SACD Activities -School Records Request (Appendix Vlll)

APPENDIX VIII

SCHOOL RECORDS REQUEST

STUDENT-LEVEL SCHOOL RECORDS REQUEST

Gender

Race, ethnic group

LEP status

Special education status

Free/reduced price lunch status

Retention/promotion

Date of enrollment

Date of transfer (if applicable)

Second Grade School Year 2003-2004

Achievement test math and language arts/reading raw score, percentile, and test name

Grades in language arts/reading, mathematics, social studies, science, other

Disciplinary referrals

Days attended

Days absent

Days tardy

Days suspended

Days expelled

Third Grade School Year 2004-2005

Achievement test math and language arts/reading raw score, percentile, and test name

Grades in language arts/reading, mathematics, social studies, science, other

Disciplinary referrals

Days attended

Days absent

Days tardy

Days suspended

Days expelled

AGGREGATE SCHOOL-LEVEL RECORDS DATA FORM

Guidance and Definitions

This form provides guidance and definitions for the collection of aggregate school-level records data for the Social and Character Development Research Program Multisite Evaluation. The purpose is to obtain aggregate measures that most schools will maintain at the school level.

Although schools and districts maintain records in differing formats, we hope to obtain some consistent information across sites. Consequently, we have developed a form to serve as a guide in the collection of school-level records.

The form details the data elements that we would like to obtain in the form of survey questions, but the form may be used in a variety of ways depending on site preferences. The form may be used as a survey, and provided to school or district personnel to complete. Or, the form may be used simply as a checklist for grant personnel to verify that the data elements were requested or provided. Thus, you need not fill out the form, although you may do so if that is a convenient way to organize the data in a particular school. What is important is that the form provides a listing of and definitions for the data items that we would like to utilize in the multisite evaluation, and provides guidance for coordination with local school administrators.

Given the variability in data systems across sites, some schools may collect data elements that deviate slightly from the data elements defined in this form. This is expected. However, we request that each site determine how each of the data elements collected by the schools and districts deviate from the elements provided within the form, and provide us with descriptions of these differences (for example, number of students who left after the first day of school is not available, only an average mobility rate is available: 18 percent).

1. What was the school’s total student enrollment provided to the state for each of the following school years? Please provide total student enrollment as well as the date on which this count was taken.

School year 2003-2004:	Date of count:
School year 2004-2005:	Date of count:

2. What was the total number of classrooms in the school for the following school years, including special education or temporary classrooms?

School year 2003-2004:
School year 2004-2005:

3. How many instructional days were there in the following school years?

(Exclude days on which teachers were present but children were not present.)

School year 2003-2004:
School year 2004-2005:

4. How many paid staff members were at the school in the following categories?

(If no such staff, please record zero.)

	Number of Staff Per School Year
	2003-2004		2004-2005
	Full-Time	Part-Time	Full-Time	Part-Time
Regular classroom teachers	| | |	| | |	| | |	| | |
Regular classroom teachers’ aids or paraprofessionals	| | |	| | |	| | |	| | |
Special education teachers	| | |	| | |	| | |	| | |
Special education aides	| | |	| | |	| | |	| | |
Counselors/Mental health professionals	| | |	| | |	| | |	| | |

5. Please provide the average daily percent of students in each of the following categories:

	Percent of Students Per School Year
	2003-2004	2004-2005
Average daily percentage of students absent	| | | | %	| | | | %
Average daily percentage of students tardy	| | | | %	| | | | %

6. What percent of the school’s students fit the following criteria?

	Percent of Students Per School Year
	2003-2004	2004-2005
Percent eligible for free or reduced price lunch	| | | | %	| | | | %
Percent Limited English Proficient (LEP)	| | | | %	| | | | %
Percent students receiving special education services	| | | | %	| | | | %
Percent male	| | | | %	| | | | %

7. What percent of the school’s students belong to the following ethnic/racial groups?

(Please be sure the total for each year adds to 100 percent.)

	Percent of Students Per School Year
	2003-2004	2004-2005
American Indian/Alaskan Native	| | | | %	| | | | %
Asian/Pacific Islander	| | | | %	| | | | %
Hispanic	| | | | %	| | | | %
Black, non-Hispanic	| | | | %	| | | | %
White, non-Hispanic	| | | | %	| | | | %
Other (Specify)	| | | | %	| | | | %
TOTAL	| | | | %	| | | | %

8. Of the students enrolled at the end of the 2003-2004 school year, what percent were not advanced to the next grade (were retained) for the 2004-2005 school year?

| | | | PERCENT OF SY2003-2004 STUDENTS NOT

ADVANCED (RETAINED) FOR SY2004-2005

9. Of the students enrolled at the end of the 2004-2005 school year, what percent were not advanced to the next grade (were retained) for the 2005-2006 school year?

| | | | PERCENT OF SY2004-2005 STUDENTS NOT

ADVANCED (RETAINED) FOR SY2005-2006

10. Please provide the number of students who left or entered this school during the school year as follows:

	Number of Students Per School Year
	2003-2004	2004-2005
Number of students who left this school during the school year after the first day of school	| | | |	| | | |
Number of students who entered this school during the school year after the first day of school	| | | |	| | | |

11. Please provide the number of students who left or entered the school between school years. The number who left is the number of students who were enrolled at the end of one year and did not return for the next year (exclude students who matriculated to the next school level, for example, 5^th graders moving onto middle school). The number who entered is the number of students who were not enrolled at the end of one year but were “new enrollees” at the beginning of the next year.

