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pdfPre-Elementary Education Longitudinal Study
Kindergarten Teacher
Questionnaire
KINDERGARTEN
school
ELEMENTARY
W4
Pre
school
S
PE E
L
Funded by the U.S. Department of Education
Institute of Education Sciences
National Center for Special Education Research
W4
Pre-Elementary Education Longitudinal Study
Kindergarten Teacher
Questionnaire
Who should complete this questionnaire?
Your school district is participating in an important U.S. Department of Education study called
the Pre-Elementary Education Longitudinal Study (PEELS). The child named on the label is one
of more than 3,000 children nationwide who are taking part in PEELS.
The study will follow the children as they move through kindergarten and into the early
elementary school years. This questionnaire is the only source of information about the
kindergarten programs and experiences for this child. Because of this, your opinions are
vitally important.
Please complete this questionnaire and return it in the postage-paid envelope within 3 weeks.
Answer all questions to the best of your knowledge and use your best guess when answering
questions for which you are not quite sure of the answer. However, try as best you can to
avoid responses that represent complete guesses. If necessary, please consult with colleagues
in answering questions. Be assured that your answers will be confidential, and no information
will be reported that identifies you, this child, or this school. We have enclosed $10 as a token
of our appreciation.
Before beginning this questionnaire, you may want to gather the following information so that
you will be able to complete the questionnaire more quickly:
●
●
●
The school file for the child whose name is on the label, including, if applicable, the most
recent Individualized Education Program (IEP);
Attendance records for this child during October of this school year; and
Child’s previous school records.
If you have any questions about the study or the questionnaire, please feel free to call the PEELS
toll-free hot line at 1-888-534-8348, send an email to questions@peels.org, or visit the PEELS web
site at www.peels.org.
Thank you so much for your contribution to this very important study.
Sincerely,
Elaine Carlson
Project Director, PEELS
Questions?
Dear Teacher:
Call the PEELS
toll-free hot line:
1-888-534-8348
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number.
The valid OMB control number for this information collection is 1850-0809. The time required to complete this information collection is estimated to average 20 minutes per
response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any
comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington,
D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: National Center for Special
Education Research, Institute of Education Sciences, U.S. Department of Education, 555 New Jersey Ave., NW, Washington, D.C. 20208.
OMB Control # 1850-0809, Expiration date: 1/31/08
This questionnaire should be completed by the teacher or service provider who knows the child
whose name appears on the label above and can describe the kindergarten program or special
education and related services for this child.
●
Can you tell us about the child whose name appears on the label?
1
2
●
No
Can you tell us about this child’s kindergarten program?
1
2
●
Yes
Yes
No
Can you tell us about special services this child receives (e.g., speech therapy)?
1
2
Yes
No
If you answered NO to ALL three questions:
DO NOT COMPLETE THIS QUESTIONNAIRE. PLEASE PASS THE QUESTIONNAIRE ON TO THE PERSON
WHO IS BEST ABLE TO DESCRIBE THIS CHILD’S KINDERGARTEN PROGRAM OR SPECIAL SERVICES.
If you answered YES to ANY of the three questions:
PLEASE PROCEED TO SECTION A ➜
notes:
• If the child does not attend a kindergarten class but receives services, interpret references to the child’s
class to mean the service setting.
• Any question referring to IEPs (Individualized Education Programs for a child with a disability) is meant
to refer also to IFSPs (Individualized Family Service Plans for a child with a disability) in states using the
latter for children ages 3 through 5.
1
Section A:
A4. In what capacity (or capacities) are you involved with this child?
PLEASE
KINDERGARTEN PROGRAM AND CHILD PROGRESS
01
REMINDER: “This child” refers to the child whose name appears on the label.
A1. What is the current grade level placement of this child? PLEASE
1
2
3
✓CHECK ONE.
Kindergarten
07
OR
Number of
hours/week
a. Regular education classroom
c. Therapy/special service setting
(office, small room, etc.)
e. Home instruction
c. Provide consultation to this child’s teacher(s)
d. Provide case management (e.g., program monitoring) for this child
e. Program administrator/supervisor
f. Supervise instructional assistant assigned to work with this child
g. Other (Specify: ___________________________________________)
1
2
3
✓CHECK ONE.
