ECLS-K Use of cochlear implant PQ1, PQ2 CHQ.271 In what year was it implanted? ECLS-K Use of cochlear implant PQ1, PQ2 CHQ.272a/b How old was {CHILD} when it was implanted? ECLS-K:2011 Use of cochlear implant PQ1, PQ2 CHQ.273 In what years were they implanted? ECLS-K Use of cochlear implant PQ1, PQ2 CHQ.274 [In what years were they implanted?] ECLS-K Use of cochlear implant PQ1, PQ2 CHQ.275a/b {How old was {CHILD} when it was implanted in the left ear?}{How old was {CHILD} when they

were implanted?} ECLS-K:2011 Use of cochlear implant PQ1, PQ2

CHQ.276a/b {How old was {CHILD} when it was implanted in the right ear?}{How old was {CHILD} when they

were implanted?} ECLS-K:2011 Use of cochlear implant PQ1, PQ2

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165 A B C D E F CHQ.277 Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} cochlear implant {s} . {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person whispersto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2

CHQ.278 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} cochlear implant {s} .]{CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person talks in a normal voiceto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2

CHQ.279 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} cochlear implant {s} .] {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person shoutsto {him/her} from across a quiet room. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2

CHQ.280 [Please indicate whether the following statement describes {CHILD}'s hearing when wearing

{his/her} cochlear implant {s} .] {CHILD} can usually hear and understandwhat a person says without seeing his or her face if that person speaks loudlyinto {his/her} {better} ear. ECLS-K:2011 Hearing ability: with cochlear implant PQ1, PQ2

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169

170

171

172

173 A B C D E F CHQ.285 Now I want to ask you about {CHILD}’s vision. Without the use of eyeglasses or contact lenses,

does {CHILD} have difficulty seeing objects in the distance or letters on paper? ECLS-K Vision ability PQ1, PQ2

CHQ.286 Is {CHILD}’s difficulty with seeing objects in the distance, things up close (like letters on paper), or

both? ECLS-K:2011 Vision ability PQ1, PQ2 CHQ.290 {Since last spring has/Has} {CHILD}'s vision {ever} been evaluated by an eye care professional? ECLS-K (modified) Evaluated for vision ability PQ1, PQ2 CHQ.300 Did you obtain a diagnosis of a vision-relatedproblem from an eye care professional? ECLS-K (modified) Diagnoses for visionrelated problems PQ1, PQ2
CHQ.301/301OS What was the diagnosis? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2
CHQ.305a/b How old was {CHILD} when the first diagnosis of a problem was made? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2

CHQ.310a/b What was the month and year the diagnosis was made? ECLS-K:2011 Diagnoses of disabilities and health conditions PQ1, PQ2

CHQ.311 Has {CHILD} been prescribed glasses or contact lenses to improve {his/her} vision? ECLS-K:2011 Use of glasses or contact lenses PQ1, PQ2

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177 178

179

180

181

182

183 A B C D E F CHQ.312 How often does {CHILD} wear glasses or contact lenses?

All of the time, Most of the time, Sometimes, Rarely, or Never? ECLS-K:2011 Use of glasses or contact lenses PQ1, PQ2

CHQ.313 Does {CHILD} have glasses or contact lenses? ECLS-K:2011 Use of glasses or contact lenses PQ1, PQ2 CHQ.314 Do {CHILD}’s glasses or contacts help {him/her} see things up close, see things in the distance, or

both? ECLS-K:2011 Use of glasses or contact lenses PQ1, PQ2 CHQ.330 Would you say {CHILD}'s health is ...

Excellent, Very good, Good, Fair, or Poor? ECLS-K Child's general health PQ1, PQ2

CHQ.340 During this school year, has {CHILD} received therapy services or taken part in a program for

children with disabilities? ECLS-K Services for disabilities PQ1, PQ2 CHQ.420 During this school year, did {CHILD} participate in a special education program? ECLS-K (modified) Participation in school services for disabilities PQ1, PQ2
CHQ.430 Overall, how satisfied are you with the progress {CHILD} has made in the special services or

special education program this school year? Are you... Completely satisfied, Very satisfied, Fairly satisfied, Somewhat dissatisfied, or Very dissatisfied? ECLS-K:2011 Rating school services for disabilities PQ1, PQ2

**Parent's Psychological**  **Well-Being and Health**  PPQ.100 I'm going to read some statements that may relate to how you have felt about yourself and your life during the past week. For each statement I read, please indicate how often in the past week you felt or behaved this way. There are no right or wrong answers. How often during the past week have you felt that you were bothered by things that don't usually bother you? Would you say never, some of the time, a moderate amount of the time, or most of the time? ECLS-K Depression and subjective well-being

PQ1, PQ3 PPQ.110 How often during the past week have you felt that you did not feel like eating, that your appetite

was poor? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.120 How often during the past week have you felt that you could not shake off the blues even with

help from your family or friends? ECLS-K Depression and subjective well-being PQ1, PQ3
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185

186

187

188

189

190

191

192

193 194 A B C D E F PPQ.130 How often during the past week have you felt that you had trouble keeping your mind on what

you were doing? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.140 How often during the past week have you felt depressed? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.150 How often during the past week have you felt that everything you did was an effort? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.160 How often during the past week have you felt fearful? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.170 How often during the past week have you felt your sleep was restless? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.180 How often during the past week have you felt that you talked less than usual? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.190 How often during the past week have you felt lonely? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.200 How often during the past week have you felt sad? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.210 How often during the past week have you felt that you could not get going? ECLS-K Depression and subjective well-being PQ1, PQ3 PPQ.220 Now, I would like to ask you about your health. In general, would you say that your health is...

Excellent, Very good, Good, Fair, or Poor? ECLS-K Parent health PQ1, PQ3, PQ5

PPQ.225 During the past 12 months, would you say that you experienced a lot of stress, a moderate

amount of stress, relatively little stress, or almost no stress at all? CAM Parent health PQ1, PQ3, PQ5

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197 198 199 200 201

202 203 204 205 206

207 A B C D E F

**Food Security** FDQ.130a/b/c These next questions are about whether your family is able to afford the food that you need. I am going to read you several statements that people have made about their food situation. For these statements, please tell me whether the statement was often true, sometimes true, or never true for {you/your household} in the last 12 months, that is, since last {CURRENT MONTH}, 2014. a. {I/We} worried whether {my/our} food would run out before {I/we} got money to buy more. b. The food that {I/we} bought just didn't last, and {I/we} didn't have money to get more. c. {I/We} couldn't afford to eat balanced meals. ECLS-K Family food security PQ1, PQ3

FDQ.140 In the last 12 months, did {you/you or other adults in your household} ever cut the size of your

meals or skip meals because there wasn't enough money for food? ECLS-K Family food security PQ1, PQ3 FDQ.150 How often did this happen? Would you say...

Almost every month Some months, but not every month, or In only 1 or 2 months? ECLS-K Family food security PQ1, PQ3

FDQ.160 In the last 12 months, did you ever eat less than you felt you should because there wasn't enough

money for food? ECLS-K Adult food security PQ1, PQ3 FDQ.170 In the last 12 months, were you ever hungry but didn't eat because there wasn't enough money

for food? ECLS-K Adult food security PQ1, PQ3 FDQ.180 In the last 12 months, did you lose weight because there wasn't enough money for food? ECLS-K Adult food security PQ1, PQ3 FDQ.190 In the last 12 months, did {you/you or other adults in your household} ever not eat for a whole

day because there wasn't enough money for food? ECLS-K Adult food security PQ1, PQ3 FDQ.191 How often did this happen? Would you say...

Almost every month, Some months, but not every month, or In only 1 or 2 months? ECLS-K Adult food security PQ1, PQ3

**Parent's Education**  PEQ.020 {Now I have a few questions about education.} What is the highest grade or year of school that {you/{NAME}} {have/has} completed? ECLS-K:2011 (modified) Parent education PQ1, PQ3 PEQ.021 {Do/Does} {you/{NAME}} have a high school diploma, or its equivalent, such as a GED, or neither? ECLS-K Parent education PQ1, PQ3 PEQ.030 {Are you/Is {NAME}} currently attending or enrolled in any courses from a school, college, or

university? ECLS-K:2011 Parent education PQ1, PQ3 PEQ.040 {Are you/Is {NAME}} currently taking courses full-time or part time? ECLS-K:2011 Parent education PQ1, PQ3 PEQ.050 {Are you/Is {NAME}} currently participating in a job training or on the job training program?

Please do not report participation in any vocational or technical programs taken at a college or university that you just told me about. ECLS-K:2011 Parent education PQ1, PQ3

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210 211 212 213

214 215

216 217 218 219 220 221 A B C D E F PEQ.060 About how many hours a week {do/does} {you/{NAME}} spend in that program? Please include

hours spent on homework for the training program. ECLS-K:2011 Parent education PQ1, PQ3 PEQ.062 What type of school or job training {are you/Is {NAME}} currently in? ECLS-K:2011 Parent education PQ1, PQ3 **Parent's Employment**  **Section 1 (NAEP sample only)**  EMQ.020 During the past week, did {you/{NAME}} work at a job for pay? ECLS-K:2011 Parent employment PQ1, PQ3

EMQ.030 {Were you/Was {NAME}} on leave or vacation from a job? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.040 How many jobs {do you/does {NAME}} have now? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.050 About how many total hours per week {do you/does {NAME}} usually work for pay {counting

{all/both} {# of jobs from EMQ.040 IF MORE THAN TWO} jobs}? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.060 {Have you/Has {NAME}} been actively looking for work in the past 4 weeks? By actively looking

for work, we mean activities such as checking with a public employment agency, a private employment agency, or an employer directly; checking about jobs with friends or relatives; placing or answering ads; sending a resume; contacting a school or university employment center; or checking a union or professional register. ECLS-K:2011 Parent employment PQ1, PQ3

EMQ.070 What {have you/has {NAME}} been doing in the past 4 weeks to find work? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.080 What {were you/was {NAME}} doing most of last week? Would you say...

Keeping house, or caring for children or other family members, Going to school, Retired, Unable to work, or Something else? What was that? (SPECIFY) ECLS-K:2011 Parent employment PQ1, PQ3

EMQ.100 Could {you/{NAME}} have taken a job last week if one had been offered? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.120 For whom {do/does/did} {you/{NAME}} work {when {you/{he/she}}last worked}? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.130 What kind of business or industry {is/was} this? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.140 What kind of work {are/is/were/was} {you {NAME}} doing? ECLS-K:2011 Parent employment PQ1, PQ3 EMQ.150 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? ECLS-K:2011 Parent employment PQ1, PQ3

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223

224

225

226 227

228 A B C D E F

**Parent's Employment**  EMQ.200 Which best describes {your/NAME'S} current employment situation? {Are you/Is {NAME}}... working part-time, working full-time, a stay-at-home parent or guardian, or not working? Westat Parent employment PQ1, PQ3

EMQ.210 {Since last spring/Since {CHILD} was born}, {have you/has {NAME}} served on active duty in the

U.S. Armed Forces, military Reserves, or National Guard? Active duty does not include training for the Reserves or National Guard, but DOES include activation, for example, for the war in Afghanistan. United States Census Bureau (modified) Active duty military service: since child was born PQ1, PQ3

EMQ.215 {Are you/Is {NAME}} currently on active duty in the U.S. Armed Forces, military Reserves, or

National Guard? United States Census Bureau (modified) Active duty military service: current PQ1, PQ3
**Welfare and Other Public**  **Transfers** WPQ.100 In the past 12 months, have you or anyone in your household received Temporary Assistance for Needy Families, sometimes called {TANF or} {STATE TANF PROGRAM NAME}? ECLS-K:2011 Public assistance PQ1, PQ3
WPQ.110 In the past 12 months, have you or anyone in your household received food stamps, also called

SNAP (the Supplemental Nutrition Assistance Program), or food benefits on EBT (Electronic Benefit Transfer)? ECLS-K:2011 Public assistance PQ1, PQ3
WPQ.170 Does {CHILD} receive free or reduced price lunches at school? ECLS-K:2011 Free/reduced lunch PQ1, PQ3

**Parent Income and Assets**  PAQ.100 In studies like this, households are sometimes grouped according to income. 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? Was it... $25,000 or less, or More than $25,000? ECLS-K Annual family income PQ1, PQ3

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231

232 233

234 A B C D E F PAQ.110 Was it...

$5,000 or less $5,001 to $10,000 $10,001 to $15,000 $15,001 to $20,000 $20,001 to $25,000 $25,001 to $30,000 $30,001 to $35,000 $35,001 to $40,000 $40,001 to $45,000 $45,001 to $50,000 $50,001 to $55,000 $55,001 to $60,000 $60,001 to $65,000 $65,001 to $70,000 $70,001 to $75,000 $75,001 to $100,000 $100,001 to $200,000 $200,001 or more ECLS-K Annual family income PQ1, PQ3

PAQ.120 What was your total household income last year, to the nearest thousand? ECLS-K Annual family income PQ1, PQ3 PAQ.140/140OS What is your current housing situation? Do you...

own your own house or condominium, rent your house or apartment, exchange services for housing, not pay for housing, live in temporary housing or a shelter, live with a relative or in a dwelling owned by a relative (MAY OR MAY NOT CONTRIBUTE TO EXPENSES OR CONTRIBUTION UNKNOWN), or have another type of arrangement (SPECIFY)? ECLS-K Housing PQ1, PQ3

**Mobility and Tracking**  **Updates** CMQ.010 Have you moved since {DATE OF LAST INTERVIEW}? ECLS-K Child Mobility NA

CMQ.020/020OS Why did you move? ECLS-K Child Mobility NA CMQ.060 Just to make sure I can reach you for the next interview, which will take place next school year,

I'd like to ask a few questions about how to find you. Is there a second phone number, such as a work number, a friend or relative's number, or a beeper or cell phone number, where you can sometimes be reached? ECLS-K Closing NA

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238 239

240 241 242 243 244 245 246 247 248

249 250 251 252 A B C D E F CMQ.100 Just to make sure I can reach you for the next interview, which will take place next school year,

I'd like to ask a few questions about how to find you. I have recorded {PHONE NUMBER} as a second phone number where you can sometimes be reached. Is this the right number? ECLS-K Closing NA

CMQ.140 What is that telephone number? ECLS-K Closing NA CMQ.150/155 Where is that telephone located? ECLS-K Closing NA CMQ.200 I have recorded that {NAME OF RELATIVE/FRIEND}

at {PHONE NUMBER}

on {STREET ADDRESS, LINE 1} {STREET ADDRESS, LINE 2} {CITY} {STATE} {ZIP CODE} will always know where you are if you move. Is this still true? ECLS-K Closing NA

CMQ.205 Is there a relative or friend, who does not live in this household, who will always know where you

are if you move? ECLS-K Closing NA CMQ.210/220/23 0/240/250/255/2 55OS/260/270 What is the name, address, and telephone number of that person? ECLS-K Closing NA
CMQ.280 What is the person's relationship to you? ECLS-K Closing NA CMQ.382 I have also recorded that your e-mail address is {EMAIL ADDRESS}. Is that correct? ECLS-K Closing NA CMQ.383 Is there an e-mail address where we could reach you? ECLS-K Closing NA CMQ.384 What is your e-mail address? ECLS-K Closing NA CMQ.680 WAS THIS INTERVIEW CONDUCTED BY TELEPHONE OR IN-PERSON? ECLS-K Closing NA CMQ.690/690OS WAS THIS INTERVIEW CONDUCTED IN ENGLISH, SPANISH, A CHINESE LANGUAGE, VIETNAMESE,

OR ANOTHER LANGUAGE? ECLS-K Closing NA CMQ.695 WHERE WAS THIS INTERVIEW CONDUCTED? ECLS-K Closing NA CMQ.700 Thank you very much for your cooperation and for taking the time to participate in the Early

Childhood Longitudinal Study. ECLS-K Closing NA CMQ.701 We would like to call the parent or guardian for {CHILD} at the household where {he/she} lives.

