District responses

Summer Reading Program Study

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 (expires XXXX). The time required to complete this information collection is estimated to average 15 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: Dean Gerdeman, U.S. Department of Education, 555 New Jersey Avenue, N.W., Room 506D, Washington, D.C. 20208.

Regional Educational Laboratory – Southwest

Student Background Data Request

for

(Insert District Name Here)

The Summer Reading Program study will collect demographic, pretest and post-test data on all 3rd grade students in the treatment and control groups for the 2009 and 2010 school years. REL Southwest understands all district data belongs to the district; however, the results of the study will belong to REL Southwest.

We request the following data elements for 3rd grade students:

• Unique identifier for each student linking the student

  • School

  • Teacher(s)/classroom(s)

• Gender

  • Male

  • Female

• Race/Ethnicity

  • Current Department of Education 2007 Race/Ethnicity Categories

• Free Lunch Status

  • Free

  • Reduced

  • Neither

• English language status

  • Former English language learner (ELL)

  • Current ELL

  • Native English speaker

• Special Education status

• Standardized Student Achievement Scores

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 for statistical purposes only. 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.