Regular education classroom teacher
Special education teacher
Related service provider (Specify: ______________________)
Other (Specify: ______________________)
Number of years
A7. What are the total numbers of children with IEPs and without IEPs enrolled in this
child’s main class? PLEASE ENTER ONE NUMBER ON EACH LINE. IF THE CHILD IS
A3. Which of the settings below is considered to be this child’s main education setting?
04
b. Provide related services directly to this child
A6. How many years have you been teaching or working in your current professional
capacity?
d. Setting outside of the classroom for other
remediation or assistance (e.g. Title I,
English as a second language [ESL])
03
a. Provide instruction directly to this child
A5. What is your main role in this school? PLEASE
4
b. Special education setting
02
04
06
Other (Specify: ______________________)
Number of
minutes/week
01
03
05
Ungraded
A2. Approximately how much school time per week does this child currently spend in
the following settings? PLEASE INDICATE EITHER MINUTES OR HOURS PER WEEK.
PLEASE
02
✓CHECK ALL THAT APPLY.
✓CHECK ONE.
ENROLLED IN MORE THAN ONE CLASS, PLEASE RESPOND FOR THE CLASS IN WHICH
THE CHILD SPENDS THE MOST TIME.
Number of children with IEPs in child’s class
Regular education classroom
Number of children without IEPs in child’s class
Special education setting
“0,” go to
} IfQuestion
A9
Home
Other (Specify:________________________________)
A8. Among the children without IEPs in this child’s main classroom, how many are
currently under formal review for special education services?
PLEASE ENTER ONE NUMBER.
Number of children under formal review
2
3
A9. Approximately how many TOTAL hours per week does this child spend in
your classroom or instructional setting?
A11. Does this child participate in the following? PLEASE
✓CHECK ONE IN EACH ROW.
Yes
Number of hours per week
A10. How many of the following people are usually in the room during the majority of
this child’s time in your classroom?
PLEASE ENTER ONE NUMBER ON EACH LINE. ENTER “0” IF NONE.
Number
of people
a. Kindergarten teachers (not special education)
No
Don’t
know
a. Program for gifted and talented students
1
2
8
b. Title I
1
2
8
c. Bilingual education or instruction for English language
learners (ELL) (e.g., ESL or limited English proficient [LEP])
1
2
8
d. Program for children with behavioral or
emotional problems
1
2
8
e. Free/reduced-price lunch program
1
2
8
b. Special education teachers
c. One-to-one assistants or aides assigned to this child
d. One-to-one assistants or aides assigned to any other
child in this child’s class
A12. Which of the following best describes the curriculum materials for this child?
PLEASE
1
2
e. Kindergarten aides
3
f. Special education aides
4
g. Other specialists or therapists
h. Nurse or other medical personnel
✓CHECK ONE.
Regular education grade-level curriculum materials are used
without modification
Some modifications in regular education curriculum materials have been made
Substantial modifications in regular curriculum materials have been made
Specialized curriculum or materials are used
A13. What percentage of the day does this child spend in the following activities?
THE PERCENTAGES YOU PROVIDE SHOULD TOTAL 100%. PLEASE EXCLUDE TIME FOR
LUNCH AND RECESS IN CALCULATING PERCENTAGES.
i. Adult volunteers
j. Other
a. Instructional or therapy services outside the classroom
%
b. Adult-directed whole class activities
%
c. Adult-directed small group activities
%
d. Adult-directed individual activities
%
e. Child-selected activities
%
f. Other (Specify: ____________________________________)
%
100%
4
5
A14. Which of the following teaching practices and methods are used with this child on a
CHECK ONE IN EACH ROW.
