Student Background Data Request

Collaborative Strategic Reading for Fifth Graders

Student Background Data Request

Paperwork Burden Statement

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 xxxx-xxxx. The time required to complete this information collection is estimated to average 16 hours 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. 20202-4700. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Rafael (Ray) Valdivieso, U.S. Department of Education, 555 New Jersey Avenue, N.W., Room 506E, Washington, D.C. 20208.

Regional Educational Laboratory – Southwest

Student Background Data Request

for

(Insert District Name Here)

The Collaborative Strategic Reading (CSR) study will collect demographic and pretest data on all fifth (5^th) grade students in the treatment and control classrooms for the 2006-07 school year. REL Southwest understands all school and/or district data belongs to the school and/or district, however the results of the study will belong to REL Southwest.

We request data for 5^th grade students in the following schools participating in the study: (insert school names here)

The data elements requested are:

• Unique identifier for each student linking the student

  • School

  • Teacher(s)/Classroom(s)

• Gender

  • Male

  • Female

• Race/Ethnicity

  • Current U.S. census categories

• Free Lunch Status

  • Free

  • Reduced

  • Neither

• English Language status

  • Former ELL

  • Current ELL

  • Native English Speaker

• Special Education status

• Standardized Student Achievement Scores from Spring 2006 test

Choice of Format and Media

Data may be provided in SAS, Excel, or flat ASCII file format.

Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.

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