Could you please give me the name and telephone number for the home that I should call? ECLS-K Closing NA
CMQ.702 We would like to call back when {this person/{CHILD}’s parent or guardian is available. Please tell

me when we should call back. ECLS-K Closing NA CMQ.703 Thank you. ECLS-K Closing NA CMQ.720 PRESS 1 AND ENTER TO SAVE AND EXIT THIS CASE. ECLS-K Closing NA

Page 30 of 30**Section Item #**  **Item Stem Source**  A1 a-d Which of the following subjects do you teach

during this school year? ECLS-K:2011 Grade 3

a. Reading/language arts b. Mathematics c. Science d. Social studies A2 a-j How oftendoes the typical child in your class(es)

usually work on lessons or projects in the following general subject areas, whether as a whole class, in small groups, or in individualized arrangements? a. Reading and language arts b. Mathematics c. Social studies d. Science e. Music f. Art g. Physical education h. Dance/creative movement i. Theatre/creative dramatics j. Foreign language (excluding English for ELL students) ECLS-K

A3 a -j On days when children have work in these areas,

how much time does the typical child in your class(es) usually work on lessons or projects in the following general subject areas? a. Reading and language arts b. Mathematics c. Social studies d. Science e. Music f. Art g. Physical education h. Dance/creative dramatics i. Theatre/creative dramatics j. Foreign language (excluding English for ELL students) ECLS-K 

## Spring Fourth-Grade General Classroom Teacher Questionnaire, Appendix H
**Student, School, and Staff Activities** A4 How many days a week do children have recess? Zero; One; Two; Three; Four; Five; Other/Varies by week ECLS-K

A5 On days when children have recess, between the

school day starting time and the dismissal time, how many times a day do children have recess? One; Two; Three; Four; Five; Other/Varies by day ECLS-K

A6 a-d What percentage of children in your class(es) have

parents who participate in the following activities? a. Attend teacher-parent conferences b. Volunteer regularly to help in your classroom or another part of the school c. Attend open houses or parties d. Attend art/music events or demonstrations ECLS-K

A7 a-i How important is each of the following in

evaluating the children in your class(es) for reporting to parents? a. Individual child's achievement relative to the rest of the class b. Individual child's achievement relative to local, state, or professional standards c. Individual improvement or progress over past performance d. Effort e. Class participation f. Daily attendance g. Classroom behavior or conduct h. Cooperativeness with other children i. Ability to follow directions ECLS-K

Please indicate the extent to which you agree or disagree with each of the following statements about your school. a. The level of child misbehavior ) for example, noise, horseplay, or fighting in the halls or cafeteria) in this school interferers with my teaching. b. Many of the children I teach are not capable of learning the material I am supposed to teach them. c. Parents are supportive of school staff. d. There is a great deal of cooperative effort among the staff members. **Views on School Climate and School**  **Environment** B1 a-h ECLS-Ke. There is a consensus among administrators and teachers on goals and expectations. f. The academic standards at this school are too low. g. The school administrator sets priorities, makes plans, and sees that they are carried out. h. The school administration's behavior toward the staff is supportive and encouraging. B2 a-e To what extent do you agree or disagree with the

following statements ? a . The attitudes and habits students bring to my class ﴾ es ﴿ greatly reduce their chances for academic success
. b
. My success or failure in teaching is due primarily to factors beyond my control rather than to my own effort or ability
. c . The amount a student can learn is primarily related to family background
. d
. I really enjoy my present teaching job
. e . If I could start over, I would choose teaching again as my career
. ECLS-K

**Teacher Background**  C1 What is your gender? ECLS-K

C2 In what year were you born? ECLS-K C3 Are you Hispanic or Latino? ECLS-K C4 Which best describes your race? MARK ONE OR

MORE RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO BE. American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White ECLS-KC5 a-j Counting this school year, how many years have you taught each of the following grades and programs, including years in which you taught part time? a. Preschool or kindergarten b. First grade c. Second grade d. Third grade e. Fourth grade f. Fifth grade g. Sixth grade or higher h. English as a Second Language (ESL), bilingual education, and/or dual language program i. Special education program j. Program for gifted children ECLS-K

C6 Counting this school year, how many total years

have you been a school teacher, including years in which you taught part-time? ECLS-K

C7 Is this school year the first year you have taught in

this school? New C8 What is the highest level of education you have

completed? Did not complete high school; High school diploma or equivalent/GED; Some college or technical or vocational school; Associate's degree; Bachelor's degree; Master's degree; An advanced professional degree beyond a master's degree (for example, Ph.D, MD) ECLS-KC9 a-n If you have an associate's or bachelor's degree, indicate your undergraduate major field of study. a. Early childhood education b. Elementary education c. English d. Reading and/or language arts e. Curriculum and instruction f. Mathematics education g. Mathematics h. Science education i. Life science j. Physical science k. Earth science l. Special education m. Other education-related major (for example, secondary education, educational psychology, administration, music education, etc.) n. Non-education major (for example, history, etc.) ECLS-K

C10 a-n If you have a graduate degree, indicate the major

field of study of your highest level graduate degree. a. Early childhood education b. Elementary education c. English d. Reading and/or language arts e. Curriculum and instruction f. Mathematics education g. Mathematics h. Science education i. Life science j. Physical science k. Earth science l. Special education m. Other education-related major (for example, secondary education, educational psychology, administration, music education, etc.) n. Non-education major (for example, history, etc.) ECLS-KC11 a-d Have you ever taken a college course that addressed issues related to the following? a. Using published research evidence to identify and select effective interventions and supports for students b. Using formal assessment data to inform the choice of READING interventions and supports for students c. Using formal assessment data to inform the choice of MATH interventions and supports for students d. Using data to inform the choice of behavioral interventions and supports for students C12 Which of the following describes the teaching

certificate you currently hold in THIS state? Regular or standard certificate or advanced professional certificate; Certificate issued after satisfying all requirements except the completion of a probationary period; Certificate that requires some additional coursework, student teaching, or passage of a test before regular certification can be obtained; Certificate issued to persons who must complete a certification program in order to continue teaching; I do not hold any of the above certifications in THIS state. ECLS-K

C13 Date questionnaire completed**Construct Research**  **Question 6/10/14 Comments**  Subjects taught TQ3

Use of class time, by subject area TQ1 added (es) in item stem.

Use of class time, by subject area TQ1 added (es) in item stem.Class activities (outside of class)/

recess TQ1 Class activities (outside of class)/ recess TQ1

Parent involvement in school TQ2 added (es) in item stem.

Methods of assessing children's progress TQ1 added (es) in item stem.

School climate TQ4Teacher’s sense of efficacy;Job

satisfaction TQ4

Teacher demographic information TQ4 Teacher demographic information TQ4 Teacher demographic information TQ4 Teacher demographic information TQ4Teaching experience, by grade

and program TQ4

Teaching experience, total years TQ4

First year teaching in this school TQ4 Teacher's education TQ4Teacher's education: major field

of study TQ4

Teacher's education: major field of study TQ4Teacher's education: coursework ;

Response to Intervention-related practices TQ4

Type of teaching certification held TQ4

N/A N/A**Section Item #**  **Item Stem Source** 

**Social Skills** A1 a-z Items focusing on general social skills in the classroom. Items not included due to copyright restrictions (26 items total) SSRS Elementary Scale A; ECLS-K Please indicate how often each of these items applies to the child identified on the cover of this questionnaire. a. Likes to come to school b. Dislikes school c. Has fun at school d. Likes being in school e. Seems unhappy in school f. Enjoys most classroom activities g. Groans or complains about suggested activities **Classroom Behaviors**  B1 a-m Item about classroom behaviors. Items not included due to copyright restrictions (13 items total) TMCQ
For the items below, please think about the friends with whom the child identified on the cover of this questionnaire has associated the most during the past month or two. Please indicate how true you think each of these items is for this group of children. If you cannot answer these items because the child has not usually associated with a group of other children in the past month or two, then mark "Not applicable."

a. This is a good group of kids b. I worry when this child is with this group c. Some of these kids are a bad influence d. These kids must be closely supervised by an adult e. These kids get into trouble f. These kids are excellent students g. These kids are hard workers h. This child has a fun time with this group i. Most of these kids are kind to other children **Peer Relationships** C1 a-i Adapted from Vandell, 2001. 

## Spring Fourth-Grade Reading and Language Arts Teacher Questionnaire, Appendix H
**Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**

A2 a-g Adapted from Ladd & Price, 1987; Ladd, 1990C2 a-I Items asking how often certain statements related to the child's relationships with peers apply to the child. Items not included due to copyright restrictions (9 items total) Adapted from the Child Behavior Scale. Gary W. Ladd, 2010 During this school year, how often have other students
...

a. Teased, made fun of, or called this student names? b. Told lies or untrue stories about this student ? c. Pushed, shoved, slapped, hit, or kicked this student ? d. Intentionally excluded or left this studentout from playing with them? C4 a-d During this school year, how often has this student
...

a. Teased, made fun of, or called other studentsnames? b. Told lies or untrue stories about other students ? c. Pushed, shoved, slapped, hit, or kicked other students ? d. Intentionally excluded or leftother studentsout from playing with him or her? Source: Adapted from Espelage and Holt, 2001

Thinking about the child identified on the cover of this questionnaire compared to a typical child in his/her grade, please evaluate this child in the following areas. a. Understands others' feelings b. Accurately interprets what a peer is trying to do c. Generates good quality solutions to interpersonal problems d. Is aware of the effects of his/her behavior on others C3 a-d Source: Adapted from Espelage and Holt, 2011

C5 a-d Source: Pierce, Hamm, and Vandell, 1999.**Student**

**Information** D1 a-d Are you this child's primary teacher in the following subject areas? a. Reading/language arts b. Mathematics c. Science d. Social studies ECLS-K

D2 How long has this child been in your

reading/language arts class this school year until now? Entire school year until now; More than one semester but less than the entire school year until now; More than one quarter but less than one semester; Less than one quarter of the school year ECLS-K

D3 Please indicate the total number of times this child

has been absent from your reading/language arts class during the current school year. No absences; 1 to 4 absences; 5 to 7 absences; 8 to 10 absences; 11 to 19 absences; 20 or more absences ECLS-K

D4 a-c Does this child receive (or has he/she received

during this school year) instruction in any of the following types of programs in your school? a. Individual tutoring or remedial program in reading/language arts b. Gifted and talented program in reading/language arts c. Gifted and talented program with no specific content focus ECLS-K

D5 Is English this child's native language? ECLS-K D6 Does this child participate in an instructional

program designed to teach English language skills to children with limited English proficiency? ECLS-KD7 Would you say the instruction this child receives is primarily ... **Programs that focus on developing students' literacy in two languages. For example:**  Two-way immersion program or two-way bilingual program; Developmental bilingual program, late exit transitional program, or maintenance bilingual education program; Transitional program, early exit bilingual program, or early exit transitional program; Heritage language program or indigenous language program **Programs that focus on developing students' literacy**  **solely in English . For example:**  Sheltered English instruction or content-based English as a Second Language (ESL) program; Structured English Immersion (SEI); Pull-out English as a Second Language (ESL) or English Language Development (ELD); Push-in ESL program **Other program(s) ( PLEASE SPECIFY)**  **; No specialized language program is provided to**  **this child.** Adapted from the "Types of language instruction educational programs," provided by the National Clearinghouse for English Language Acquisition.