regular basis? PLEASE
h. Paper, coloring books, crayons, pencils, pens
08
Don’t
know
i. Playground equipment (e.g., climbing structure, swings, trikes or
bikes, digging tools)
09
j. Balls (of various sizes), Nerf-style toys, sports equipment
10
k. Computer and software
11
l. Video games
12
m. Board games
13
✓
Yes
No
Activity code
a. One-on-one instruction
1
2
8
b. Small-group instruction
1
2
8
c. Large-group instruction
1
2
8
d. Cooperative learning
1
2
8
e. Peer tutoring
1
2
8
f. Computer-based instruction
1
2
8
n. Toys: vehicles and work machines (e.g., cars, trains, trucks,
backhoe loaders)
14
g. Direct instruction
1
2
8
o. Toys: tools (e.g., hammer, stethoscope, cash register, cell phone)
15
h. Cognitive strategies
1
2
8
p. Dolls and stuffed animals
16
i. Self-management
1
2
8
q. Commercial toys (e.g., action figures, Barbie)
17
j. Behavior management
1
2
8
2
8
18
k. Discrete trial training
1
r. Commercial educational toys (e.g., light-bright, puzzles,
sorting cups, bead stringing)
s. Musical instruments
19
t. Tape or CD player with tapes and CDs
20
u. Nap/rest time
21
v. Breakfast
22
w. Lunch/snack
23
x. Hot lunch
24
y. Commercial television/videotapes
25
z. Educational television/videotapes
26
aa. Flashcards
27
bb.Counting and number materials
28
cc. Alphabet and language materials
29
A15. What kinds of activities and materials are routinely available to this child in your
classroom or program? PLEASE
CHECK ALL THAT APPLY.
✓
Activity code
a. Arts and crafts projects and materials, clay, or playdough
01
b. Blocks, Legos, K’nex, other building toys
02
c. Sand and water play
03
d. Playhouse, toy kitchen, dishes, plastic food
04
e. Dress-up, costumes, puppets, theater props
05
f. Children’s books and magazines
06
g. Sensory table (e.g., cornmeal, beans, and other tactile materials)
07
continued >
6
7
A16. Of the items specified earlier, what three activities or materials does this child
engage in most often in your classroom or program? Do not include meals or naps.
USE THE ACTIVITY CODE THAT CORRESPONDS WITH THE ACTIVITY FROM A15.
Activity code from list
A18. Overall, how would you rate this child’s academic skills compared to typical children
CHECK ONE.
of the same grade level? PLEASE
1
2
3
4
a. Most frequent activity
5
b. Second most frequent activity
✓
Far below average
Below average
Average
Above average
Far above average
c. Third most frequent activity
A17. The following are statements commonly associated with various educational philosophies. Which three statements best describe your approach to working with this child?
•
•
•
•
Write the number 1 next to the most important approach.
Write the number 2 next to the second most important approach.
Write the number 3 next to the third most important approach.
Leave 5 squares blank.
b. We believe that teaching children the knowledge and skills they need
to succeed in school is critical. Structured learning experiences in
academic content areas are a central part of the program.
c. We emphasize principles of behavior modification and precision
teaching. Target behaviors are specified and skills are sequenced
and taught using strategies such as modeling, prompting, fading,
and reinforcing of successive approximation.
d. We combine developmental theory with a behavioral model to identify
target behaviors and use behavioral strategies when appropriate.
e. We emphasize the way individual children and parents/guardians
influence each other’s behavior. Interventions target primarily the
parent/guardian, who is taught to interpret the child’s behavior
and respond appropriately.
1
2
3
4
Rank 1, 2, 3
Use each number
only once.
a. We assume that children learn naturally when they are developmentally ready. The interest of the child and age appropriateness
of skills are emphasized in determining program content.
A19. During play time, how does this child compare with other children in the class in
terms of physical activity? PLEASE
CHECK ONE.
5
✓
A lot less active than most
A little less active than most
About the same as most
A little more active than most
A lot more active than most
A20. Compared to his/her classmates, how many friends does this child have in
CHECK ONE.
your classroom? PLEASE
1
2
3
4
5
✓
Far fewer than most
Fewer than most
As many as most
More than most
Far more than most
A21. Overall, how appropriate do you think this child’s placement is in your classroom?
PLEASE
1
2
3
4
8
✓CHECK ONE.
Very appropriate
Somewhat appropriate
Not very appropriate
Not at all appropriate
Don’t know
f. We focus on a child’s medical diagnosis and concentrate on
therapeutic interventions.
g. We recognize that the child is a member of a family system and base
services on the perceived strengths and priorities of family members.
h. Other (Specify: ______________________________________________
_____________________________________________________________)
8
9
A22. Social Skills
SOCIAL SKILLS RATING SYSTEM
This questionnaire is designed to measure how often a student exhibits certain social skills.
