ECLS-K:2011 Pilot Tests of the Third-, Fourth-, and Fifth-Grade Direct Child Assessment, Child Questionnaire, and Online School Administrator Questionnaire

NCES Cognitive, Pilot, and Field Test Studies System

Appendix A ECLS-K2011 Spring2013 PT Child Questionnaire

ECLS-K:2011 Pilot Tests of the Third-, Fourth-, and Fifth-Grade Direct Child Assessment, Child Questionnaire, and Online School Administrator Questionnaire

OMB: 1850-0803

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1850-0803 can be found here:

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Appendix A:
Child Questionnaire

Child Questionnaire
Section

OPEN [Child Questionnaire Into in CAPI]

Sequence: 2

CLQ005

QUESTION TEXT:
PLUG HEADPHONES INTO THE COMPUTER. POSITION LAPTOP DIRECTLY IN FRONT OF THE CHILD SO THAT
THE CHILD CAN REACH THE LAPTOP SCREEN AND READ IT EASILY.
SAY: Now you are going to use the computer and tell us a little more about yourself. The computer will read
some sentences and questions to you while you listen on the headphones [HOLD UP HEADPHONES]. Then
you will use this stylus pen [HOLD UP STYLUS PEN] to pick an answer by touching the computer screen
[TOUCH MIDDLE OF THE COMPUTER SCREEN WITH THE STYLUS PEN]. If you don’t want to pick an answer,
you don’t have to.
POINT TO THE VOLUME CONTROL BUTTONS ON THE BOTTOM RIGHT CORNER OF THE COMPUTER SCREEN.
SAY: You can change the volume if you want to. To make it louder, [POINT TO THE RIGHT BUTTON] press the
right button. To make it softer, [POINT TO THE MIDDLE BUTTON] press the middle button.
SHOW THE CHILD HOW TO ADJUST THE SIZE OF THE HEADPHONES.
HAND THE CHILD THE HEADPHONES.
SAY: Go ahead and put these headphones on now. You can also hold the stylus pen now [HAND THE CHILD
THE STYLUS PEN]. You will hear directions about what to do. Ok, do you have any questions? [PAUSE 2-3
SECONDS AND ANSWER ANY QUESTIONS] Are you ready to get started?
PRESS 1 AND ENTER TO CONTINUE.
ENTER TEXT

Length

Child Questionnaire :: OPEN CLQ
Page 1 of 1

2012-11-29 16:56

Child Questionnaire
Section

CLQ [Child Questionnaire]

Sequence: 3

CLQ007

QUESTION TEXT:
Hello. Before we begin, make sure the volume on the headphones is right for you. This is how it will sound
when the sentences are being read to you.
If you want to make the sound louder, press the right button on the bottom right side of the screen now.
If you want to make the sound softer, press the middle button on the bottom right side of the screen now.
You can change the sound at any time.

Please use the stylus pen to touch the "Next" button and move to the next screen.
ENTER TEXT
PROGRAMMER INSTRUCTIONS:
PLACE A "NEXT" BUTTON AT BOTTOM RIGHT OF SCREEN.
TURN OFF CONFIRMATION SCREEN.

CLQ010

QUESTION TEXT:
This is your chance to tell me about yourself. Be sure that your answers tell me about YOU. There are no right
or wrong answers. Your answers are private. No one will be told the answers that you pick.

Please use the stylus pen to touch the "Next" button and move to the next screen.
ENTER TEXT

Length

PROGRAMMER INSTRUCTIONS:
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.
TURN OFF CONFIRMATION SCREEN.

CLQ012
Child Questionnaire :: CLQ
Page 1 of 39

2012-11-30 12:32

QUESTION TEXT:
You will see sentences on the laptop screen, and you will hear the sentences and list of answers being read to
you. If you want, you can read quietly to yourself as you listen. Think about the sentence and decide how well
it describes you. Is the sentence "Not at all true; A little bit true; Mostly true; or Very true" for you? For
example:
I enjoy going to gym class.
Not at all true
A little bit true
Mostly true
Very true

Please use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true

PROGRAMMER INSTRUCTIONS:
DISPLAY EXAMPLE ITEM AND RESPONSE OPTIONS.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.
TURN OFF CONFIRMATION SCREEN.

CLQ015

DISPLAY INSTRUCTIONS:
MARIA'S ANSWER SELECTION "VERY TRUE" SHOULD BE HIGHLIGHTED AS IT IS READ OVER AUDIO, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
A student, Maria, has already given answers for two sentences to show you how to do it. The first sentence
read to Maria was
I like to read comic books.
Not at all true
A little bit true
Mostly true
Very true
Maria used the stylus pen to touch the button on the screen with the answer "Very true." This means that
she really likes to read comic books.