D8 a-c How oftendoes this child usually receive

specialized language instruction of the following program types? a. Program that focuses on developing students' literacy in two languages b. Program that focuses on developing students' literacy solely in English c. Other program ECLS-K

D9 a-c On the days when this child receives specialized

language instruction, for how much time does he/she receive instruction of the following program types? a. Program that focuses on developing students' literacy in two languages b. Program that focuses on developing students' literacy solely in English c. Other program ECLS-KD10 During this school year, how often is this child's reading instructionprovided in his/her native language? None of the time; Less than half of the time; Half of the time; More than half of the time; Almost all the time ECLS-K

D11 Does this child have an IEP on record with the

school? ECLS-K D12 a-b Does this child receive instruction in any of the

following types of programs in your school? a. Speech -language therapy for children with speech or language disorders/impairments b. Special education services, not including speech therapy, whether provided in the classroom or in a pull -out setting ECLS-K

D13 a-d Overall, how would you rate this child’s academic

skills in each of the following areas, based on curriculum standards for his/her current grade level? a. Reading b. Writing c. Oral language d. Social studies ECLS-K

D14 How often does this child work to the best of

her/his ability in READING AND LANGUAGE ARTS? Never; Seldom; Usually; Always ECLS-K

D15 How many instructional groups based on

achievement or ability levels in READING do you currently have in this child's class? I do not use instructional groups for reading; Two; Three; Four; Five or more ECLS-K

D16 In which reading instructional group is this child

currently placed? USE "1" FOR THE HIGHEST INSTRUCTIONAL GROUP. ECLS-K

D17 How involved at the school would you say this

child’s parents/guardians are? Not involved at all; Somewhat involved; Very involved; Don't know ECLS-K

**Part 2: To be completed only** **if there is a red dot next to the child's name on the cover of this questionnaire.**From the first day of school until today, please indicate on how many days you have covered each of the following READING AND LANGUAGE ARTS skills and concepts in this child's class . Please include the time during which you provide direct instruction as well as the time you spend supervising students as they work. **Literature** a. **Understanding key ideas and details**, for example, identifying the main idea or theme; summarizing; describing characters and settings; etc. b. **Understanding craft and structure**, for example, explaining major differences between poems, plays, and prose; comparing the point of view from which different stories are narrated; etc. c. **Integrating knowledge and ideas**, for example, making connections between text and a visual or oral presentation of the text; comparing treatment of similar themes in stories and myths; etc. **Informational Text** d. **Integrating knowledge and ideas**, for example, making connections between text and a visual or oral presentation of the text; comparing treatment of similar themes in stories and myths; etc. e. **Understanding craft and structure**, for example, describing the chronology of events in a text; recognizing cause and effect; comparing different accounts of the same event or topic; etc. f. **Integrating knowledge and ideas**, for example, interpreting how charts, graphs, or timelines relate to the text; integrating information from two texts onb the same topic; etc. **Writing and Language** g. **Writing**narratives, opinion pieces, and informational text with facts and details h. **Developing and strengthening writing**by planning, drafting, revising, and editing i. **Building vocabulary**, for example, studying words and their meanings in text; learning about roots, prefixes, and suffixes; using context clues to derive meaning; etc. **Reading and Language Arts**  **Instruction** E1 a-i ECLS-K, updated to reflect "Common Core State Standards," corestandards.orgE2 a-k How often do the children in this class engage in the following reading and language arts activities ? a . Read silently b
. Read books they have chosen themselves c . Talk with others about what they have read d
. Do a group activity or project about what they have read e . Discuss different interpretations of what they have read f
. Look up vocabulary words and write definitions g . Demonstrate understanding of words by relating them to their opposites ﴾ antonyms ﴿ and to words with similar meanings ﴾synonyms ﴿ h
. When given specific questions, write responses that are at least 3 to 4 sentences long i
. Gather evidence from literary or informational texts ﴾ in books and/or digital sources ﴿ to inform their writing j
. Spend extended time writing and revising text that they have written k
. Edit their classmates ' writing ECLS-K, updated to reflect "Common Core State Standards," corestandards.org

**Classroom and Student**  **Characteristics** F1 a-c As of today’s date, how many children... a. Are currently enrolled in this class? b. Are boys? c. Are girls? ECLS-K

F2 a-e What grade levels are included in this class?

a. 2nd grade or lower b. 3rd grade c. 4th grade d. 5th grade e. 6th grade or higher ECLS-K

F3 How many of the children in this class are repeating

their grade this year? ECLS-K F4 a-b How many children in this class...

a. Are classified as Gifted and Talented? b. Are participating in a Gifted and Talented program? ECLS-K

F5 How many children in this class are absent on an

average day? ECLS-KF6 a-b How many children in this class are below grade level, about on grade level, or above grade level in their English reading skills and in social studies? a. English reading skills? b. Social studies? ECLS-K

F7 At this point in the school year, how would you rate

the behavior of the children in this class? Group misbehaves very frequently and is almost always difficult to handle. Group misbehaves frequently and is often difficult to handle. Group misbehaves occasionally. Group behaves well. Group behaves exceptionally well. ECLS-K

F8 a-d Approximately what percentage of the students in

this class demonstrate the following problems ? a . Have difficulty paying attention in class b
. Lack self-control ﴾ disruptive behavior﴿ c . Are rejected by peers d
. Do not accept authority New. From Abry, Swanson, & Fabes (2012)

F9 How many children in this class have a diagnosed

disability? ECLS-K F10 Do you have any children who are English language

learners in this class? (English language learners are childrenwhose native language is one other than Englishand whose skills in listening, speaking, reading, or writing English are such that they have difficulty understanding school instruction in English.) ECLS-K

F11 How many English language learners (ELLs) do you

have in this class? ECLS-K **Classroom Instruction and**  **Evaluation** G1 a-e In a typical day, how much time do children in this reading and language arts class spend in the following activities? a. Working independently b. Working on individual tasks under teacher direction c. Working with peers under teacher direction d. Working in small groups with teacher e. Teacher lecture with large group and/or large group discussion led by teacher ECLS-K:2011 Grade 1G2 a-b Do any of the following staff members provide direct instruction to students in this reading and language arts class who are struggling or at risk of failurein reading? INCLUDE STAFF OTHER THAN YOURSELF WHO PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL-OUT SETTING. EXCLUDE PARAPROFESSIONALS/AIDES. a. A READING specialist/interventionist who has specialized training in reading instruction b. A special education teacher Adapted from Reading First Impact Study-- Teacher Survey

G3 a-h In this class, how frequently do you or your

students use computers or the following electronic devices for instructional purposes in reading and language arts ? Please include any desktop, laptop, or other computer

-type devices
. a . Computer ﴾ desktop, laptop or other computer-type device such as a tablet﴿ b
. LCD or DLP projector c . Interactive whiteboard ﴾for example, SMART Board , Activboard ﴿ d
. Digital camera ﴾still or video ﴿ e . CD player or MP 3 player/iPod f
. DVD player or VCR g . TV h
. Other electronic devices ( PLEASE SPECIFY) ECLS-K

G4 In an average week, how many days a week is

reading and language arts homework assigned in this class? Please count homework assigned over the weekend as one day. 0 days; 1 day; 2 days; 3 days; 4 days; 5 days ECLS-K

G5 On days when homework is assigned, how much

time do you expect children in this class to spend on homework in reading and language arts? 1 to 10 minutes; 11 to 20 minutes; 21 to 30 minutes; More than 30 minutes ECLS-KG6 a-e In this class, how often do you use a formal assessment in READING for the following purposes? a. To evaluate how well each student is responding to the core curriculum provided in the general education classroom b. To monitor each student's progress on specific skills over the school year c. To identify the deficits in specific skills of struggling students d. To monitor the progress of students who fall below benchmark levels e. To determine whether students need placement in a more or less intensive level of instruction ECLS-K:2011 Grade 1

G7 a-c **For each of the following statements about**

**READING ,**  **indicate how strongly you agree or disagree**  **.** MARK ONE RESPONSE ON EACH ROW
. a . This school has a set of clear, predetermined , grade-level benchmarks ﴾that is, cut scores, goals/targets, or percentiles ﴿ that are used to determine which students are struggling or at risk of failure in reading in fourth grade
. b
. This school has clear, predetermined criteria for determining the level of interventionfourth-grade studentswill receive in reading
. c . This school has clear, predetermined criteria for determining when fourth grade studentsno longer need a reading intervention
. Adapted from WA (RTI) and HB 2136: Spring 2010

**Staff Activities** H1 Did you participate in any professional development within the the last 12 months? ECLS-K:2011 Grade 1H2 a-c How often did you participate in professional development activities covering the following topics in the last 12 months? a. How to use assessment data to identify students who are struggling or at risk of failure in READING b. How to use and apply assessment data to guide READING instruction c. How to implement the READING curriculum Adapted from Reading First Impact Study-- Teacher Survey

H3 a-d Have you received support from any of the

following staff members during the current academic year? a. A school or district staff member whose role is to provide ongoing training and support to classroom teachers in the delivery of effective READING instruction b. A school or district staff member who provides ongoing training and support to classroom teachers in the delivery of effective behavioral supports c. A school or district staff member who supports teachers in collecting, organizing, and managing assessment data d. A school or district staff member who supports teachers in the interpretation and use of assessment data to guide instruction ECLS-K:11 Grade 1

H4 Date Questionnaire Completed:**Construct Research**  **Question** Social skills and approaches to learning TQ5

Social skills and approaches to learning TQ5
Peer relationships TQ5 

## Spring Fourth-Grade Reading and Language Arts Teacher Questionnaire, Appendix H
**Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**

School liking and avoidance TQ5Peer acceptance/exclusion TQ5

Victimization of other students by this student TQ5 Target of victimization by other students TQ5

Peer relationships TQ5Grade/class configuration TQ1

Family mobility TQ3

Attendance TQ3; TQ5

Receipt of remedial or gifted services TQ3; TQ7

Native language other than English TQ2; TQ3 Receipt of instruction for English language learners TQ1; TQ3Receipt of instruction for English

language learners TQ1; TQ3

Receipt of instruction for English language learners TQ1; TQ3

Receipt of instruction for English language learners TQ1; TQ3Receipt of instruction for English

language learners TQ1; TQ3

IEP status TQ3; SEQ1 Receipt of special education services TQ1; TQ3; SEQ1

Comparison to peers: academic skills for current grade level in reading, language arts, and social studies TQ5

Working to the best of one's ability TQ5

Use of achievement grouping: Reading TQ1; TQ3

Placement in achievement grouping: Reading TQ5

Parent involvement in school activities TQ2

**if there is a red dot next to the child's name on the cover of this questionnaire.**Time spent on specific activities

and skills in reading/language arts TQ7Time spent on specific activities

and skills in reading/language arts TQ7

Classroom characteristics: enrollment, gender distribution TQ1; TQ2

Classroom characteristics: grade levels within class TQ2

Classroom characteristics: number of repeaters TQ2; TQ3 Classroom characteristics: number of gifted and talented TQ3

Student absenteeism TQ2Students above or below grade

level in reading/social studies TQ3

Overall behavior of the class TQ2; TQ5

Classroom climate (student difficulties) TQ2; TQ5

Number of students with disabilities TQ3 Number of English language learners TQ3

Number of English language learners TQ3 Proportion of time students spend working independently, small group, large group TQ1Response to Intervention-related

policies and practices TQ6

Availability, use, and adequacy of resources TQ1

Use of homework TQ1

Use of homework TQ1Response to Intervention-related

policies and practices TQ6

Response to Intervention-related policies and practices TQ6

Professional development activities TQ4Professional development

activities; Response to Intervention-related policies and practices TQ6

Response to Intervention-related policies and practices TQ6

N/A**Section Item #**  **Item Stem Source** 

**Student Information**  A1 a-d Are you this child's primary teacher in the following subject areas? a. Reading/language arts b. Mathematics c. Science d. Social studies ECLS-K

A2 How long has this child been in your math class this

school year until now? Entire school year until now; More than one semester but less than the entire school year until now; More than one quarter but less than one semester; Less than one quarter of the school year ECLS-K

A3 Please indicate the total number of times this child

has been absent from your math class during the current school year. No absences; 1 to 4 absences; 5 to 7 absences; 8 to 10 absences; 11 to 19 absences; 20 or more absences ECLS-K

A4 a-b Does this child receive (or has he/she received

during this school year) instruction in any of the following types of programs in your school? a. Individual tutoring or remedial program in mathematics b. Gifted and talented program in mathematics ECLS-K

A5 Is English this child's native language? ECLS-K A6 During this school year, how often is this child's

math instruction provided in his/her native language? None of the time; Less than half of the time; Half of the time; More than half of the time; Almost all the time ECLS-K

A7 Overall, how would you rate this child’s academic

skills in math, based on curriculum standards for his/her current grade level? Below grade level; About on grade level; Above grade level ECLS-K 

## Spring Fourth-Grade Math Teacher Questionnaire, Appendix H
**Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**A8 How often does this child work to the best of her/his ability in MATH? Never; Seldom; Usually; Always ECLS-K

A9 How many instructional groups based on

achievement or ability levels in MATHEMATICS do you currently have in this child's class? I do not use instructional groups for mathematics; Two; Three; Four; Five or more ECLS-K

A10 In which mathematics instructional group is this

child currently placed? USE "1" FOR THE HIGHEST INSTRUCTIONAL GROUP. ECLS-K

**Mathematics Instruction**  From the first day of school until today, please indicate on how many days you have covered each of the following MATHEMATICS skills and concepts in this child ' s class
. Please include the time during which you provide direct instruction as well as the time you spend supervising students as they work
. Please focus on the skill areas that are shown in bold text
. ﴾The unbolded examples are only a sample of things you may do or cover under this skill area
. ﴿ a . **Using operations to solve problems**, for example, solving problems by multiplying or dividing two whole numbers; solving multiple-step word problems that use several different operations; interpreting remainders; finding factor pairs; etc . b
. **Using algebraic thinking**, for example, solving word problems by representing the problem as an equation with a symbol for the unknown number; etc . c . **Understanding place value**, for example, reading and writing multi-digit whole numbers; comparing two numbers based on meanings of the digits in each place ; using understanding of place value to round whole numbers to any place ; etc . d
. **Adding and subtracting multiple-digit numbers** using strategies based on place value and properties of operations **Part 2: To be completed only** **if there is a red dot next to the child's name on the cover of this questionnaire**

B1 a-h ECLS-K, updated to reflect "Common Core State Standards," corestandards.orge. **Understanding fractions**, for example, comparing fractions with different numerators or denominators; adding and subtracting fractions; multiplying fractions by whole numbers; understanding the relationship between decimals and fractions; etc. f. **Solving problems involving measurement**, for example, solving problems involving measures of distance, time, volume, or money; understanding the relative size of units of measurement; finding the area or perimeter of rectangles; etc. g. **Representing and interpreting data**, for example, making line plots or other visuals to display fractions of a unit; using addition and subtraction of fractions to answer questions about a line plot; etc. h. **Drawing and identifying lines and angles**, for example, drawing points, lines, line segments, rays, angles, and perpendicular and parallel lines; recognizing right triangles; understanding lines of symmetry; etc.B2 a-l How often do the children in this class engage in the following mathematics activities ? a . Solve mathematics problems from textbooks or worksheets b
. Solve mathematics problems from the blackboard , whiteboard/SMART Board® , or projector c . Solve mathematics problems in small groups or with a partner d
. Work with measuring instruments ﴾for example, rulers, compasses, protractors ) e . Work with manipulatives ﴾for example, geometric shapes, fraction bars ﴿ f
. Use a calculator g . Take mathematics tests/quizzes h
. Write a few sentences about how to solve a mathematics problem i
. Discuss solutions to mathematics problems with other students j
. Work on and discuss mathematics problems that reflect real-life situations k
. Use a computer for math ﴾ beyond using a computer' s calculator) l
. Create or interpret visual representations ﴾for example, diagrams, graphs, tables, models ﴿ ECLS-K, updated to reflect "Common Core State Standards," corestandards.org