Ratings of problem behaviors are also requested.
PLEASE
CHECK ONE IN EACH ROW TO INDICATE HOW OFTEN THE STUDENT DOES
THE BEHAVIOR DESCRIBED.
✓
How Often?
Read each of the items on A22 and A23 and think about this student’s behavior during the
past month or two. Decide how often the student does the behavior described.
•
•
•
If the student never does this behavior, check the 0.
If the student sometimes does this behavior, check the 1.
If the student very often does this behavior, check the 2.
Here are two examples:
How Often?
Never
Shows empathy for peers.
Asks questions of you when
unsure of what to do in
schoolwork.
0
0
Sometimes
1
1
Very
Often
2
✓
✓
2
This student very often shows empathy for classmates. Also,
this student sometimes asks questions when unsure of schoolwork.
Please do not skip any items. In some cases you may not
have observed the student perform a particular behavior. Make an
estimate of the degree to which you think the student would
probably perform that behavior.
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American Guidance Service, Inc., 4201 Woodland
Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to Westat for research purposes only. All rights reserved. www.agsnet.com
Never
Sometimes
Very
Often
1. Controls temper in conflict
situations with peers.
0
1
2
2. Introduces herself or himself to
new people without being told.
0
1
2
3. Appropriately questions
rules that may be unfair.
0
1
2
4. Compromises in conflict
situations by changing own
ideas to reach agreement.
0
1
2
5. Responds appropriately to
peer pressure.
0
1
2
6. Says nice things about himself
or herself when appropriate.
0
1
2
7. Invites others to join in
activities.
0
1
2
8. Uses free time in an
acceptable way.
0
1
2
9. Finishes class assignments
within time limits.
0
2
10. Makes friends easily.
0
1
11. Responds appropriately to
teasing by peers.
0
1
2
12. Controls temper in conflict
situations with adults.
0
1
2
1
2
13. Receives criticism well.
0
1
2
14. Initiates conversations
with peers.
0
1
2
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
10
11
continued >
A23. Problem Behaviors
How Often?
Never
15. Uses time appropriately
while waiting for help.
16. Produces correct schoolwork.
Sometimes
PLEASE
CHECK ONE IN EACH ROW TO INDICATE HOW OFTEN
THE STUDENT DOES THE BEHAVIOR DESCRIBED.
✓
Very
Often
0
1
2
0
1
2
How Often?
Never
Sometimes
Very
Often
1. Fights with others.
0
1
2
2. Has low self-esteem.
0
1
2
3. Threatens or bullies others.
0
1
2
17. Appropriately tells you when
he or she thinks you have
treated him or her unfairly.
0
1
2
18. Accepts peers’ ideas for
group activities.
0
1
2
4. Appears lonely.
0
1
2
19. Gives compliments to peers.
0
1
2
5. Is easily distracted.
0
1
2
20. Follows your directions.
0
1
2
6. Interrupts conversations
of others.
0
1
2
21. Puts work materials or
school property away.
0
1
2
7. Disturbs ongoing activities.
0
1
2
22. Cooperates with peers
without prompting.
0
1
2
8. Shows anxiety about being
with a group of children.
0
1
2
23. Volunteers to help peers
with classroom tasks.
0
1
2
9. Is easily embarrassed.
0
1
2
0
1
2
10. Doesn’t listen to what
others say.
0
1
2
11. Argues with others.
0
1
2
25. Responds appropriately when
pushed or hit by other children.
0
1
2
12. Talks back to adults
when corrected.
0
1
2
26. Ignores peer distractions
when doing class work.
00
1
2
13. Gets angry easily.
0
1
2
27. Keeps desk clean and neat
without being reminded.
0
1
2
14. Has temper tantrums.
0
1
2
0
1
2
15. Likes to be alone.
28. Attends to your instructions.
0
1
2
16. Acts sad or depressed.
0
1
2
0
1
2
17. Acts impulsively.
0
1
2
0
1
2
18. Fidgets or moves
excessively.
0
1
2
24. Joins ongoing activity or group
without being told to do so.
29. Easily makes transition
from one classroom activity
to another.
30. Gets along with people
who are different.