	Number of Students Per School Year
	Summer 2004	Summer 2005
Number of students who left this school over the summer (number enrolled at the end of the year but NOT enrolled the next year)	| | | |	| | | |
Number of students who entered this school over the summer (number NOT enrolled at the end of the year but newly enrolled at the beginning of the next year)	| | | |	| | | |

12. Please record the number of incidents this school recorded during the 2003-2004 and the 2004-2005 school year for the offenses listed below. Please provide information on:

• The number of incidents, not the number of victims

• Recorded incidents regardless of whether any disciplinary action was taken

• Recorded incidents regardless of whether students or non-students were involved

• Incidents occurring before, during or after normal school hours

• Only the most serious offense when an incident involved multiple offenses. For example, if an incident included a physical assault with a weapon, include the incident only under “violent incident.” The list below does not necessarily indicate the order of seriousness. Use your own judgment when determining which is the most serious offense.

	Number of Incidents Per School Year
	2003-2004	2004-2005
Violent incidents (e.g., physical or sexual assault, robbery)	| | | |	| | | |
Theft (i.e., taking things over $10)	| | | |	| | | |
Possession of a weapon (e.g., firearm, knife)	| | | |	| | | |
Possession or distribution of illegal drugs or alcohol	| | | |	| | | |
Vandalism	| | | |	| | | |

13. Please provide the number of students who were subject to the following disciplinary actions in each school year indicated. If a student was subject to more than one disciplinary action, count the student under the most serious action.

	Number of Students Per School Year
	2003-2004	2004-2005
Removal from school or transfer to another School	| | | |	| | | |
Out of school suspension	| | | |	| | | |
In-school suspension	| | | |	| | | |
Detention/After school/Saturday school	| | | |	| | | |
Corporal punishment	| | | |	| | | |
Referral to administrative staff for discipline	| | | |	| | | |
Referral for counseling or special services	| | | |	| | | |

14. Please provide expenditures per pupil for this school for each school year indicated. If the school or district does not calculate expenditures per pupil for this school, provide expenditures per pupil for the district and write in “NA” on the school level line below.

	SY2003-2004	SY2004-2005
School level—expenditures per pupil	$	$

IF SCHOOL LEVEL EXPENDITURES PER PUPIL NOT AVAILABLE PROVIDE DISTRICT LEVEL EXPENDITURES PER PUPIL:	SY2003-2004	SY2004-2005
District level—expenditures per pupil	$	$

STANDARDIZED ACHIEVEMENT TESTS

Please record the standardized achievement tests administered to grades 2 through 5 at the school during the 2003-2004 and the 2004-2005 school years in the grids that follow.

Please note that there is a separate grid for each grade (2 through 5) for each school year. There are two grids per page. There are separate grids for grades 2, 3, 4, and 5 for the 2003-2004 school year followed by grids for grades 2, 3, 4, 5 for the 2004-2005 school year.

In each grid please record the name of the test (for example, TERA NOVA) and the date it was administered to that particular grade. Next, record the content areas covered by the test in the column headings. For example, if the TERA NOVA test for 2^nd graders included Math, Reading, Social Studies and Science you would write these at the top of the columns in the Grade Two grid on the line under the words “Content Area 1,” “Content Area 2,” etc. Finally, record the mean raw score, mean standard score, mean percentile and mean grade equivalent for each content area covered by the test.

If no standardized tests were administered to a particular grade, please write in “NONE” on the line labeled “Test Name/Publisher” in the grid for that grade. For example, if 2^nd graders in the 2003-2004 school year did not take any standardized tests, you would write in “NONE” in the Test Name/Publisher line for the 2003-2004 School Year, Grade Two grid (the first one presented below).

2003-2004 SCHOOL YEAR

GRADE TWO

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE THREE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

2003-2004 SCHOOL YEAR

GRADE FOUR

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE FIVE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

2004-2005 SCHOOL YEAR

GRADE TWO

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE THREE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

2004-2005 SCHOOL YEAR

GRADE FOUR

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE FIVE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

2006-2007 SCHOOL YEAR

GRADE TWO

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE THREE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

2006-2007 SCHOOL YEAR

GRADE FOUR

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

GRADE FIVE

Test Name/Publisher:

Dates Administered:

	Content Area One	Content Area Two	Content Area Three	Content Area Four	Content Area Five
	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________	Specify: _____________
Mean Raw Score
Mean Standard Score
Mean Percentile
Mean Grade Equivalent

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