School Information Sheet

Collaborative Strategic Reading
for Fifth Graders

School Information Sheet

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 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. 20202–4700. 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.

9901 IH 10 West Suite 700

San Antonio, TX 78230
210-558-1902
Toll Free 866-552-2118
Fax 210-558-1075

E-mail: llogan@edvanceresearch.com

School Information Sheet

Thank you for your interest in our research study. Please complete the form below so we can learn more about your school. Simply fill in your responses and fax the form to 210-558-1075.

Assessing the Impact of Collaborative Strategic Reading on ELL

Fifth Graders’ Comprehension and Vocabulary Skills

School Name: District Name:

School Address:

City: State: Zip:

Your Name: Title:

What is your preferred email address?

What grade levels are at this site (e.g., 1st grade through 5th grade)?

How many 5th grade Classrooms are in your school?

What is the average number of 5th grade Students in each class?

How many of your 5th grade teachers teach both English/Language Arts and Social Studies?

What textbook(s) are used in your 5th grade English/Language Arts classes?

What other instructional material(s) are used in your 5th grade English/Language Arts classes?

What textbook(s) are used in your 5th grade Social Studies classes?

What other instructional material(s) are used in your 5th grade Social Studies classes?

9901 IH 10 West Suite 700

San Antonio, TX 78230
210-558-1902
Toll Free 866-552-2118
Fax 210-558-1075

E-mail: llogan@edvanceresearch.com

School Information Sheet

Page 2

What specific programs or initiatives are in place regarding ELL and reading comprehension?

Please describe these current programs/initiative(s):

%

What percentage of your 5th grade students are considered to be English Language Learners (ELL)?

%

What is the annual student attrition/turnover rate in your school?

Do teachers in your school have regular access to email? (Yes or No):

Do teachers in your school have regular access to the Internet? (Yes or No):

Is there any other Information you would like us to know about your school?

Thank you again for taking this time to complete our School Information Sheet.
Please fax this form to 210-558-1075.

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.