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
12
Social Skills Rating System (SSRS) Teacher Questionnaire by Frank Gresham and Stephen Elliott ©1990 American
Guidance Service, Inc., 4201 Woodland Road, Circle Pines, MN 55014-1796. Permission to reproduce granted to
Westat for research purposes only. All rights reserved. www.agsnet.com
13
A26. Language and literacy
PLEASE
Items A24 and A25 omitted.
ACADEMIC RATING SCALE
✓CHECK ONE IN EACH ROW.
Directions: The Academic Rating Scale is separated into two areas: (1) language and literacy and
(2) mathematical thinking. You are asked to rate this child’s skills, knowledge, and behaviors
within each of these areas based on your experience with this child. This is NOT a test
and should not be administered directly to the child. Each question includes examples that
are meant to help you think of the range of situations in which the child may demonstrate
similar skills and behaviors. The examples do not exhaust all the ways that a child may
demonstrate what he/she knows or can do.
THIS CHILD…
The following five-point scale is used for each of the questions. It reflects the degree to which
a child has acquired/chooses to demonstrate the targeted skills, knowledge, and behaviors.
b. Understands and interprets a
story or other text read to him/
her (e.g., retelling a story just read
to the group, or telling about
why a story ended as it did, or
connecting part of the story to
his/her own life).
1
=
Not yet
Child has not yet demonstrated skill, knowledge, or behavior.
2
=
Beginning
Child is just beginning to demonstrate skill, knowledge, or
behavior and may do so very inconsistently.
3
=
In progress
Child demonstrates skill, knowledge, or behavior with
some regularity but varies in level of competence.
4
=
Intermediate
Child demonstrates skill, knowledge, or behavior with
increasing regularity and average competence but is not
completely proficient.
5
=
N/A =
Proficient
Child demonstrates skill, knowledge, or behavior
competently and consistently.
Not applicable Skill, knowledge, or behavior has not been introduced in
classroom setting.
Rate only the child’s current achievement or motivation. Rate this child compared to other
children of the same age level. If the skill, knowledge, or behavior has been introduced in
the classroom, please rate the child using the numbers 1 through 5. Check “NA” only if the
skill, knowledge, or behavior has not been introduced in your classroom setting.
Children with limited English proficiency (LEP) (e.g., ESL, ELL): Please answer the questions based on your knowledge of this child’s skills. If the child does not yet demonstrate
skills in English but does demonstrate them in his/her native language, please answer the
questions with the child’s native language in mind.
Children with special needs: It may be necessary to consider adaptations for some questions
to make them more inclusive for this child’s skills/use of adaptive equipment. Some children
may utilize alternative forms of verbal communication (e.g., sign language, communication
boards) or written communication (e.g., word processors, Braille, dictation). Please answer
the questions with these adaptations in mind.
14
a. Uses complex sentence
structures (e.g., says “If she
had brought her umbrella, she
wouldn’t have gotten wet,” or
“Yesterday it was raining cats and
dogs,” or “Why can’t we go on
the field trip at the same time as
the first grade?”).
Not yet
Beginning
In
progress
Intermediate
Proficient
Not
applicable
1
2
3
4
5
0
1
2
3
4
5
0
c. Easily and quickly names all
upper- and lowercase letters of
the alphabet.
1
2
3
4
5
0
d. Produces rhyming words
(e.g., says a word that rhymes with
“chip,” “shop,” drink,” or “light”).
1
2
3
4
5
0
e. Reads simple books
independently (e.g., reads books
with a repetitive language pattern).
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
1
2
3
4
5
0
f. Uses different strategies to read
unfamiliar words (e.g., examines
cues from pictures or context, or
uses consonant sounds to read
words, or uses prior knowledge
in order to make predictions).
g. Composes simple stories (e.g., by
writing about a personal experience
in a journal).
h. Demonstrates an understanding
of some of the conventions of
print (e.g., by using both upperand lowercase letters when writing,
or putting spaces between words,
or using a period at the end of
a sentence).
i. Uses the computer for a variety
of purposes (e.g., by drawing a
picture, or counting objects, or
typing numbers, letters, or words).
15
A27. Mathematical thinking
PLEASE
✓CHECK ONE IN EACH ROW.
