1

TEACHER AND COUNSELOR SURVEY

Survey Instructions

The Corporation for National and Community Service (CNCS), with its contractor [TBD], is conducting a study of the 

School Turnaround AmeriCorps program, a partnership between CNCS and the Department of Education. The purpose of 

the study is to learn about how School Turnaround AmeriCorps programs are being implemented and how they are 

helping schools improve. 

You have been selected to complete a survey as part of the study. Your perspective is very important, so please answer 

honestly. Your participation in this study is completely voluntary. Refusing to participate will not involve any penalty or 

affect your AmeriCorps status/employment in any way. It also will have no effect on your relationship with your school. 

It should take you approximately 30 minutes to complete the survey. We understand that your school may have 

interactions with multiple AmeriCorps programs. Answer the questions based only on your experience with the School 

Turnaround AmeriCorps program at your school this year.

All responses are anonymous and your responses will be kept confidential to the extent provided by law. Under no 

circumstances will anyone from your AmeriCorps program/school have access to any information that can be 

attributable to you. The information you provide in the survey will be summarized with the information from other 

respondents and included in a report that will be shared with your School Turnaround AmeriCorps program and with 

CNCS.

Please contact XXXX of XXXX, at XXX-XXX-XXXX or XXXX, if you have any questions regarding this research. 

[Note: Most questions will be asked at both grantee and comparison schools, though questions asking specifically about 

School Turnaround AmeriCorps will only be asked at grantee schools. Most, but not all, questions will be asked at both 

the beginning and the end of the school year.]
2

1. What is your current position at the school? ______________________________________________________

2. Which subjects do you teach? (Check all that apply.)

___ Mathematics

___ Reading

___ English Language Arts

___ Science, e.g. Biology, Chemistry, Physics, Environmental Science

___ Social Studies

___ Foreign languages

___ Computer Science

___ Elective (art, music, computer technology/literacy, home economics, shop, etc.)

___ Physical Education/Health

___None: I am a counselor

___ Other, please specify: _______________________________________________________________________________

3. What grades do you work with? (Check all that apply.)

___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10 ___11 ___12

4. How many years total have you worked at this school, including this year? _____

 (If this is your first year at this school, enter 1.)

5. Across all your responsibilities, approximately how many students did you work with this year? _____

6. What is your average classroom size? _____

(If not applicable, enter NA) 

7. Approximately how many of the students you worked with were involved in School Turnaround AmeriCorps 

programming? 

Please enter the percentage OR number of students, of all the students you worked with.

Percentage of students: _____% OR Number of students: _____ If you don’t know, check here: ___

8. To the best of your knowledge, what mechanisms did the school use to identify students for activities led by School 

Turnaround AmeriCorps members? (Check all that apply.)

___ Teacher recommendation

___ Counselor recommendation

___ Parent request

___ Student request

___ Standardized test scores

___ Grades

__ Other, please specify: ________________________________________________________________________________

9. To the best of your knowledge, what are the reasons that students were identified to participate School Turnaround 

AmeriCorps programming? (Check all that apply.)

__ Improve academic achievement (standardized test scores and/or grades)

__ Improve academic engagement (attendance, interest in school)

__ Assist students at risk for dropping out

__ Improve self-esteem or socio-emotional health

__ Improve behavior

__ Sustain performance

__ Other, please specify: ________________________________________________________________________________
3

10. To the best of your knowledge, did School Turnaround AmeriCorps members provide direct services to individual 

students or to the whole classroom or school? (Check all that apply.)

__ AmeriCorps programming was targeted to individual students

__ AmeriCorps programming supported the whole classroom

__ AmeriCorps programming supported all students in the school

11. Do you know which students were served by School Turnaround AmeriCorps members? 

Yes: _____ No: _____ Sometimes but not always: _____ 

12. What do you consider to be the most important school turnaround outcomes for students over the next two years? 

(Check all that apply.)

___ Enhanced academic achievement

___ Improved grades

___ Improved completion of assignments

___ Increased motivation

___ Increased self-esteem

___ Improved attendance

___ Improved socio-emotional health

___ Improved behavior

___ Other: ___________________________________________________________________________________________

13. Please fill in the following table about school improvement outcomes for students.

Was there improvement in this area 

for one or more of your students at 

your school this year?