**Classroom and Student**  **Characteristics** C1 a-c As of today’s date, how many children... a. Are currently enrolled in this class? b. Are boys? c. Are girls? ECLS-K

C2 a-e What grade levels are included in this class?

a. 2nd grade or lower b. 3rd grade c. 4th grade d. 5th grade e. 6th grade or higher ECLS-K

C3 How many of the children in this class are repeating

their grade this year? ECLS-K C4 a-b How many children in this class...

a. Are classified as Gifted and Talented? b. Are participating in a Gifted and Talented program? ECLS-K

C5 How many children in this class are absent on an

average day? ECLS-KC6 How many children in this class are below grade level, about on grade level, or above grade level in mathematics skills? ECLS-K

C7 At this point in the school year, how would you rate

the behavior of the children in this class? Group misbehaves very frequently and is almost always difficult to handle; Group misbehaves frequently and is often difficult to handle; Group misbehaves occasionally; Group behaves well; Group behaves exceptionally well. ECLS-K

C8 a-d Items asking the percentage of the students in the

classroom who demonstrate behaviors or characteristics that either disrupt or create a challenging learning environment. Items not included due to copyright restrictions (4 items total). New. From Abry, Swanson, & Fabes (2012)

C9 How many children in this class have a diagnosed

disability? ECLS-K C10 Do you have any children who are English language

learners in this class? (English language learners are childrenwhose native language is one other than Englishand whose skills in listening, speaking, reading, or writing English are such that they have difficulty understanding school instruction in English.) ECLS-K

C11 How many English language learners (ELLs) do you

have in this class? ECLS-K **Classroom Instruction and**  **Evaluation** D1 a-e In a typical day, how much time do children in this math class spend in the following activities? a. Working independently b. Working on individual tasks under teacher direction c. Working with peers under teacher direction d. Working in small groups with teacher e. Teacher lecture with large group and/or large group discussion led by teacher ECLS-K:2011 Grade 1D2 a-b Do any of the following staff members provide direct instruction to students in this math class who are struggling or at risk of failurein math? INCLUDE STAFF OTHER THAN YOURSELF WHO PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL-OUT SETTING. EXCLUDE PARAPROFESSIONALS/AIDES. a. A math specialist/interventionist who has specialized training in MATH instruction b. A special education teacher Adapted from Reading First Impact Study-- Teacher Survey

D3 a-h In this class, how frequently do you or your

students use computers or the following electronic devices for instructional purposes in math ? Please include any desktop, laptop, or other computer

type devices
. a . Computer ﴾ desktop, laptop or other computer-type device such as a tablet﴿ b
. LCD or DLP projector c . Interactive whiteboard ﴾for example, SMART Board , Activboard ﴿ d
. Digital camera ﴾still or video ﴿ e . CD player or MP 3 player/iPod f
. DVD player or VCR g . TV h
. Other electronic devices ( PLEASE SPECIFY) ECLS-K

D4 In an average week, how many days a week is math

homework assigned in this math class? Please count homework assigned over the weekend as one day. 0 days; 1 day; 2 days; 3 days; 4 days; 5 days ECLS-K

D5 On days when homework is assigned, how much

time do you expect children in this class to spend on homework in math? 1 to 10 minutes; 11 to 20 minutes; 21 to 30 minutes; More than 30 minutes ECLS-KD6 a-e In this class, how often do you use a formal assessment in MATH for the following purposes? a. To evaluate how well each student is responding to the core curriculum provided in the general education classroom b. To monitor each student's progress on specific skills over the school year c. To identify the deficits in specific skills of struggling students d. To monitor the progress of students who fall below benchmark levels e. To determine whether students need placement in a more or less intensive level of instruction ECLS-K:2011 Grade 1

D7 a-c For each of the following statements about MATH

indicate how strongly you agree or disagree
. a . This school has a set of clear, predetermined , grade-level benchmarks ﴾that is, cut scores, goals/targets, or percentiles ﴿ that are used to determine which students are struggling or at risk of failure in math in fourth grade
. b
. This school has clear, predetermined criteria for determining the level of intervention fourth-grade studentswill receive in math
. c . This school has clear, predetermined criteria for determining when fourth

-grade studentsno longer need a math intervention
. Adapted from WA (RTI) and HB 2136: Spring 2010

**Staff Activities** E1 Did you participate in any professional development* within the last 12 months? ECLS-K:2011 Grade 1 E2 a-c How often did you participate in professional

development activities covering the following topics in the last 12 months? a. How to use assessment data to identify students who are struggling or at risk of failure in MATH b. How to use and apply assessment data to guide MATH instruction c. How to implement the MATH curriculum Adapted from Reading First Impact Study-- Teacher SurveyE3 a-d Have you received support from any of the following staff members during the current academic year? a. A school or district staff member whose role is to provide ongoing training and support to classroom teachers in the delivery of effective MATH instruction b. A school or district staff member who provides ongoing training and support to classroom teachers in the delivery of effective behavioral supports c. A school or district staff member who supports teachers in collecting, organizing, and managing assessment d. A school or district staff member who supports teachers in the interpretation and use of assessment data to guide instruction ECLS-K:11 Grade 1

E4 Date Questionnaire Completed:**Construct Research**  **Question** Grade/class configuration TQ1

Family mobility TQ3

Attendance TQ3; TQ5

Receipt of remedial or gifted services TQ3; TQ7

Native language other than English TQ2; TQ3 Receipt of instruction for English language learners TQ2; TQ3

Comparison to peers: academic skills for current grade level in math TQ5 **Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**Working to the best of one's

ability TQ5
Use of achievement grouping: mathematics TQ1; TQ3

Placement in achievement grouping: mathematics TQ5
**if there is a red dot next to the child's name on the cover of this questionnaire** Time spent on specific activities and skills in mathematics TQ7Time spent on specific activities

and skills in mathematics TQ7

Classroom characteristics: enrollment, gender distribution TQ1; TQ2

Classroom characteristics: grade levels within class TQ2

Classroom characteristics: number of repeaters TQ2; TQ3 Classroom characteristics: number of gifted and talented TQ3

Students above or below grade level TQ3Student absenteeism TQ2

Overall behavior of the class TQ2; TQ5

Classroom climate (student difficulties) TQ2; TQ5

Number of students with disabilities TQ3 Number of English language learners TQ3

Number of English language learners TQ3 Proportion of time students spend working independently, small group, large group TQ1Response to Intervention-related

policies and practices TQ6

Availability, use, and adequacy of resources TQ1

Use of homework TQ1

Use of homework TQ1Response to Intervention-related

policies and practices TQ6

Response to Intervention-related policies and practices TQ6

Professional development activities TQ4 Response to Intervention-related policies and practices TQ6Response to Intervention-related

policies and practices TQ6

N/A N/A**Section Item #**  **Item Stem Source** 

**Student Information**  A1 a-d Are you this child's primary teacher in the following subject areas? a. Reading/language arts b. Mathematics c. Science d. Social studies ECLS-K

A2 How long has this child been in your science class

this school year until now? Entire school year until now; More than one semester but less than the entire school year until now; More than one quarter but less than one semester; Less than one quarter of the school year ECLS-K

A3 Please indicate the total number of times this child

has been absent from your science class during the current school year. No absences; 1 to 4 absences; 5 to 7 absences; 8 to 10 absences; 11 to 19 absences; 20 or more absences ECLS-K

A4 Is English this child's native language? ECLS-K A5 During this school year, how often is this child's

science instructionprovided in his/her native language? None of the time; Less than half of the time; Half of the time; More than half of the time; Almost all the time ECLS-K

A6 Overall, how would you rate this child’s academic

skills in SCIENCE, based on curriculum standards for his/her current grade level? Below grade level; About on grade level; Above grade level ECLS-K

A7 How often does this child work to the best of

his/her ability in SCIENCE? Never; Seldom; Usually; Always ECLS-K 

## Spring Fourth-Grade Science Teacher Questionnaire, Appendix H
**Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**

**Part 2: To be completed only** **if there is a red dot next to the child's name on the**From the first day of school until today, please indicate on how many days you have covered each of the following SCIENCE skills and concepts in this child ' s class
. Please include the time during which you provide direct instruction as well as the time you spend supervising students as they work
. Please focus on the skill areas that are shown in bold text
. ﴾The unbolded examples are only a sample of things you may do or cover under this skill area
. ﴿ **Fields of Science** a . **Physical science**, for example, understanding electricity, magnetism , energy, waves, chemistry, etc . b
. **Life science**, for example, learning about organisms, life cycles, food chains, ecosystems, etc . c . **Earth science**, for example, learning about rocks and minerals, weather, erosion , water, volcanoes, earthquakes, etc . **Scientific Method** d
. **Observations and hypotheses**, for example, understanding the difference between observations and inferences, formulating predictions that can be tested , etc . e . **Scientific testing**, for example, planning and conducting investigations, measuring using appropriate tools, demonstrating safe behavior, etc . f. **Analysis and conclusions**, for example, analyzing the results of a scientific investigation and determining whether the results support the initial prediction, etc. **Science, Engineering and Technology** g. **Interdependence of science, technology and engineering** , for example, exploring how scientific discoveries lead to the development of new technologies, new technologies lead to new scientific discoveries, etc. h. **Engineering concepts**, for example, identifying a simple design problem that can be solved through the development of an object, tool, process, or system; etc. **Science Instruction** B1 a-h ECLS-K, updated to reflect "Common Core State Standards," corestandards.orgB2 a-l How often do the children in this class engage in the following science activities ? a . Read a science textbook b
. Discuss science in the news c . Generate and test hypotheses d
. Work with other children on a science activity or project e . Use science equipment ﴾ e . g . , magnifying glass, scales, thermometers﴿ f
. Prepare a written science report g . Engage in hands-on activities or investigations in science h
. Talk about measurements and results from children’s hands-on activities i
. Take a science test or quiz j
. Use library resources for science k
. Use computers for science l
. Use the Internet for science ECLS-K, updated to reflect "Common Core State Standards," corestandards.org

**Classroom and Student**  **Characteristics** C1 a-c As of today’s date, how many children... a. Are currently enrolled in this class? b. Are boys? c. Are girls? ECLS-K

C2 a-e What grade levels are included in this class?

a. 2nd grade or lower b. 3rd grade c. 4th grade d. 5th grade e. 6th grade or higher ECLS-K

C3 How many of the children in this class are repeating

their grade this year? ECLS-K C4 a-b How many children in this class...

a. Are classified as Gifted and Talented? b. Are participating in a Gifted and Talented program? ECLS-K

C5 How many children in this class are absent on an

average day? ECLS-K C6 How many children in this class are below grade

level, about on grade level, or above grade level in science skills? ECLS-KC7 At this point in the school year, how would you rate the behavior of the children in this class? Group misbehaves very frequently and is almost always difficult to handle; Group misbehaves frequently and is often difficult to handle; Group misbehaves occasionally; Group behaves well; Group behaves exceptionally well. ECLS-K

C8 Items asking the percentage of the students in the

classroom who demonstrate behaviors or characteristics that either disrupt or create a challenging learning environment. Items not included due to copyright restrictions (4 items total). New. From Abry, Swanson, & Fabes (2012)

C9 How many children in this class have a diagnosed

disability? ECLS-K C10 Do you have any children who are English language

learners in this class? (English language learners are childrenwhose native language is one other than Englishand whose skills in listening, speaking, reading, or writing English are such that they have difficulty understanding school instruction in English.) ECLS-K

C11 How many English language learners (ELLs) do you

have in this class? ECLS-K **Classroom Instruction and**  **Evaluation** D1 a-e In a typical day, how much time do children in this science class spend in the following activities? a. Working independently b. Working on individual tasks under teacher direction c. Working with peers under teacher direction d. Working in small groups with teacher e. Teacher lecture with large group and/or large group discussion led by teacher ECLS-K:2011 Grade 1D2 a-b Do any of the following staff members provide direct instruction to students in this science class who are struggling or at risk of failurein science? INCLUDE STAFF OTHER THAN YOURSELF WHO PROVIDE DIRECT INSTRUCTION EITHER IN THIS CLASS OR IN A PULL-OUT SETTING. EXCLUDE PARAPROFESSIONALS/AIDES. a. A SCIENCE specialist/interventionist who has specialized training in science instruction b. A special education teacher Adapted from Reading First Impact Study-- Teacher Survey

D3 a-h In this class, how frequently do you or your

students use computers or the following electronic devices for instructional purposes in science ? Please include any desktop, laptop, or other computer-type devices
. a . Computer ﴾ desktop, laptop or other computer-type device such as a tablet﴿ b
. LCD or DLP projector c . Interactive whiteboard ﴾for example, SMART Board , Activboard ﴿ d
. Digital camera ﴾still or video ﴿ e . CD player or MP 3 player/iPod f
. DVD player or VCR g . TV h
. Other electronic devices ( PLEASE SPECIFY) ECLS-K

D4 In an average week, how many days a week is

science homework assigned in this class? Please count homework assigned over the weekend as one day. 0 days; 1 day; 2 days; 3 days; 4 days; 5 days; ECLS-K

D5 On days when homework is assigned, how much

time do you expect children in this class to spend on homework in science? 1 to 10 minutes; 11 to 20 minutes; 21 to 30 minutes; More than 30 minutes ECLS-KD6 a-e In this class, how often do you use a formal assessment in SCIENCE for the following purposes? a. To evaluate how well each student is responding to the core curriculum provided in the general education classroom b. To monitor each student's progress on specific skills over the school year c. To identify the deficits in specific skills of struggling students d. To monitor the progress of students who fall below benchmark levels e. To determine whether students need placement in a more or less intensive level of instruction ECLS-K:2011 Grade 1

D7 a-c For each of the following statements about

SCIENCE indicate how strongly you agree or disagree
. a . This school has a set of clear, predetermined , grade-level benchmarks ﴾that is, cut scores, goals/targets, or percentiles ﴿ that are used to determine which students are struggling or at risk of failure in science in fourth grade
. b
. This school has clear, predetermined criteria for determining the level of intervention fourth-grade studentswill receive in science
. c . This school has clear, predetermined criteria for determining when fourth