THIS CHILD…
a. Sorts, classifies, and compares
math materials by various rules
and attributes (e.g., creating a rule
for sorting keys, such as “keys with
numbers” in one pile and “keys
without numbers” in another
pile, or sorting shapes by several
attributes such as “large plastic
shapes” and “small wooden shapes”).
b. Orders a group of objects (e.g., by
ordering rods or sticks by length, or
arranging paints from lightest to
darkest, or musical instruments
from softest to loudest).
c. Shows an understanding of the
relationship between quantities
(e.g., knowing that a group of 10
small stones is the same quantity
as a group of 10 larger blocks).
d. Solves problems involving
numbers using concrete objects
(e.g., “Vera has six blocks, George
has three, how many blocks are there
in all?” or “How many do I need
to give George so he will have the
same number of blocks as Vera?”).
e. Demonstrates an understanding
of graphing activities (e.g., by
looking at a picture graph on
favorite ice cream flavors and
knowing which flavor is the most
popular and which one is the best).
f. Uses instruments accurately
for measuring (e.g., by using a
balance scale to compare the
weight of two objects, or using
tablespoons and teaspoons during
a cooking project, or using a
measuring tape to measure the
length of different objects).
g. Uses a variety of strategies to
solve math problems (e.g., using
manipulative materials, looking for
a pattern, or acting out a problem).
Not yet
A28. Which of the following methods do you commonly use to assess how well this child
CHECK ALL THAT APPLY.
is doing in your class? PLEASE
Beginning
In
progress
Intermediate
Proficient
Not
applicable
01
02
03
1
2
3
4
5
0
04
05
06
07
08
1
2
1
2
3
3
4
4
5
5
0
0
98
2
3
4
5
0
PLEASE
01
03
04
05
06
1
2
3
4
5
0
a. Impressions based on experience with child and written notes
about specific events
b. Direct observation with general anecdotal notes
c. Direct observation with checklist of skills
d. Direct assessment or testing
e. Video/audio recording
f. Portfolios of child’s work samples
g. Other (Specify: __________________________________________________)
h. Child progress is not formally monitored
i. Not sure
A29. Other than at IEP meetings, how do you and other staff come together to discuss and
plan progress and programs for the children with IEPs in your class?
02
1
✓
07
08
✓CHECK ALL THAT APPLY.
a. Staff communicate on an as-needed basis.
b. We hold regular weekly meetings.
c. We hold regular biweekly meetings.
d. We hold regular monthly meetings.
e. We provide release time or change program hours so that both special
education and regular education teachers can attend regularly.
f. We hold common inservice meetings and training sessions for regular
education and special education staff.
g. Other (Specify: _________________________________________________)
h. Not applicable, no other staff serve this child.
A30. How do you communicate with the parents or guardians of this child?
1
2
3
4
5
0
PLEASE
01
02
03
04
1
2
3
4
5
0
05
06
07
08
16
✓CHECK ALL THAT APPLY.
a. I give parents regular written progress reports.
b. I regularly give parents report cards for this child.
c. I call them on the phone, send email, or send notes home.
d. I speak with parents before or after school when this child is
being dropped off or picked up.
e. We have regularly scheduled parent-teacher meetings.
f. We share a daily or weekly journal for this child.
g. There is a regular system for communicating with parents
(e.g., newsletter or phone tree).
h. Parents have access to the school’s web site with information
specifically for parents.
17
A31. During this school year, approximately how often have you and this child’s parents
or guardians communicated (by phone, in person, or in writing) about his/her
progress, excluding routine progress reports or report cards? PLEASE
CHECK ONE.
1
2
3
4
5
✓
At least once a week
✓
1
Not at all
2
Somewhat
3
A few times a month
Extensively
4
About once a month
Not applicable—transition planning not done
Less than once a month
Never
A37. Which of the following strategies were used before the child started in your program
in order to support this child’s transition into your school, program, or classroom?
A32. How involved is this child’s parent or guardian in his/her school experiences
CHECK ONE.
(e.g., monitoring homework or child’s progress in school)? PLEASE
1
A36. To what extent were you involved in planning this child’s transition into your class
CHECK ONE.
or program? PLEASE
PLEASE
✓CHECK ONE IN EACH ROW.
✓
Yes
Not at all involved
No
Don’t
know
Not
applicable
a. We received the child’s previous records.
