Teacher Data Form - Sam and Pat - (2009)

Adult ESL Literacy Impact Study

Sam and Pat Teacher Data Form (2009)

Program Name: Site:

Last Name: First Name:

Address: Apt #:

Zip code:

Phone #: (______) _______ ___________

Classes taught at this program: ___________________________________________________

Name of Class in Study: ___________________ Meeting Days: _________ Meeting Times: ________

A. Supports for Sam and Pat Instruction

How many times did you access the following supports for teaching with Sam and Pat during summer 2008 through spring 2009?

Write ‘0’ if you did not access a particular support; please fill in all boxes.

	Number of times support was accessed (Write ‘0’ if you accessed none)
a. Phone call support from Sam and Pat developers
b. Video support from Sam and Pat developers (e.g., clips of instructional modeling via cd-rom, dvd, or online)
c. E-mail support from Sam and Pat developers

B. Professional Development Not Provided By Study

Excluding any professional development provided by the study, what is the total number of hours you spent participating in professional development workshops during summer 2008 through spring 2009 that covered the following topics?

Write the total number of hours you spent in these activities, excluding hours of professional development provided by the study. If you attended professional development that falls under multiple categories, please divide the number of hours you estimate was spent on each topic.

Round to nearest whole hour. Write ‘0’ if you participated in none; please fill in all boxes.

	Number of hours (Write ‘0’ if you participated in none)
a. Teaching reading or general training on literacy instruction for ESOL learners
b. Teaching reading or general training on literacy instruction for non-ESOL learners
c. Teaching general ESOL (oral communication skills, pronunciation, vocabulary, etc.)
d. Other (specify): _______________________________________

C. Implementation of Sam and Pat and Other Materials Used in the Study Class

How many minutes per week, on average, did you spend preparing to teach your study class? Please report the average number of minutes per week separately for the fall 2008 and the winter/spring 2009 terms.

Number of Minutes Spent Preparing
Fall 2008	Winter/Spring 2009

As of the end of the fall 2008 and the winter/spring 2009 terms, what was the final lesson number you covered from the Sam and Pat workbook used in your study class?

Number of Final Lesson (or Unit) Covered from Sam and Pat Workbook
Fall 2008	Winter/Spring 2009

During the fall 2008 and winter/spring 2009 terms, to what extent, on average, did you supplement the Sam and Pat workbook used in your study class with any other materials? (mark (X) each box that applies)

	Not used in study class	Used less than once a month	Used one to two times a month	Used three to four times a month	Used more than once a week
A second workbook or text, or handouts from a second workbook or text. Specify workbook: ______________________________________	0 	1 	2 	3 	4 
A third workbook or text, or handouts from a third workbook or text. Specify workbook: ______________________________________	0 	1 	2 	3 	4 
Worksheets related to a Sam and Pat lesson that I or another teacher created	0 	1 	2 	3 	4 
Worksheets not related to a Sam and Pat lesson that I or another teacher created	0 	1 	2 	3 	4 
Stories or paragraphs that I or another teacher created	0 	1 	2 	3 	4 
Stories or paragraphs that students created	0 	1 	2 	3 	4 
Stories or paragraphs from other sources (e.g., other publishers, newspapers)	0 	1 	2 	3 	4 
Dictionaries or picture dictionaries	0 	1 	2 	3 	4 
Computer software	0 	1 	2 	3 	4 
E-mail or webpages	0 	1 	2 	3 	4 
Audio recordings	0 	1 	2 	3 	4 
Video recordings	0 	1 	2 	3 	4 

Please indicate the extent to which you agree or disagree with the following statements about the use of the Sam and Pat workbook in your study class (mark (X) one box on each line):

	Strongly Disagree	Disagree	Agree	Strongly Agree
I have had adequate opportunities to learn how to use Sam and Pat in my classroom	1 	2 	3 	4 
I can explain to other teachers how to use Sam and Pat	1 	2 	3 	4 
Sam and Pat is aligned well with our program’s curriculum standards	1 	2 	3 	4 
Sam and Pat conflicts with my preferred approach to literacy instruction	1 	2 	3 	4 
Sam and Pat assumes major changes to the way I teach	1 	2 	3 	4 
Sam and Pat is difficult to use	1 	2 	3 	4 
Sam and Pat is more trouble than it’s worth	1 	2 	3 	4 

How likely would you be to use Sam and Pat again, given the choice? (mark (X) one box)

Not at all likely	Likely	Very Likely
1 	2 	3 

What would you say are the most useful features of Sam and Pat?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What would you say are the least useful features of Sam and Pat?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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