If you marked “Yes,” what were the outcomes 

with the greatest degree of improvement, 

across students? 

Rank, with 1=Greatest improvement. Do not 

rank outcomes where you marked “No.”

Enhanced academic achievement, as 

measured by interim progress or unit 

assessments

___Yes ___No

Improved grades ___Yes ___No

Improved completion of assignments ___Yes ___No

Increased motivation ___Yes ___No

Increased self-esteem ___Yes ___No

Improved attendance ___Yes ___No

Improved socio-emotional health ___Yes ___No

Improved behavior ___Yes ___No

Other: __________________________ ___Yes ___No

14. Please indicate the level of agreement/disagreement with the following statements about teacher relationships with 

School Turnaround AmeriCorps members. (Mark one response in each row.)

Strongly 

Disagree Disagree Agree

Strongly 

Agree

Not 

Applicable

a. Teachers in this school are supportive of the 

AmeriCorps program.

b. Teachers in this school share and discuss instructional 

practices with AmeriCorps members.

c. Teachers in this school share and discuss behavioral 

management strategies with AmeriCorps members.
4

d. Teachers in this school discuss their expectations for 

students with AmeriCorps members.

e. Teachers and AmeriCorps members successfully 

collaborate to support students.

15. Please indicate your level of agreement/disagreement with the following statements about your school this year. (Mark 

one response in each row.)

My school ... Strongly 

Disagree Disagree Agree Strongly Agree

Don’t 

Know

Not 

Applic

able

a. Offers students a supportive and inviting environment 

within which to learn.

b. Sets high standards for academic performance for all 

students.

c. Prompts academic success for all students.

d. Emphasizes helping students academically when they 

need it.

e. Provides adequate counseling and support services for 

students.

f. Emphasizes teaching lessons in ways relevant to students.

g. Offers staff a supportive and inviting environment within 

which to work.

h. Promotes trust and collegiality among staff.

i. Provides the materials, resources, and training 

(professional development) needed to do your job 

effectively.

j. Provides the materials, resources, and training 

(professional development) needed to work with special 

education (IEP) students.

k. Encourages opportunities for students to decide things 

like class rules.

l. Gives all students equal opportunity to participate in 

classroom discussions or activities.

m. Gives all students equal opportunity to participate in a 

variety of extracurricular activities.

n. Gives all students equal opportunity to participate in a 

variety of enrichment activities.

o. Gives students opportunities to “make a difference” by 

helping other people, the school, or the community (e.g., 

service learning).

p. Encourages students to enroll in rigorous courses (such as 

honors and AP), regardless of race, ethnicity, or 

nationality.

q. Emphasizes using instructional materials that reflect the 

culture or ethnicity of our students.

r. Has staff examine their own cultural biases through 

professional development.

s. Considers closing the racial/ethnic achievement gap a 

high priority.

t. Fosters an appreciation of student diversity and respect 

for one another.

u. Emphasizes showing respect for all students’ cultural 

beliefs and practices.
5

My school ... Strongly 

Disagree Disagree Agree Strongly Agree

Don’t 

Know

Not 

Applic

able

v. Clearly communicates to students the consequences of 

breaking school rules.

w. Handles discipline problems fairly.

x. Effectively handles student discipline and behavioral 

problems.

y. Is a safe place for students.

z. Is a safe place for staff.

aa. Is welcoming to and facilitates parent involvement.

bb. Makes information and resources available to 

parents/guardians about how they can support their 

children’s education.

cc. Has clean and well-maintained facilities and property

dd. Has sufficient teaching staff to meet the needs of 

students.

ee. Has sufficient support staff to meet the needs of students.

16. Please indicate the level of agreement/disagreement with the following statements about community involvement and 

partnerships with your school. (Mark one response in each row.) 

This school works with organizations in the community to ... Strongly 

Disagree Disagree Agree

Strongly 

Agree

Not 

Applicable

a. Provide academic enrichment, extended learning time or other 

academic supports to students.

b. Make appropriate support services available to students with 

special needs.

c. Deliver wraparound services and non-academic (social/emotional)

supports to students.

d. Increase awareness about and access to health resources/services 

(e.g. targeting drug use, mental health, teen pregnancy).

e. Expose students to post-secondary education opportunities and 

increase student interest in and knowledge about college.

f. Connect parents/guardians to information and resources to help 

them support their children’s education.