1
2
8
0
b. The sending program provided information
about this child.
1
2
8
0
c. Someone from your program provided parents
with written information about your program.
1
2
8
0
PLEASE ENTER THE NUMBER OF DAYS.
d. Someone from your program called the
child’s parents.
1
2
8
0
Number of days absent
e. The parents or guardians of this child were
encouraged to meet the staff before the child
entered the school or program.
1
2
8
0
f.
1
2
8
0
g. Someone from your program visited the
child’s home.
1
2
8
0
h. Someone from your program visited the
child’s previous setting.
1
2
8
0
i.
Someone from your program met with staff
of the sending program specifically about
this child.
1
2
8
0
j.
Someone from your program participated in
IEP development for this child.
1
2
8
0
k. Your staff developed preparatory strategies
specifically for this child (e.g., behavior plans,
school scheduling modifications, etc.).
1
2
8
0
l.
1
2
8
0
2
3
4
8
Not very involved
Fairly involved
Very involved
Don’t know
A33. During October of this school year, how many days was this child absent?
A34. How many of these were unexcused absences?
PLEASE ENTER THE NUMBER OF DAYS.
Number of unexcused absences
A35. Where was this child enrolled in an early childhood or kindergarten program, or
CHECK ONE.
receiving services 1 year ago? PLEASE
1
2
3
4
5
✓
Exact same school and class as now
Same school but different kindergarten
classroom
Not sure, don’t know where child was
Preschool class in same school
Some other program or at home
18
}
}
Go to Question A40
Continue with Question A36
This child and family visited your classroom
or school.
Other (Specify: ____________________________
_______________________________)
19
A38. How adequate were the planning and support that were provided to this
child and his/her family during the transition into your class or program?
PLEASE
1
2
3
4
8
CHECK ONE.
✓
Extremely adequate
Somewhat adequate
Not very adequate
Transition planning and support were
not needed for this child or family
1
2
3
4
✓
1
Yes, this child has an IEP for special education services.
2
Yes, this child has a 504 plan.
3
No, this child does not have an IEP or 504 plan.
8
Don’t know.
CHECK ONE.
✓
2
8
2
3
Somewhat difficult
03
Very difficult
✓CHECK ONE.
Yes
➜
No
Don’t know
}
1
2
3
4
05
06
Continue with Question A41
Go to Question A45
07
Not applicable—the child is not in a regular education classroom.
Not applicable—this child’s IEP goals are not addressed in the regular education
classroom; they are addressed elsewhere.
The special education teacher or aide works individually with the child
on special tasks.
The regular education teacher or aide works individually with the child on
special tasks.
Related services personnel work individually with the child on special tasks.
Related services personnel work with the child in group activities.
The goals and objectives are embedded in common classroom activities.
Go to Question A43
✓
A45. How would you characterize the way children with and without disabilities are
primarily brought together in this child’s class or program? PLEASE
CHECK ONE.
00
01
Not at all
02
Somewhat
Extensively
03
A42. Did you review this child’s records related to early intervention, special education,
or other special services before this child enrolled in your school or program?
PLEASE
Go to Question A50
✓
02
Somewhat easy
A41. To what extent did you communicate with the person(s) who provided early
CHECK ONE.
childhood special education for this child last year? PLEASE
1
➜
GOALS AND OBJECTIVES ARE PRIMARILY ADDRESSED.
01
Very easy
A40. Did this child have an IEP or IFSP during the year prior to this school year?
1
Go to Question A45
A44. How are this child’s IEP goals and objectives primarily addressed in the regular
CHECK THE ONE THAT BEST DESCRIBES HOW
education classroom? PLEASE
04
PLEASE
➜
➜
with
} Continue
Question A44
Don’t know
A39. How easy was it for this child to make the transition into your class or program?
PLEASE
A43. Does this child currently have either an IEP or a 504 plan for children with
CHECK ONE.
disabilities? PLEASE
✓CHECK ONE.
04
05
Yes, in detail.
06
Yes, briefly.
No, I don’t have access to the records.
08
✓
Not applicable—we do not currently have children without disabilities enrolled
in this class or program.
Children with and without disabilities are not in contact with one another.