Child Questionnaire :: CLQ
Page 2 of 39

2012-11-30 12:32

Please use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true

CLQ020

DISPLAY INSTRUCTIONS:
MARIA'S ANSWER SELECTION "A LITTLE BIT TRUE" SHOULD BE HIGHLIGHTED AS IT IS READ OVER AUDIO,
AND REMAIN HIGHLIGHTED.
QUESTION TEXT:
The second sentence read to Maria was
I am neat and tidy.
Not at all true
A little bit true
Mostly true
Very true
Maria answered "A little bit true" because she is not very neat, but she is not very messy either.

Please use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true

CLQ025
Child Questionnaire :: CLQ
Page 3 of 39

2012-11-30 12:33

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
If you want to change an answer, use the stylus pen to touch the "Erase" button and then touch the new
answer you want to pick. Your new answer will light up and be read to you. To change your answer on a past
screen, use the stylus pen to touch the "Back" button and move to the past screen. On the past screen, touch
the "Erase" button and then touch the new answer you want to pick. After you have picked the answer that
best describes you, always use the stylus pen to touch the "Next" button and move to the next screen.
Now you try. Choose the answer that best describes you by touching it on the screen with the stylus pen.
I like to watch TV.
Not at all true
A little bit true
Mostly true
Very true
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY EXAMPLE ITEM AND RESPONSE OPTIONS.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ028

QUESTION TEXT:
Thank you for practicing with me. I like how well you followed directions. In a minute we will begin. You can
pick your answer whenever you are ready. You can pick your answer even if the computer is still reading to
you.
Remember, if you do not want to give an answer for a sentence, just use the stylus pen to touch the "Next"
button and the computer will give you a chance to skip the sentence.
Please use the stylus pen to touch the "Next" button and move to the next screen.
ENTER TEXT
PROGRAMMER INSTRUCTIONS:
TURN OFF CONFIRMATION SCREEN.

Child Questionnaire :: CLQ
Page 4 of 39

2012-11-30 12:33

CLQ030

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
Let's begin.
I have lots of friends.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the
next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ035

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am good at SCIENCE.
Not at all true
A little bit true
Mostly true
Very true

Child Questionnaire :: CLQ
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2012-11-30 12:33

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ040

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I get good grades in READING.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

Child Questionnaire :: CLQ
Page 6 of 39

2012-11-30 12:33

PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ045

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
Work in MATH is easy for me.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ050

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I enjoy doing work in SCIENCE.
Not at all true
A little bit true

Child Questionnaire :: CLQ
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2012-11-30 12:33

Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ055

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I like READING.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.

Child Questionnaire :: CLQ
Page 8 of 39

2012-11-30 12:33

THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the
next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ060

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I make friends easily.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ065

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I cannot wait to do MATH each day.

Child Questionnaire :: CLQ
Page 9 of 39

2012-11-30 12:33

Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ070

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
Work in READING is easy for me.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW
Child Questionnaire :: CLQ

Page 10 of 39

2012-11-30 12:33

CLQ075

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I like SCIENCE.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ080

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.

Child Questionnaire :: CLQ
Page 11 of 39

2012-11-30 12:33

QUESTION TEXT:
I get good grades in MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ085

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am interested in READING.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
Child Questionnaire :: CLQ

Page 12 of 39

2012-11-30 12:33

REFUSED
DON'T KNOW
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the
next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ090

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I get along with kids easily.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ095

DISPLAY INSTRUCTIONS:

Child Questionnaire :: CLQ
Page 13 of 39

2012-11-30 12:33

WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I cannot wait to READ each day.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ100

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am interested in MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true
Child Questionnaire :: CLQ

Page 14 of 39

2012-11-30 12:33

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ105

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am easy to like.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ110

Child Questionnaire :: CLQ
Page 15 of 39

2012-11-30 12:33

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I can do very difficult problems in MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ115

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I know a lot about SCIENCE.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.

Child Questionnaire :: CLQ
Page 16 of 39

2012-11-30 12:33

CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ120

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
Other kids want me to be their friend.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

Child Questionnaire :: CLQ
Page 17 of 39

2012-11-30 12:33

CLQ125

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
Work in SCIENCE is easy for me.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ130

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I like MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.

Child Questionnaire :: CLQ
Page 18 of 39

2012-11-30 12:33

CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ135

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I have more friends than most other kids.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

Child Questionnaire :: CLQ
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2012-11-30 12:33

CLQ140

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am good at READING.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ145

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am interested in SCIENCE.
Not at all true
A little bit true
Mostly true
Very true

Child Questionnaire :: CLQ
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Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ150

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I like READING long chapter books.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

Child Questionnaire :: CLQ
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PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ155

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I enjoy doing work in MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ160

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I cannot wait to do SCIENCE.
Not at all true
A little bit true
Mostly true
Very true

Child Questionnaire :: CLQ
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Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ165

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I enjoy doing work in READING.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the

Child Questionnaire :: CLQ
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next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ170

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am good at MATH.
Not at all true
A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ175

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I get good grades in SCIENCE.
Not at all true