17. Please indicate whether the following topics represent challenges in your school this year. (Mark one response in each 

row.)

Not a challenge Moderate 

Challenge

Severe Challenge

a. Student academic performance

b. Student behavior and discipline

c. Student engagement in school

d. Student attendance

e. Student safety

f. Student aspirations for college and/or career

g. Student fatigue/lack of sleep

h. Student alcohol and drug use

i. Student tobacco use

j. Harassment or bullying among students

k. Physical fighting between students
6

Not a challenge Moderate 

Challenge

Severe Challenge

l. Disruptive student behavior

m. Racial/ethnic conflict among students

n. Student depression or other mental health problems

o. Lack of respect of staff by students

p. Cutting classes or being truant

q. Gang-related activity

r. Weapons possession

s. Vandalism (including graffiti)

t. Theft

18. Please indicate the level of agreement/disagreement with the following statements about your school. (Mark one 

response in each row.)

Strongly 

Disagree Disagree Agree

Strongly 

Agree

Not 

Applicable

a. [G,C] Students take their school work seriously.

b. [G,C] Students treat each other with respect.

c. [G,C] Students treat teachers with respect.

d. [G] Students treat AmeriCorps members with respect.

e. [G,C] There is communication and collaboration 

between teachers and other school staff.

f. [G,C] Families play an active role in our school.

g. [G] AmeriCorps members offer supports that are 

beneficial to the teachers in this school.

h. [G] AmeriCorps members provide helpful support to the 

students in this school.

i. [G] AmeriCorps activities occur frequently enough to be 

valuable.

j. [G] AmeriCorps members are important partners in 

improving student outcomes.

19. For this school year, please indicate the level of satisfaction/dissatisfaction with each of the elements listed below:

Very 

Dissatisfied Dissatisfied Satisfied

Very 

Satisfied

Not 

Applicable

a. Overall quality of AmeriCorps programming.

b. Communication and collaboration between teachers 

and AmeriCorps members.

c. Implementation of the roles and responsibilities 

outlined in the school partnership agreements

d. Placement of members in meaningful service activities

e. Referral of students to receive services offered by 

AmeriCorps members

f. Matching of members to students in need of academic 

strengthening and social/emotional supports

20. In your opinion, how successful was the School Turnaround AmeriCorps program in the following areas this year? (Mark 

one response in each row.)

Very 

Unsuccessful

Somewhat 

Unsuccessful

Somewhat 

Successful

Very 

Successful
7

g. Overall success of the AmeriCorps program

h. AmeriCorps program’s success in improving student 

academic achievement

i. AmeriCorps program’s success in improving student socioemotional health

j. AmeriCorps program’s success in improving school climate

k. AmeriCorps program’s success in improving the school’s 

capacity to implement its turnaround model
8

TEACHER EVALUATION OF IMPROVEMENT 

Thinking about the student whose last name is closest to the beginning of the alphabet, and the student whose last name is 

closest to the end of the alphabet, please complete the following for those two students.

21. Since beginning to work with a School Turnaround AmeriCorps member(s), to what extent has your student changed his 

or her behavior in terms of:

Student #1:

Significant 

Decline

Moderate 

Decline

No Change Moderate 

Improvement

Significant 

Improvement

Did not Need 

to Improve

a. Turning in his/her 

homework on time.

b. Completing

homework to your 

satisfaction.

c. Participating in 

class.

d. Volunteering (e.g., 

for extra credit or 

more 

responsibilities).

e. Attending class 

regularly.

f. Being attentive in 

class.

g. Coming to school 

motivated to learn.

h. Getting along well 

with other students.

 Student#2:

Significant 

Decline

Moderate 

Decline

No Change Moderate 

Improvement

Significant 

Improvement

Did not Need 

to Improve

a. Turning in his/her 

homework on time.

b. Completing 

homework to your 

satisfaction.

c. Participating in 

class.

d. Volunteering (e.g., 

for extra credit or 

more 

responsibilities).

e. Attending class 

regularly.

f. Being attentive in 

class.

g. Coming to school 

motivated to learn.

h. Getting along well 

with other students.