Classes for children with and without disabilities share common space only
(e.g., playground/lunch room).
Children without disabilities spend part of the day in the classroom for
children with disabilities.
Children with disabilities spend part of the day in a classroom for children
without disabilities.
Children with disabilities spend the entire day in a classroom for children
primarily without disabilities.
Other (Specify: ___________________________________________________)
Not sure; don’t know.
No, I have access to the records, but have not reviewed them.
20
21
A46. Overall, how adequate are the supports that are provided to this child because of
CHECK ONE.
his/her disabilities? PLEASE
1
2
3
4
8
0
✓
Very adequate
3
Not very adequate
4
Not at all adequate
8
Don’t know
0
No support is needed
2
3
4
5
➜
Very adequate
Somewhat adequate
Not very adequate
Not at all adequate
Don’t know
No support is needed
✓
Continue with Question A48
Not applicable—we do not currently have children
without disabilities enrolled in this class or program.
Not applicable—this child does not have contact with
children without disabilities during our program.
Not applicable—no support is needed.
No.
}
Kindergarten
Go to Question A49
A48. Does your program use any of the following methods to support social interaction
between this child and children without disabilities?
PLEASE
✓
A50. To the best of your knowledge, what school and grade level do you anticipate this
child will be in next year? PLEASE
CHECK ONE.
✓
Yes.
1
2
Somewhat adequate
A47. Does your program support social interaction between this child and children
CHECK ONE.
without disabilities? PLEASE
1
A49. Overall, how adequate are the supports and resources that are provided to you for
CHECK ONE.
this child because of his/her disabilities? PLEASE
✓CHECK ONE IN EACH ROW.
First grade
Other
a. Same school as this year
1
2
(Specify: ________________)
b. Different school next year
1
2
(Specify: ________________)
c. Don’t know
1
2
(Specify: ________________)
Please write the name and address of the school (if known) if you expect
this child will attend a different school next year.
Name of new school: _________________________________________________
School address: _______________________________________________________
Yes
a. We present a specific disability awareness program
during group times.
1
No
2
b. We assign children without disabilities to be “helpers”
or “buddies” to this child.
1
2
c. We prompt and reinforce this child for initiating and
maintaining interactions with children without disabilities.
1
2
d. We prompt and reinforce the children without disabilities
for initiating and maintaining interactions with this child.
______________________________________________________________________
A51. We want to know what you think about special education for young children.
In the space provided, please print any suggestions or concerns you have regarding
the provision of special education services for young children. (Be assured that your
answers will be confidential.)
________________________________________________________________________________________
1
2
________________________________________________________________________________________
________________________________________________________________________________________
e. We structure play and task situations so that they require
interaction between this child and children without disabilities.
f. Other (Specify: _____________________________________)
22
1
2
1
2
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
23
Instructions for Section B of this Questionnaire:
1. Section B of the questionnaire is to be completed only for children with IEPs or 504 plans.
Does this child have an IEP or 504 plan?
●
YES, this child DOES have an IEP or 504 plan. Please continue with next question.
●
NO, this child does NOT have an IEP or 504 plan. Please go to page 33 of this
questionnaire.
2. Section B is to be completed by the teacher or specialist most familiar with the child’s
special education and related services. Can you describe this child’s special services?
●
YES. Please continue with Section B on the next page.
●
NO. Please remove Section B and give it to the person who you feel could best answer
questions about this child’s special education or related services. Please provide this
person’s name and phone number below. When this person completes Section B,
please have him or her return it directly to Westat using the self-mailer.
Name:
Phone:
(
)
Thank you for completing
this questionnaire.
Date Completed: ____/____/____
mm dd yy
Please provide your name and contact information below,
so that we can reach you if we have questions.
Your Name:
School/Program Name:
Address:
Phone:
(
)
Email:
Please continue to the back cover.
24
33
Thank you for completing
this questionnaire.
Please return this questionnaire
in the postage-paid envelope to:
Pre-Elementary Education Longitudinal Study
Westat
1650 Research Blvd.
Rockville, MD 20850
WESTAT
21469.1206.80890309
thank you!
National Center for
Special Education Research
| File Type | application/pdf |
| File Title | design 1 |
| File Modified | 2006-12-12 |
| File Created | 2006-12-12 |