-grade studentsno longer need a science intervention
. Adapted from WA (RTI) and HB 2136: Spring 2010

**Staff Activities** E1 Did you participate in any professional development* within the last 12 months? ECLS-K:2011 Grade 1 E2 a-c How often did you participate in professional

development activities covering the following topics in the last 12 months? a. How to use assessment data to identify students who are struggling or at risk of failure in SCIENCE b. How to use and apply assessment data to guide SCIENCE instruction c. How to implement the SCIENCE curriculum Adapted from Reading First Impact Study-- Teacher SurveyE3 a-d Have you received support from any of the following staff members during the current academic year? a. A school or district staff member whose role is to provide ongoing training and support to classroom teachers in the delivery of effective SCIENCE instruction b. A school or district staff member who provides ongoing training and support to classroom teachers c. A school or district staff member who supports teachers in collecting, organizing, and managing assessment data d. A school or district staff member who supports teachers in the interpretation and use of assessment data to guide instruction ECLS-K:11 Grade 1

E4 Date Questionnaire Completed:**Construct Research**  **Question** Grade/class configuration TQ1

Family mobility TQ3

Attendance TQ3; TQ5

Native language other than English TQ2; TQ3 Receipt of instruction for English language learners TQ2; TQ3

Comparison to peers: academic skills for current grade level in science TQ5

Working to the best of one's ability TQ5 **Part 1: Please answer the questions in Part 1 about the child identified on the cover of this questionnaire.**Time spent on specific activities

and skills in science TQ7Time spent on specific activities

and skills in science TQ7

Classroom characteristics: enrollment, gender distribution TQ1; TQ2

Classroom characteristics: grade levels within class TQ2

Classroom characteristics: number of repeaters TQ2; TQ3 Classroom characteristics: number of gifted and talented TQ3

Student absenteeism TQ3 Students above or below grade level in science TQ2Overall behavior of the class TQ2; TQ5

Classroom climate (student difficulties) TQ2; TQ5

Number of students with disabilities TQ3 Number of English language learners TQ3

Number of English language learners TQ3 Proportion of time students spend working independently, small group, large group TQ1Response to Intervention-related

policies and practices TQ6

Availability, use, and adequacy of resources TQ1

Use of homework TQ1

Use of homework TQ1Response to Intervention-related

policies and practices TQ7

Response to Intervention-related policies and practices TQ6

Professional development activities TQ4 Professional development activities; Response to Intervention-related policies and practices TQ6Response to Intervention-related

policies and practices TQ6

N/A**Item # Item Stem**  **Source**

1 What is your gender? ECLS-K 2 In what year were you born? ECLS-K 3 Are you Hispanic or Latino? ECLS-K 4 Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO BE. American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White ECLS-K

5 What is the highest level of education you have completed ? Did not complete high school ; High school diploma or equivalent/GED ; Some college or technical or vocational school ; Associate’s degree; Bachelor ' s degree; Master' s degree; An advanced professional degree beyond a master’s degree ﴾for example, Ph
. D
. , MD ﴿ ECLS-K

6 Is this school year the first year you have worked with children in this school? ECLSK:2011 7 Counting this school year, how many totalyears have you been working with children receiving special education or related services in any school, including years in which you worked part time? ECLS-K

8 Counting this school year, how many totalyears have you been working with children in any school, including years in which you worked part time? This would include other assignments such as teaching in a regular classroom or otherwise providing services to children. ECLS-K 

## Spring Fourth-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix H9 a-m Which of the following credentials, licenses, or certificates do

you have for working with children with disabilities ? DO NOT INCLUDE ACADEMIC DEGREES, SUCH AS A BACHELOR ' S DEGREE, MASTER ' S DEGREE OR PH
. D
. a . Emergency credential b
. Provisional or temporary credential c . Disability-specific credential or endorsement d
. Special education credential or endorsement ﴾for more than one disability category﴿ e . General education credential f
. Speech/ language therapy state license or certification g . Physical therapy state license or certification h
. Occupational therapy state license or certification i
. Social work license or certification j
. School psychology license or certification k
. Clinical psychology license or certification l
. Certificate of Clinical Competence m . Other professional license, credential , or endorsement ﴾ PLEASE SPECIFY﴿ ECLS-K

10 Have you taken the exam for National Board for Professional Teaching Standards certification? Not taken; Taken and passed; Taken and have not yet passed; Taken and awaiting test results; Not applicable ECLS-K11 a-r Have you ever taken a college course in the following areas ?

a . Early childhood education b
. Early childhood special education c . Elementary education d
. Child development e . English as a Second Language ﴾ ESL﴿ or teaching English language learners f
. General special education g . Learning disabilities h
. Intellectual disability * i
. Orthopedic impairments j
. Serious emotional disturbance k
. Deafness and hearing l
. Blindness and vision m . Communication disorders n . Infants and toddlers with disabilities o . Physical therapy p . Occupational therapy q . School psychology r . Classroom management ECLS-K

12 a-d Have you ever taken a college course that addressed issues related to the following? a. Using published research evidence to identify and select effective interventions and supports for students b. Using formal assessment data to inform the choice of READING interventions and supports for students c. Using formal assessment data to inform the choice of MATH interventions and supports for students d. Using data to inform the choice of behavioral interventions and supports for students ECLSK:2011 Grade 1

13 Which of the following best describes your current position in this school ? Special education teacher; Special education teacher consultant; General education teacher; Special education classroom aide ; Speech-language pathologist; Physical therapist; Physical therapy assistant or aide ; Occupational therapist; Occupational therapy assistant or aide ; School psychologist; School counselor; School social worker; Other ﴾ PLEASE SPECIFY﴿ ECLS-K14 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? Regular full-time teacher/service provider; Regular part-time teacher/service provider; Itinerant teacher/service provider ﴾that is, your assignment requires you to provide instruction/ related services at more than one school ) ; Long-term substitute ﴾that is, your assignment requires that you fill the role of a teacher on a long

-term basis, but you are still considered a substitute ) ; Teacher aide; Other ﴾ PLEASE SPECIFY﴿ ECLS-K

15 a-e During this school year, where have you worked with children with IEPs ? INCLUDE ONLY CHILDREN WHO ATTEND THIS SCHOOL
. a . In a general education classroom b
. In a special education classroom c . In a non-classroom space ﴾for example, office, therapy room , small work space, mobile van , etc . ﴿ d
. In a location outside of the school setting ﴾for example, a child ' s home, a private clinic, etc . ﴿ e . Other ﴾ PLEASE SPECIFY﴿ ECLS-K

16 a-d Please indicate the extent to which you agree or disagree with each of the following statements. a. I really enjoy my present job. b. I am certain I am making a difference in the lives of the children I work with. c. If I could start over, I would choose this career again. d. I am satisfied with my class size/caseload. ECLS-K

17 During the school year, how many children with IEPs have you worked with or provided services for, on average, each week ? (Include children you work with directly, as well as children for whom you consult with the general education teacher and/or another special education teacher/service provider? 1 -10; 11-20; 21-40; More than 40; Don't know ECLS-K

18 Date questionnaire completed:**Construct Research**  **Question** Teacher demographic information SEQ4 Teacher demographic information SEQ4 Teacher demographic information SEQ4 Teacher demographic information SEQ4

Teacher’s education SEQ4

First year teaching in current school SEQ4 Teaching experience in special education SEQ4

Total years teaching experience SEQ4 

## Spring Fourth-Grade Special Education Teacher Teacher-Level Questionnaire, Appendix HTeaching certification, credentials,

and licenses SEQ4

Teaching certification, credentials, and licenses SEQ4Teacher’s education SEQ4

Teacher’s education; Response to Intervention-related practices SEQ4

Teaching position and assignment SEQ4Teaching position and assignment SEQ4

Locations in which teacher delivers services SEQ1, SEQ3, SEQ5

Teacher’s sense of efficacy;Job satisfaction SEQ4

Teaching student caseload SEQ4, SEQ5

N/A**Item # Item Stem**  **Source**

1 Is this child currently receiving gifted/talented services through an IEP, or has the

child received such services during this school year? ECLS-K 2 Is this child currently receiving special education services through an IEP due to a

disability or has the child received such services during this school year? ECLS-K
3 a-f In what capacity or capacities do you teach or provide services to this child ?

a . Provide instruction directly to the child b
. Provide related services directly to the child c . Provide consultation services directly to the child d
. Provide indirect consultation services ﴾for example, consultation to the child ' s teacher﴿ e . Provide case management f
. Other ﴾ PLEASE SPECIFY﴿ ECLS-K

4 When was this child first determined eligiblefor special education or related

services ? Before kindergarten ; During kindergarten ; During first grade ; During second grade ; During third grade ; During fourth grade ; Other ﴾ PLEASE SPECIFY﴿ ; Don 't know ECLS-K

5 Is this the first school year that the child has been receivingspecial education

services? ECLS-K 6 When did this child first start receivingspecial education or related services?

Before kindergarten; During kindergarten; During first grade; During second grade; During third grade; Other (PLEASE SPECIFY); Don't know ECLS-K

7 To what extent were you involved in planning the transition from last year's

special education program to this year's special education program for this child? Not at all; Somewhat; Extensively ECLS-K

8 To what extent did you communicate with the person(s) who provided special

education for this child last year? Not at all; Somewhat; Extensively; I provided special education for this child last year. ECLS-K

9 Have you reviewed this child’s records related to special education services

provided before this school year? Yes; No, I don't have access to the records; No, I have access to the records, but have not reviewed them; No, I provided special education to this child last year ECLS-K 

## Spring Fourth-Grade Special Education Teacher Child-Level Questionnaire, Appendix H10 What is this child’s primarydisability as identified on the child’s IEP ? PLEASE

SELECT THE CATEGORY BELOW INTO WHICH THE CHILD ' S PRIMARY DISABILITY FITS BEST
. Speech or language impairments; Specific learning disabilities; Emotional disturbance ; Intellectual disability * ; Developmental delay; Visual impairments ﴾ including blindness ﴿ ; Hearing impairments ﴾ including deafness ﴿ ; Orthopedic impairments; Other health impairments; Autism ; Traumatic brain injury; Deaf-blindness; Multiple disabilities ( children included in this categry should be those who have more than one primary disability which do not include deaf

blindness or developmental delay ) ; No classification is given ECLS-K

11 a-n During this school year, for which of the following disabilities has this child

received special education or related services, whether for the child’s primary disability or another of his/ her disabilities ? a . Speech or language impairments b
. Specific learning disabilities c . Emotional disturbance d
. Intellectual disability * e . Developmental delay f
. Visual impairments ﴾ including blindness ﴿ g . Hearing impairments ﴾ including deafness ﴿ h
. Orthopedic impairments i
. Other health impairments j
. Autism k
. Traumatic brain injury l
. Deaf-blindness m . Multiple disabilities ( children included in this category should be those who have more than one primary disability which do not include deaf

- blindness or developmental delay) n . No classification given
. ECLS-K

12 During this school year, has this child received any special education or related

services because of a diagnosed Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD)? ECLS-K **THE REST OF THE ITEMS IN THIS QUESTIONNAIRE REFER TO THIS CHILD'S SPECIAL EDUCATION EXPERIENCE DURING THE CURRENT SCHOOL YEAR** 13 a-p During this school year, which of the following describe(s) the IEP goals for this

child? **Academics** a. Reading b. Mathematics c. Language Arts d. Science **Speech and language** e. Auditory processing f. Listening comprehension g. Oral expression h. Voice/speech articulation i. Language pragmatics **Social** j. Social skills k. General appropriateness of behavior **Life skills** l. Adaptive behavior or self-help skills **Physical/Mobility** m. Fine motor skills n. Gross motor skills o. Orientation and mobility **Other** p. Other (PLEASE SPECIFY) ECLS-K

14 a-m During this school year, which of the following related services have been

provided through the school to this child ? a . Audiology b
. Counseling services c . Occupational therapy d
. Physical therapy e . Psychological services f
. Health services g . Social work services h
. Special transportation i
. Speech or language therapy j
. Orientation services k
. Mobility services l
. Rehabilitation services m . Other ﴾ PLEASE SPECIFY﴿ ECLS-K15 a-n During this school year, has this child received any of the following ?

a . Adaptive physical education b
. Assistance from classroom aides ﴾for example, teacher aide, behavioral assistant, special education aide ﴿ c . Interpreter for the deaf or hard of hearing ﴾ oral or sign ﴿ d
. Teacher used Braille to provide instruction e . Child was taught how to use Braille f
. Teacher used American Sign Language to provide instruction g . Child was taught how to use American Sign Language h
. Teacher used Manual English to provide instruction i
. Child was taught how to use Manual English j
. Teacher used Cued Speech to provide instruction k
. Child was taught how to use Cued Speech l
. Mental health services, personal/group counseling, therapy, or psychiatric care provided to the child m . Tutoring/ remediation from special education teacher n . Training, counseling, and other supports/services provided to this child ' s family ECLS-K

16 During this school year, has this child’s primary placement been a general

education classroom? ECLS-K 17 During this school year, approximately how many hours per weekof direct special

education and related services (that is, service provided directly to the child, from a teacher or another adult) has this child received? ECLS-K

18 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? ECLS-K

19 a-l During this school year, what teaching practices and methods have you and/or

other special education service providers used with this child ? a . One-on-one instruction b
. Small-group instruction c . Large-group instruction d
. Co-teaching ﴾see definition above ﴿ e . Cooperative learning f
. Peer tutoring g . Computer-based instruction h
. Direct instruction i
. Cognitive strategies j
. Self-management k
. Behavior management l
. Instruction received through a sign interpreter ECLS-K20 During this school year, which of the following best describes the curriculum

materials used with this child in thegeneral education classroom? General education curriculum materials were used without modification; General education curriculum materials were used with some modifications; General education curriculum materials were used with substantial modifications; Specially-designed commercial materials were used; Teacher-designed materials were used; Child not in this setting; Don't know ECLS-K

21 During this school year, which of the following best describes the curriculum

materials used with this child in the special educationclassroom/program? General education curriculum materials were used without modification; General education curriculum materials were used with some modifications; General education curriculum materials were used with substantial modifications; Specially-designed commercial materials were used; Teacher-designed materials were used; Child not in this setting; Don't know ECLS-K

22 During this school year, has this child had the assistance of a service animal while

at school? A SERVICE ANIMAL IS ANY GUIDE DOG, SIGNAL DOG, OR OTHER DOG INDIVIDUALLY TRAINED TO PROVIDE ASSISTANCE TO AN INDIVIDUAL WITH A DISABILITY. SERVICE ANIMALS CAN BE USED FULL TIME OR IN-SCHOOL ONLY AS PART OF A PROGRAM SUCH AS ANIMAL ASSISTED THERAPY (AAT). Yes, this child has been assisted by his/her own service dog at school; Yes, this child has been assisted by a service dog provided by a school program; No, this child has not been assisted by a service dog at school; ECLS-K:2011During this school year, which of the following assistive technologies and devices

has this child used ? **Mobility aids** a . Vans, vehicles b
. Wheelchair c . Walker d
. White cane **Communication aids** e . Electronic with voice output ﴾for example, Touch Talker﴿ f
. Electronic without voice output ﴾for example, device with visual display or printed speech output﴿ g . Non-electronic ﴾for example, manual printing board ﴿ **Hearing assistance** h
. Hearing aids i
. FM loops j
. TTYs/TDDs k
. Cochlear implants l
. Real-time captioning **Visual aids** m . Braille texts n . Electronic Braille devices o . Digital texts p . Magnifying devices q . Close-captioned television ﴾ CCTV﴿ **Learning aids (non-computer)** r. Tape recorder s. Calculator t. Electronic spelling devices **Computer hardware designed or adapted for children with disabilities (for example, alternate keyboards, switch interface)**  u. Used solely by individual child v. Shared with other children **Computer software designed for children with disabilities** w. Reading x. Writing y. Mathematics **Other assistive technologies or devices** z. Other (PLEASE SPECIFY) 24 Does this child have a computer, laptop, or word processing device assigned to

him/her for use full time this school year? ECLS-K 23 a-z ECLS-K25 During this school year, on average, how often have you met with general

education teacher﴾s ﴿ to discuss this child ' s program or progress ? Not applicable because I am the child ' s general education teacher; Not applicable to my work with this child ; Every day or several times a week; Once a week or several times a month ; Once a month ; A few times over the school year; Once during this school year; Never during this school year ECLS-K

26 On average, how long were the meetings with the general education teacher﴾s ﴿ to

discuss this child ' s program or progress ? 1 to 15 minutes ; 16 to 30 minutes; 31 to 45 minutes; 46 to 60 minutes; More than 60 minutes ECLS-K

27 During this school year, approximately how often have you communicated with

this child ' s parents about this child ' s program or progress ﴾ by phone, in person , or in writing, including e-mail ﴿ ? Every day or several times a week; Once a week or several times a month ; Once a month ; A few times over the school year; Once during this school year; Never during this school year ECLS-K

28 a-h During this school year, has this child received formal individual evaluations in any

of the following areas for purposes of developing IEP goals ? a . Psychological b
. Speech/ language c . Vision d
. Hearing e . Learning style f
. Motor skills g . Academics h
. Other ﴾ PLEASE SPECIFY﴿ ECLS-K

29 To what extent is this child expected to achieve the same general education goals

as other children at his/her grade level this school year? Child is expected to attain grade level achievement for all of the academic content standards; Child is expected to attain grade level achievement for some of the academic content standards; Child is expected to attain grade level achievement for only a few of the academic content standards; Child is not expected to attain grade level achievement for any of the academic content standards; There are no academic content standards at this grade level; Don't know ECLS-K

30 What percentage of this child's current IEP goals have been met or nearly met at

this point in the school year? 76 to 100 percent; 51 to 75 percent; 26 to 50 percent; 1 to 25 percent; 0 percent ECLS-K31 Which of the following best expresses the likelihood that this child will continue to

receive some level of special education services ﴾through an IEP ﴿ in the next school year? Definitely will continue in special education ; Very likely to continue in special education ; Rather likely to continue in special education ; Rather unlikely to continue in special education ; Very unlikely to continue in special education ; Definitely will **not**continue in special education ( will be dismissed from services ) ECLS-K

32 During this school year, to what extent has this child participated in any

grade-level assessment administered as part of the school's testing program? Child did not participate in the school's testing or assessment program; Child participated in alternate assessments and no regular assessments; Child participated in some alternate assessments and some regular assessments; Child participated fully in the school's regular testing or assessment program; There is no testing or assessment program at this grade level; Don't know ECLS-K

33 Did this child receive special accommodations to participate in the school's regular

testing or assessment program this school year? ECLS-K 34 In which grade is this child enrolled?

Kindergarten; First grade; Second grade; Third grade; Fourth grade; Fifth grade or higher; This child is in an ungraded classroom ECLS-K

35 Date Questionnaire Completed :**Construct Research**  **Question** Child's receipt of services: gifted/talented SEQ1 Child's receipt of services: special education SEQ1
Type of special education services SEQ1

Length of diagnosis and services SEQ7

Age/Grade of first IEP and services for child SEQ7 Age/Grade of first IEP and services for child SEQ7

Transition activities SEQ1

Transition activities SEQ1

Transition activities SEQ1 

## Spring Fourth-Grade Special Education Teacher Child-Level Questionnaire, Appendix HChild’s disability SEQ2

Child’s disability SEQ2

Child's disability SEQ2 **DURING THE CURRENT SCHOOL YEAR .** IEP goals SEQ5

Type of special education services SEQ1, SEQ2Type of special education services SEQ1, SEQ2

Child’s classroom placement SEQ1;SEQ3, SEQ5 Frequency of special education services SEQ1

Frequency of special education services: outside general education classroom SEQ1, SEQ3

Teaching methods and materials SEQ1, SEQ2Teaching methods and materials SEQ1, SEQ2

Teaching methods and materials SEQ1, SEQ2

Teaching methods and materials: assistive technology SEQ1, SEQ2Teaching methods and materials:

assistive technology SEQ5, SEQ7 Teaching methods and materials: assistive technology SEQ2, SEQ5Staff communication SEQ5, SEQ7

Staff communication SEQ5, SEQ7

Parent communication SEQ6

Participation in assessment TQ3, SEQ5, SEQ7

Expectation for achievement of general education goals TQ3, SEQ5

IEP goal achievement SEQ1; SEQ7IEP goal achievement TQ3, SEQ7

Participation in assessment TQ3,SEQ3, SEQ5

Participation in assessment: special accommodations TQ3,SEQ3, SEQ5 Current grade level N/A
N/A N/A**Section Item #** 

**School Characteristics**  A1

A3

A4

A6

A7 

## Spring Fourth-Grade School Administrator Questionnaire For New Schools, Appendix H

A2 a-d

A5A9

A11
B1 a-f **School-Family- Community**  **Connections**

B2 a-b

A10 a-c A8 a-hB3

B4

B8 a-g B7 a-i B6 a-f B5 a-bB11

B12 **School Policies and Practices**  C1

C2 C3

C4 a-d B10 a-k B9 a-fC5

C7

C9

C11

**School Programs for**  **Particular Populations**  D1

C10 a-b C8 a-d C6 a-dD2

D3

D5

D6

D8 a-e D7a-b D4 a-cD9

**Federal Programs: Title**  **I, Adequate Yearly Progress,**  **and Title III**

E1

E2 E3 E4

E5

F2 a-h **Staffing and Teacher**  **Characteristics** F1 a-fF6

F7

F8

**School Administrator**  **Characteristics** G1

G2 F5 a-b F3 a-e

F4 a-bG3

G4

G7

G9

G10 G8 a-f G6 a-f G5 a-cG11

G12

G13

G14**Item Stem Source** 

How many instructional days will this school provide during this academic year? IF THIS IS A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF INSTRUCTIONAL DAYS A GIVEN CHILD WOULD ATTEND.C15 ECLS-K

School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE FOLLOWING. a. Total enrollment in fourth gradein your school around October 1, 2014, or the date nearest to that for which data are available b. Total enrollment for your school (across all grades) around October 1, 2014, or the date nearest to that for which data are available c. Number of children who have enrolled in your school Sicne October 1, 2014 d. Number of children who have left your school since October 1, 2014, and have not returned Approximately, what is the Average Daily Attendancefor your school this year? WRITE IN PERCENT OR NUMBER BELOW. TO CALCULATE PERCENT, DIVIDE THE NUMBER OF STUDENTS ATTENDING ON AN AVERAGE DAY BY THE NUMBER OF STUDENTS ENROLLED AND THEN MULTIPLY BY 100. ECLS-K

Mark all grade levels included in your school. ECLS-K Which of the following characterizes your school? MARK ALL THAT APPLY. Regular public school (not including magnet school) Public magnet school Charter school Catholic school: Diocesan; Parish; Private order Other private school, religious affiliation Private school affiliated with NAIS, no religious affiliation Other private school, no religious or NAIS affiliation Early childhood center (school/center includes preschool and/or early grades) Special education school -- primarily serves chldren with disabilities Year-round school Bureau of Indian Education (BIE) or tribal school IF YOU MARKED "CHARTER SCHOOL" IN Q 15, GO TO Q A6. IF YOU DID NOT MARK "CHARTER SCHOOL," THEN SKIP TO Q A8. In what year did this school start providing instruction as a public CHARTER school? ECLS-K

Which of the following characterizes your public CHARTER school? For profit; Not for profit ECLS-K 

## Spring Fourth-Grade School Administrator Questionnaire For New Schools, Appendix H

ECLS-K

ECLS-KApproximately how many or what percentage of the children in your school belongs to

each of the following racial/ethnic groups? COMPLETE EITHER THE NUMBER OR PERCENT COLUMN. ENTER "0" IF YOUR SCHOOL HAS NO CHILDREN IN THAT RACIAL/ETHNIC GROUP. THE NUMBER COLUMN SHOUD ADD TO YOUR TOTAL SCHOOL ENROLLMENT OR THE PERCENT COLUMN SHOULD ADD TO 100%. a. Hispanic/Latino of any race b. American Indian or Alaska Native, not Hispanic or Latino c. Asian, not Hispanic or Latino d. Black or African American, not Hispanic or Latino e. Native Hawaiian or Other Pacific Islander, not Hispanic or Latino f. White, not Hispanic or Latino g. Two or more races, not Hispanic or Latino h. Total school enrollment (sum of a through g) If your school is a private, magnet, or charter school, please check here and SKIP TO Q A11. ECLS-K:2011 Grade 1
About what percentage of the children enrolled in this school attend from outsideof this school’s assigned attendance area because.... a. They have special needs (gifted and talented, children with disabilities, etc.) and attend to receive a specialized program or service? b. They transferred into the school because their previous school did not make adequate yearly progress (AYP)? (Adequate yearly progress is your state's measure of yearly progress toward achieving state academic standards.) c. They attend this school under public school choice for reasons other than their assigned school did not make AYP (that is, excluding those who are reported in b)? About what percentage of the children enrolled in this school are eligible for free or reduced-price lunch? ECLS-K
Please indicate how often each of the following activities is provided by your school. a. PTA, PTO, or Parent-Teacher-Student organization meetings b. Reports (report cards) of chldren's performance provided to parents c. Information on the child's standardized assessment scores provided to parents d. Teacher-parent conferences e. School performances to which parents are invited f. Classroom programs like class plays, book nights, or family math nights During this school year, how often has your school used the following ways to communicate with all parents ? a. Electronic communication to all parents, such as group emails, electronic newsletters, website postings, "robocalls" (mass automated phone calls), text alerts, or other electronic notices for all parents b. Non-electronic communications to all parents, such as letters, newsletters, phone calls, or other non-electronic messages for all parents ECLS-K

ECLS-K:2011 ECLS-K ECLS-KDuring this school year, has your school used an online tool or website that is available to

the general public and that parents can access withouta login or password? ECLS-K:2011 During this school year, has your school (or any teacher)) used an online tool or website that parents can only access witha login or password to get information about their child, the child's class, or the school? ECLS-K:2011

Have the following types of information been provided in the online tool or website that parents can only access witha login and password? a. Classroom-specific assignments, including homework b. Child- or parent-specific information, such as progress reports between grading periods How much of a problem are the following in the neighborhood where this school is located? a. Tensions based on dracial, ethnic, or religious differences b. Selling or using drugs or excessive drinking in public c. Gangs d. Vacant houses and buildings e. Crime in the neighborhood f. Violence in the neighborhood To the best of your knowledge how often do the following types of problems occur at your school? a. Children bringing weapons to school b. Theft c. Physical conflicts among students d. Children bringing in or using alcohol at school e. Children bringing in or using illegal drugs at school f. Vandalism of school property g. Student bullying h. Widespread disorder in classrooms i. Class cutting Does your school take any of the following measures to ensure the safety of children? a. Security guards, unarmed b. Security guards, armed c. Metal detectors d. Locked doors during the school day e. A requirement that visitors sign in f. Intercoms or telephones in classrooms g. Other (PLEASE SPECIFY) ECLS-K ECLS-K ECLS-K ECLS-K:2011To what extent is each of the following matters a problem in this school? Indicate whether

each is a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a problem in this school. a. Student tardiness b. Student absenteeism c. Student aggressive or disruptive behavior d. Teacher absenteeism e. Teacher turnover f. Overcrowding During the past year, to what extent did any of the following changes occur at your school ? a. Funding levels decreased b. Enrollment increased c. Enrollment decreased d. The number of students receiving free or reduced-price lunch increased e. Student mobility increased (that is, the number of students transferring in and out of the school increased) f. There has been a reduction in staffing g. Class sizes increased h. Class sizes decreased i. Salaries increased j. Salaries decreased k. Number of English language learners increased During the past year, were salaries frozen at your school ? ECLS-K:2011 Grade 1 IF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO C1. IF YOUR SCHOOL IS NOTA PRIVATE, MAGNET OR CHARTER SCHOOL, GO TO Q B12. During the past year, were changes made to your school'sassigned attendance area? ECLS-K:2011 Grade 1 How many third-grade childrenwere retained at their current grade level last school year? ECLS-K
How many fourth-grade childrenwere retained at their current grade level last school year? ECLS-K Is a school-wide positive behavioral intervention and support program (for example, Positive Behavioral Support, Positive Behavioral Intervention System) implemented at your school? Adapted from FRSS 99 Dropout Prevention Services and Programs survey For each of the following statements about READING and MATH, indicate how strongly you agree or disagree. For READING a. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut scores, goals/targets, or percentiles) that are used to determine which students are struggling or at risk of failure in READING. Adapted from WA (RTI) and HB 2136: Spring 2010 ECLS-K ECLS-Kb. At this school, we use data from screening tests to determine if core instruction in

READING is meeting the needs of most of our students. For MATH c. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut scores, goals/targets, or percentiles) that are used to determine which students are struggling or at risk of failure in MATH. d. At this school, we use data from screening tests to determine if core instruction in MATH is meeting the needs of most of our students. Is Response to Intervention (RtI) currently used at your school in fourth grade, either partially or fully implemented? RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING. Adapted from IDEA national Assessment Implementatio n Study (LEA)
Is RtI currently implemented at your school in fourth gradein the following areas? a. Math b. Reading c. Writing d. Behavior/Social skills Approximately how many years ago did your school begin implemementing RtI in fourth gradein any subject? Less than 1 year ago; 1 to 2 years ago; More than 2 years ago ECLS-K:2011 Grade 1 For the 2014-2015 school year, how has your school made information available to parents/guardians to help them understand how RtI is being implemented in your school? a. Communication through written materials such as letters, email, school website, or newsletters b. Communication through workshops, discussion groups, or other meetings such as PTA meetings c. Communication through individual meetings with parents or phone calls d. Information is not distributed on this topic Has your school implemented the Common Core State Standars at any grade(s)? ECLS-K:2011
Are the Common Core State Standares currently implemented at your school infourth gradein the following areas? a. Reading and Language Arts b. Mathematics Approximately how many years ago did your school begin implementing the Common Core State Standards in any grade or subject? Less than 1 year ago; 1 to 2 years ago; More than2 years ago ECLS-K:2011
Do any of the children in this school come from a home where a language other than English is spoken? ECLS-K ECLS-K:2011 Adapted from IDEA national Assessment Implementatio n Study (LEA) Adapted from IDEA national Assessment Implementatio n Study (LEA)What percentage of children in this school are English language learners (ELL)? ECLS-K

What percentage of children in fourth grade are English language learners (ELL)? ECLS-K

Are any of the following services provided to families of children from households where a language other than English is spoken? a. Translators are made available to parents for parent/teacher and parent/school staff meetings and/or meetings are conducted in the parents' non-English language. b. Translations of written communications are provided to these parents. c. Home visits are made to families of these children. Since the beginning of this school year (2014-2015), how many students have been NEWLY evaluated at your school to determine if they are eligible for an IEP? Adapted from IDEA national Assessment Implementatio n Study (LEA)
Of those students who have been NEWLY evaluated at your school this school year (2014- 2015), how many were found eligible for an IEP, including those who may have an IEP for speech only? Adapted from IDEA national Assessment Implementatio n Study (LEA)
What method(s) are used in your school to determine special education ELIGIBILITY for students with learning disabilities? IF A COMBINATION OF THESE METHODS IS USED AT YOUR SCHOOL, MARK YES FOR BOTH A AND B. RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING. a. IQ-achievement discrepancy model which shows whether there is a discrepancy between expected performance and actual performance b. Response to Intervention (RtI) model Approximately what percentage of your fourth-gradersare in each of the following instructional programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND INDICATE IF THE PROGRAM IS NOT OFFERED IN FOURTH GRADEOR IN ANY GRADE IN a. Special education with an Individualized Education Program (IEP) b. Receive accommodations through a 504 plan c. Reading instruction for students performing below grade level in reading ECLS-K Adapted from IDEA national Assessment Implementatio n Study (LEA) ECLS-Kd. Math instruction for students performing below grade level in math

e. A gifted and talented program Where are children with Individualized Education Programs (IEPs) typically served in this school? Children with IEPs are not served in this school; Children with IEPs typically spend most of their day in separate classes; Children with IEPs typically spend most of their day in the regular classroom ECLS-K

The following items pertain to public schools only. IF YOURS IS A PRIVATE SCHOOL CHECK HERE. ECLS-K:2011

Did your school receive Federal Title I funds for this school year? ECLS-K:2011 Is your school operating a Title I targeted assistance or schoolwide program? Targeted assistance program; Schoolwide program ECLS-K:2011 Did your school receive Federal Title III funds for this school year? (Title III is “Language Instruction for Limited English Proficient and Immigrant Students.”) ECLS-K:2011 At the end of the LAST school year (2013-2014), did this school make Adequate Yearly Progress (AYP)? (Adequate Yearly Progress is your state’s measure of yearly progress toward achieving state academic standards.) ECLS-K:2011, based on NCLB Title I regulations At the end of the LAST school year (2013-2014), was this school identified for improvement due to Adequate Yearly Progress (AYP) requirements? (A school is identified for improvement if it does not make Adequate Yearly Progress for two consecutive years or more in the same content area.) ECLS-K:2011, based on NCLB Title I regulations Approximately how many staff members does your school currently have in the following categories? PLEASE PROVIDE RESPONSES IN COLUMN (1) FOR STAFF MEMBERS WHO WORK FULL TIME AT YOUR SCHOOL AND IN COLUMN (2) FOR STAFF WHO WORK PART TIME AT YOUR SCHOOL. IF A STAFF MEMBER IS SHARED WITH OTHER SCHOOLS, COUNT THAT PERSON AS "PART TIME" IN YOUR SCHOOL. PLACE EACH STAFF MEMBER IN ONLY ONE STAFF CATEGORY; IF A STAFF MEMBER FITS MORE THAN ONE CATEGORY, PICK THE CATEGORY MOST DESCRIPTIVE OF HIS/HER WORK. a. Regular classroom teachers b. ESL/bilingual education/language immersion/ELL instruction teachers c. Drama, music, or art teachers d. Gym/PE or health teachers e. Special education teachers and related service providers (for example, speech therapist, physical therapist, adaptive physical education, etc.) f. Paraprofessionals (for example, classroom aides) Does your school currently have any staff members (full- or part-time) in the following categories? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR SCHOOL. a. Teachers of gifted/talented students ECLS-K:2011, Grade 1 ECLS-Kb. Reading specialists and interventionists

c. Math specialists and interventionists d. School nurses or health professionals e. School psychologists or social workers f. Guidance counselors g. Library media specialists/librarians h. Computer/technology teachers or support staff Does your school currently have any staff members who do the following as their primary role or one of their primary roles? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR SCHOOL. ECLS-K
a. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective READING instruction b. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective MATH instruction c. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective behavioral supports d. A school staff member who supports teachers in collecting, organizing, and managing assessment data e. A school staff member who supports teachers in the interpretation and use of assessment data to guide instruction Please indicate the number of regular classroom teachers who have joined or left your school since October 1, 2014. a. Number of regular classroom teachers who have begun teaching in your school since October 1, 2014 b. Number of regular classroom teachers who have left your school since October 1, 2014 Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary schedule used in your school to reward teachers for... a. Improved student performance on state tests? b. Reaching target goals on state tests? Did this school's principal (or head administrator) complete the majority of the previous sections or was the majority completed by someone else? ECLS-K

If a person other than the school's principal (or head administrator ) h as completed the previous sections, please write in the name and title of the person who completed the majority of the sections. ECLS-K
How long has the individual listed above been employed at this school? ECLS-K
What is your gender? ECLS-K
In what year were you born? ECLS-K ECLS-K:2011, Grade 1 ECLS-KAre you Hispanic or Latino? ECLS-K

Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO BE. American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White ECLS-K

How many years of experience do you have in each of the following positions, including years in which you worked part time? a. Years as a teacher before becoming a school administrator b. Total numbers of years as a school administrator c. Number of years as school administrator at this school Through which, if any, of the types of training programs below did you receive preparation for fulfilling your role as a school administrator? a. Traditional university-based training and certification program b. District-based training program (for example, the Boston Principal Fellowship, New York City Leadership Academy's Aspiring Principals Program, Chicago's LAUNCH program) c. City-based training program (for example, Cleveland's First Ring Leadership Academy ) d. State-based training program (for example, New Jersey EXCEL) e. Training and/or certification program run by a national non- profit organization (for example, KIPP School Leadership Program, New Leaders for New Schools) f. Another school administration preparation program What is the highest level of education you have completed? High school diploma or equivalent/GED; Associate's degree; Bachelor's degree; At least one year of coursework beyond a Bachelor's degree but not a graduate degree; Master's degree; Education specialist or professional diploma based on at least one year of coursework past a Master's degree level; Doctorate or an advanced professional degree beyond a Master's degree (for example, MD, EdD) ECLS-K

What was your major field(s) of study in the highest degree you completed? a. Early childhood education b. Elementarty education c. Education administration/management d. Special education e. Other education-related major (such as secondary education, educational psychology, science education, music education, etc.) f. Non-education major (such as history, English, etc.) What is your best estimate of the percentage of children in your school you know by name? Nearly every child; 75% or more; 51% to 75%; 26% to 50%; 25% or less ECLS-K
During school hours, do you speak a language other than English with students at your school whose native language is not English? ECLS-K ECLS-K ECLS-K ECLS-K:2011, Grade KDo you speak a language other than English with students’ families whose native language

is not English? ECLS-K
If you do not speak a language other than English with EITHER students OR students’ families whose native language is not English, mark here and SKIP TO Q G14. ECLS-K What language(s) other than English do you speak with students at your school or with their families? Spanish; Vietnamese; A Chinese language; Japanese; Korean; A Filipino language; Arabic; Other (PLEASE SPECIFY) ECLS-K Date questionnaire completed/Questionnaire completed by: ECLS-K**Construct Research**  **Question** Length of school year SAQ1

Enrollment and attendance SAQ7

School type (grade levels) SAQ2

N/A N/A School type (public/private/affiliation; grades; magnet; etc) SAQ2

School type (public/private/affiliation; grades; magnet; etc) SAQ2 Enrollment and attendance SAQ2

School type (public/private/affiliation; grades; magnet; etc) SAQ2School type

(public/private/affiliation; grades; magnet; etc) SAQ2

Student demographic information:indicator of poverty SAQ2
School-based programs or services for parents and families SAQ3, SAQ4

Parent outreach and communication SAQ3, SAQ4 Student demographic information: transfers from outside attendance area SAQ2 Student demographic information: race/ethnicity distribution SAQ2Parent outreach and

communication SAQ3, SAQ4

Parent outreach and communication SAQ3, SAQ4

Measures taken to ensure school safety SAQ7 School safety SAQ7 Neighborhood problems SAQ6 Parent outreach and communication SAQ3, SAQ4Recent changes at the

school SAQ2

Recent changes at the school SAQ2 Retention policies and practices SAQ2
Retention policies and practices SAQ2Response to Interventionrelated policies and practices SAQ9

Response to Interventionrelated policies and practices SAQ9 Recent changes at the school SAQ2 Enrollment and attendance; School climate; Teacher mobility SAQ7Response to Interventionrelated policies and practices SAQ9

Response to Interventionrelated policies and practices SAQ9

Implementation of Common Core State Standards SAQ10

Implementation of Common Core State Standards SAQ10
Student demographic information: language other than English SAQ2 Implementation of Common Core State Standards SAQ10Response to Interventionrelated policies and practices; parent outreach and communication SAQ9, SAQ3Response to Interventionrelated policies and practices SAQ9Delivery of instruction to

English Language Learners (ELL) and services for language minority (LM) families SAQ2

Delivery of instruction to English Language Learners (ELL) and services for language minority (LM) families SAQ2

Evaluation for IEP SAQ9

Special education eligibility SAQ9

Delivery of special education and related services to children with disabilities SAQ4 Special education eligibility SAQ9 Delivery of instruction to English Language Learners (ELL) and services for language minority (LM) families SAQ5Delivery of special

education and related services to children with disabilities SAQ4

N/A NA

Services and programs: Title I SAQ2 Services and programs: Title I SAQ2 Services and programs: Title III SAQ2 School status relative to Adequate Yearly Progress (AYP) SAQ2

School status relative to Adequate Yearly Progress (AYP) and school improvement SAQ2

Number of staff members and specialists SAQ2Numbers of full- and parttime teachers, specialists, nurses, and paraprofessionals SAQ2Response to Interventionrelated policies and practices SAQ9

N/A N/A

N/A N/A

School administrator demographic information SAQ8

School administrator demographic information SAQ8

School administrator demographic information SAQ8 Teacher mobility SAQ2; SAQ7

Teacher Incentives SAQ2School administrator

demographic information SAQ8

School administrator's experience SAQ8

School administrator's formal education and training SAQ8

School administrator’s use of a non-English language SAQ8
School administrator’s use of a non-English language SAQ8 School administrator’s familiarity with students SAQ8 School administrator's formal education and training SAQ8 School administrator's formal education and training SAQ8School administrator’s

use of a non-English language SAQ8
School administrator’s use of a non-English language SAQ8
School administrator’s familiarity with students SAQ8**Section Item #** 

**School Characteristics** A1

A3

A4

B3

B4 B2 a-b **School-Family-Community Connections**  B1 a-f 

## Spring Fourth-Grade School Administrator Questionnaire For Continuing Schools, Appendix H

A2 a-dB9 a-k B8 a-f B7a-g B5 a-b

B6 a-iB10

B11 **School Policies and Practices** C1 C2

C3

C5

C6 a-d C4 a-dC7

C9

C11
**School Programs for Particular Populations**  D1

D2

D3C10 ab C8 a-dD4

D5

**Federal Programs: Title I and Title III**  E1 E2 E3 D7 a-e D6 a-bF3 a-e F2 a-h **Staffing and Teacher Characteristics**  F1 a-fF6 F7 F8

**School Administrator Characteristics**  G1

G2

G3

G4

G6 a-f G5 a-c F5 a-b F4 a-bG7
G8 a-f

G9

G10**Item Stem Source** 

How many instructional days will this school provide during this academic year? IF THIS IS A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF INSTRUCTIONAL DAYS A GIVEN CHILD WOULD ATTEND. ECLS-K

School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE FOLLOWING. a. Total enrollment in fourth gradein your school around October 1, 2014, or the date nearest to that for which data are available b. Total enrollment for your school (across all grades) around October 1, 2014, or the date nearest to that for which data are available c. Number of children who have enrolled in your school Sicne October 1, 2014 d. Number of children who have left your school since October 1, 2014, and have not returned Approximately what is the Average Daily Attendancefor your school this year? WRITE IN PERCENT OR NUMBER BELOW. TO CALCULATE PERCENT, DIVIDE THE NUMBER OF STUDENTS ATTENDING ON AN AVERAGE DAY BY THE NUMBER OF STUDENTS ENROLLED AND THEN MULTIPLY BY 100. ECLS-K

About what percentage of the children enrolled in this school are eligible for free or reduced-price lunch? ECLS-K
Please indicate how often each of the following activities is provided by your school. a. PTA, PTO, or Parent-Teacher-Student organization meetings b. Reports (report cards) of chldren's performance provided to parents c. Information on the child's standardized assessment scores provided to parents d. Teacher-parent conferences e. School performances to which parents are invited f. Classroom programs like class plays, book nights, or family math nights During this school year, how often has your school used the following ways to communicate with all parents ? a. Electronic communication to all parents, such as group emails, electronic newsletters, website postings, "robocalls" (mass automated phone calls), text alerts, or other electronic notices for all parents b. Non-electronic communications to all parents, such as letters, newsletters, phone calls, or other non-electronic messages for all parents During this school year, has your school used an online tool or website that is available to the general public and that parents can access withouta login or password? ECLS-K:2011 During this school year, has your school (or individual teachers) used an online tool or website that parents can only access witha login or password to get information about their child, the child's class, or the school? ECLS-K:2011 ECLS-K:2011 ECLS-K 

## Spring Fourth-Grade School Administrator Questionnaire For Continuing Schools, Appendix H

ECLS-KHave the following types of information been provided in the online tool or website that

parents can only access witha login and password? a. Classroom-specific assignments, including homework b. Child- or parent-specific information, such as progress reports between grading periods To the best of your knowledge how often do the following types of problems occur at your school? a. Children bringing weapons to school b. Theft c. Physical conflicts among students d. Children bringing in or using alcohol at school e. Children bringing in or using illegal drugs at school f. Vandalism of school property g. Student bullying h. Widespread disorder in classrooms i. Class cutting Does your school take any of the following measures to ensure the safety of children?
a. Security guards, unarmed b. Security guards, armed c. Metal detectors d. Locked doors during the school day e. A requirement that visitors sign in f. Intercoms or telephones in classrooms g. Other (PLEASE SPECIFY) To what extent is each of the following matters a problem in this school? Indicate whether each is a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a problem in this school. a. Student tardiness b. Student absenteeism c. Student aggressive or disruptive behavior d. Teacher absenteeism e. Teacher turnover f. Overcrowding During the past year, to what extent did any of the following changes occur at your school ? a. Funding levels decreased b. The number of students receiving free or reduced-price lunch increased c. There has been a reduction in staffing d. Class sizes increased e. Class sizes decreased f. Salaries increased g. Salaries decreased During the past year, were salaries frozen at your school? ECLS-K ECLS-K ECLS-K ECLS-K:2011

ECLS-KIF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO Q C1. IF YOUR

SCHOOL IS NOTA PRIVATE, MAGNET, OR CHARTER SCHOOL, GO TO Q B11. During the past year, were changes made to your school'sassigned attendance area? How manythird-grade childrenwere retained at their current grade level last school year? How many fourth-grade childrenwere retained at their current grade level last school year? ECLS-K:2011 Grade 1 Is a school-wide positive behavioral intervention and support program (for example, Positive Behavioral Support, Positive Behavioral Intervention System) implemented at your school? For each of the following statements about READING and MATH, indicate how strongly you agree or disagree. ECLS-K:2011 Grade 1 For READING ECLS-K a. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut scores, goals/targets, or percentiles) that are used to determine which students are struggling or at risk of failure in READING. ECLS-K
b. At this school, we use data from screening tests to determine if core instruction in READING is meeting the needs of most of our students. Adapted from FRSS 99 Dropout Prevention For MATH c. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut scores, goals/targets, or percentiles) that are used to determine which students are struggling or at risk of failure in MATH. d. At this school, we use data from screening tests to determine if core instruction in MATH is meeting the needs of most of our students. Is Response to Intervention (RtI) currently used at your school in fourth grade, either partially or fully implemented? RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING. Is RtI currently implemented at your school in fourth gradein the following areas? a. Math b. Reading c. Writing Adapted from IDEA national Assessment Implementatio n Study (LEA)
d. Behavior/Social skills Adapted from IDEA national Adapted from WA (RTI) and HB 2136: Spring 2010Approximately how many years ago did your school begin implemementing RtI in fourth

grade in any subject? Less than 1 year ago; 1 to 2 years ago; More than 2 years ago For the 2014-2015 school year, how has your school made information available to parents/guardians to help them understand how RtI is being implemented in your school? a. Communication through written materials such as letters, email, school website, or newsletters b. Communication through workshops, discussion groups, or other meetings such as PTA meetings c. Communication through individual meetings with parents or phone calls New
d. Information is not distributed on this topic Has your school implemented the Common Core State Standars at any grade(s)? Are the Common Core State Standares currently implemented at your school in fourth grade in the following areas? a. Reading and Language Arts b. Mathematics Approximately how many years ago did your school begin implementing the Common Core State Standards in any grade or subject? Less than 1 year ago; 1 to 2 years ago; More than 2 years ago New
Do any of the children in this school come from a home where a language other than English is spoken? What percentage of children in this school are English language learners (ELL)? What percentage of children infourth grade are English language learners (ELL)? Since the beginning of this school year (2014-2015), how many students have been NEWLY evaluated at your school to determine if they are eligible for an IEP? New Of those students who have been NEWLY evaluated at your school this school year (2014- 2015), how many were found eligible for an IEP, including those who may have an IEP for speech only? ECLS-K What method(s) are used in your school to determine special education ELIGIBILITY for students with learning disabilities? IF A COMBINATION OF THESE METHODS IS USED AT YOUR SCHOOL, MARK YES FOR BOTH A AND B. RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION SETTING. ECLS-K

a. IQ-achievement discrepancy model which shows whether there is a discrepancy between expected performance and actual performance ECLS-K New Adapted from IDEA national Assessment Implementatio n Study (LEA) IDEA national Assessment Implementatio n Study (LEA)b. Response to Intervention (RtI) model Adapted from IDEA national Assessment Implementatio n Study (LEA)
Approximately what percentage of your fourth-graders are in each of the following instructional programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND INDICATE IF THE PROGRAM IS NOT OFFERED IN FOURTH GRADE OR IN ANY GRADE IN YOUR SCHOOL. Adapted from IDEA national Assessment Implementatio n Study (LEA)
a. Special education with an Individualized Education Program (IEP)

b. Receive accommodations through a 504 plan c. Reading instruction for students performing below grade level in reading d. Math instruction for students performing below grade level in math ECLS-K
e. A gifted and talented program The following items pertain to public schools only. IF YOURS IS A PRIVATE SCHOOL CHECK HERE. Did your school receive Federal Title I funds for this school year? Is your school operating a Title I targeted assistance or schoolwide program? Targeted assistance program; Schoolwide program Did your school receive Federal Title III funds for this school year? (Title III is “Language Instruction for Limited English Proficient and Immigrant Students.”) Approximately how many staff members does your school currently have in the following categories? PLEASE PROVIDE RESPONSES IN COLUMN (1) FOR STAFF MEMBERS WHO WORK FULL TIME AT YOUR SCHOOL AND IN COLUMN (2) FOR STAFF WHO WORK PART TIME AT YOUR SCHOOL. IF A STAFF MEMBER IS SHARED WITH OTHER SCHOOLS, COUNT THAT PERSON AS "PART TIME" IN YOUR SCHOOL. PLACE EACH STAFF MEMBER IN ONLY ONE STAFF CATEGORY; IF A STAFF MEMBER FITS MORE THAN ONE CATEGORY, PICK THE CATEGORY MOST DESCRIPTIVE OF HIS/HER WORK. a. Regular classroom teachers ECLS-K b. ESL/bilingual education/language immersion/ELL instruction teachers ECLS-K c. Drama, music, or art teachers ECLS-K Adapted from IDEA national Assessment Implementatio n Study (LEA)d. Gym/PE or health teachers

e. Special education teachers and related service providers (for example, speech therapist, physical therapist, adaptive physical education, etc.) f. Paraprofessionals (for example, classroom aides) Does your school currently have any staff members (full- or part-time) in the following categories? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR SCHOOL. a. Teachers of gifted/talented students b. Reading specialists and interventionists c. Math specialists and interventionists d. School nurses or health professionals
e. School psychologists or social workers f. Guidance counselors g. Library media specialists/librarians h. Computer/technology teachers or support staff Does your school currently have any staff members who do the following as their primary role or one of their primary roles? INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF MEMBERS AT YOUR SCHOOL. a. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective READING instruction b. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective MATH instruction c. A school staff member who provides ongoing training or support to classroom teachers in the delivery of effective behavioral supports d. A school staff member who supports teachers in collecting, organizing, and managing assessment data e. A school staff member who supports teachers in the interpretation and use of assessment data to guide instruction Please indicate the number of regular classroom teachers who have joined or left your school since October 1, 2014. a. Number of regular classroom teachers who have begun teaching in your school since October 1, 2014 b. Number of regular classroom teachers who have left your school since October 1, 2014, and have not reurned Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary schedule used in your school to reward teachers for... New ECLS-K ECLS-Ka. Improved student performance on state tests?

b. Reaching target goals on state tests? Did this school's principal (or head administrator) complete the majority of the previous sections or was the majority completed by someone else? If a person other than the school's principal (or head administrator) has completed the previous sections, please write in the name and title of the person who completed the majority of the sections. How long has the individual listed above been employed at this school? What is your gender? In what year were you born? ECLS-K Are you Hispanic or Latino? ECLS-K Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT YOU CONSIDER YOURSELF TO BE. American Indian or Alaska Native; Asian; Black or African American; Native Hawaiian or Other Pacific Islander; White ECLS-K

How many years of experience do you have in each of the following positions, including years in which you worked part-time? ECLS-K
a. Years as a teacher before becoming a school administrator ECLS-K
b. Total numbers of years as a school administrator ECLS-K
c. Number of years as school administrator at this school ECLS-K
Through which, if any, of the types of training programs below did you receive preparation for fulfilling your role as a school administrator? a. Traditional university-based training and certification program b. District-based training program (for example, the Boston Principal Fellowship, New York City Leadership Academy's Aspiring Principals Program, Chicago's LAUNCH program) c. City-based training program (for example, Cleveland's First Ring Leadership Academy ) d. State-based training program (for example, New Jersey EXCEL) e. Training and/or certification program run by a national non- profit organization (for example, KIPP School Leadership Program, New Leaders for New Schools) f. Another school administration preparation program ECLS-K:2011, Grade K ECLS-K ECLS-K ECLS-KWhat is the highest level of education you have completed? High school diploma or

equivalent/GED; Associate's degree; Bachelor's degree; At least one year of coursework beyond a Bachelor's degree but not a graduate degree; Master's degree; Education specialist or professional diploma based on at least one year of coursework past a Master's degree level; Doctorate or an advanced professional degree beyond a Master's degree (for example, MD, EdD) What was your major field(s) of study in the highest degree you completed? a. Early childhood education b. Elementarty education c. Education administration/management ECLS-K
d. Special education e. Other education-related major (such as secondary education, educational psychology, f. Non-education major (such as history, English, etc.) What is your best estimate of the percentage of children in your school you know by name? Nearly every child; 75% or more; 51% to 75%; 26% to 50%; 25% or less During school hours, do you speak a language other than English with students at your school whose native language is not English? Do you speak a language other than English with students’ families whose native language is not English? If you do not speak a language other than English with EITHER students OR students’ families whose native language is not English, mark here and SKIP TO Q G1 4
. What language(s) other than English do you speak with students at your school or with their families? Spanish; Vietnamese; A Chinese language; Japanese; Korean; A Filipino language; Arabic; Other (PLEASE SPECIFY) ECLS-K Date questionnaire completed/Questionnaire completed by: ECLS-K ECLS-K**Construct Research**  **Question** Length of school year SAQ1

Enrollment and attendance SAQ7

Student demographic information:indicator of poverty SAQ2

Parent outreach and communication SAQ3, SAQ4

Parent outreach and communication SAQ3, SAQ4 Parent outreach and communication SAQ3, SAQ4 School-based programs or services for parents and families SAQ3 Enrollment and attendance SAQ2SAQ3, SAQ4

Recent changes at the school SAQ2 Enrollment and attendance; School climate; Teacher mobility SAQ7 SAQ7

Measures taken to ensure school safety SAQ7 Parent outreach and communication

School safetyRecent changes at the

school SAQ2 N/A N/A
Recent changes at the school SAQ2 Retention policies and practices SAQ2 Retention policies and practices SAQ2
Response to Interventionrelated policies and practices SAQ9

Response to Interventionrelated policies and practices SAQ9

Response to Interventionrelated policies and SAQ9Response to Interventionrelated policies and practices SAQ9Response to Interventionrelated policies and practices SAQ9

Implementation of Common Core State Standards SAQ10

Implementation of Common Core State Standards SAQ10
Student demographic information: language other than English SAQ2
Delivery of instruction to English Language Learners (ELL) and services for language minority (LM) families SAQ2

Delivery of instruction to English Language Learners (ELL) and services for language minority (LM) families SAQ2 Implementation of Common Core State Standards SAQ10Response to Interventionrelated policies and practices; parent outreach and communication SAQ9, SAQ3 related policies and practicesEvaluation for IEP SAQ9

Special education eligibility SAQ9

N/A N/A

Services and programs: Title I SAQ2 Services and programs: Title I SAQ4 Services and programs: Title III SAQ2 Delivery of special education and related services to children with disabilities SAQ4 Special education eligibility SAQ9Response to Interventionrelated policies and practices SAQ9Numbers of full- and parttime teachers, specialists, nurses, and paraprofessionals SAQ2 Total number of full- and part-time teachers, specialists, nurses, and paraprofessionals SAQ2N/A N/A

N/A N/A N/A N/A

School administrator demographic information SAQ8

School administrator demographic information SAQ8

School administrator demographic information SAQ8

School administrator demographic information SAQ8

School administrator's formal education and training SAQ8 School administrator's experience SAQ8 Teacher Incentives SAQ2 Teacher mobility SAQ2; SAQ7School administrator's

formal education and training SAQ8

School administrator’s familiarity with students SAQ8 School administrator's formal education and training SAQ8