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A little bit true
Mostly true
Very true

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all true

A little bit true

Mostly true

Very true
REFUSED
DON'T KNOW

CLQ180

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
The next set of questions and sentences are about how often things happen to you. Think about the question
or sentence and decide if these things happen "Never; Rarely; Sometimes; Often; or Very often."
During this school year, how often have other students teased you, made fun of you, or called you names?
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
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2012-11-30 12:33

CLQ185

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
During this school year, how often have other students told lies or untrue stories about you?
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ190

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DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
During this school year, how often have other students pushed, shoved, slapped, hit, or kicked you?
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ200

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
During this school year, how often have other students left you out from playing with them on purpose?
Never
Rarely
Sometimes
Often
Very often

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Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ205

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I worry about what other kids think of me.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the

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next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ210

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I feel lonely.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ215

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I try to cheer up other classmates who are upset or sad about something.

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Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ220

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I worry that other kids don't like me.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often
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Very often
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen."
IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ225

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I feel left out.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ230

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DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I help out other kids when they need it.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ235

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I'm afraid other kids will not like me.
Never
Rarely
Sometimes
Often
Very often

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Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ240

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I feel alone.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the

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next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ245

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I say or do nice things for other classmates.
Never
Rarely
Sometimes
Often
Very often

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Never

Rarely

Sometimes

Often

Very often
REFUSED
DON'T KNOW

CLQ250

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
The next set of sentences are about how you feel about your life. Think about the sentence and decide how

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well it describes you. Does the sentence describe you "Not at all; A little bit; Somewhat; Quite a bit; or Very
much"?
I am happy with my hobbies and free time activities.
Not at all
A little bit
Somewhat
Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all

A little bit

Somewhat

Quite a bit

Very much
REFUSED
DON'T KNOW

CLQ255

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am happy with the clothes, games, toys, and other things I have.
Not at all
A little bit
Somewhat
Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all
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A little bit

Somewhat

Quite a bit

Very much
REFUSED
DON'T KNOW

CLQ260

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am happy with how much attention I get from my parents.
Not at all
A little bit
Somewhat
Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all

A little bit

Somewhat

Quite a bit

Very much
REFUSED
DON'T KNOW

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PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ265

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am happy with the friends I have.
Not at all
A little bit
Somewhat
Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all

A little bit

Somewhat

Quite a bit

Very much
REFUSED
DON'T KNOW

CLQ270

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am happy with my skills and talents.
Not at all
A little bit
Somewhat

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Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all

A little bit

Somewhat

Quite a bit

Very much
REFUSED
DON'T KNOW

CLQ275

DISPLAY INSTRUCTIONS:
WHEN TOUCHED, THE CHILD'S ANSWER SELECTION SHOULD BE READ ON AUDIO, HIGHLIGHTED, AND
REMAIN HIGHLIGHTED.
QUESTION TEXT:
I am happy with the neighborhood and community in which I live.
Not at all
A little bit
Somewhat
Quite a bit
Very much

Please pick an answer and then use the stylus pen to touch the "Next" button and move to the next screen.
CODES

Not at all

A little bit

Somewhat

Quite a bit

Very much
REFUSED
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DON'T KNOW
PROGRAMMER INSTRUCTIONS:
DISPLAY ITEM AND RESPONSE OPTIONS.
THE PHRASE "Please pick an answer and then use the stylus pen to touch the "Next" button and move to the
next screen." IS DISPLAYED BUT SHOULD NOT BE READ ON AUDIO.
PLACE A "NEXT" BUTTON AT THE BOTTOM RIGHT OF SCREEN.
PLACE A "BACK" BUTTON AT THE BOTTOM LEFT OF SCREEN.

CLQ280

QUESTION TEXT:
Thank you for working with me. You are done answering questions on the computer. Please take off the
headphones now.
ENTER TEXT

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Child Questionnaire
Section

CLOS [Child Questionnaire Conclusion in CAPI]

Sequence: 4

CLQ285

QUESTION TEXT:
TAKE THE HEADPHONES AND STYLUS PEN FROM THE CHILD. TAKE THE LAPTOP FROM THE CHILD AND
PLACE THE LAPTOP DIRECTLY IN FRONT OF YOU.
SAY: Thank you. Now we are going to do something else.
PRESS 1 AND ENTER TO CONTINUE.
ENTER TEXT

Length

Child Questionnaire :: CLOSE CLQ
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2012-11-28 15:35

Child Questionnaire
Section

Globa [CLQ Programming Instructions]

Sequence: 1

CLQGLB005

RAPID RESPONSE
IF A CHILD SELECTS A COMMAND BUTTON (NEXT, BACK) OR A RESPONSE BEFORE ACASI HAS READ THE
ENTIRE CONTENTS OF THE SCREEN, ACASI SHOULD ACCEPT THE CHILD'S SELECTION BY FOLLOWING THE
COMMAND OR ACCEPTING THE ANSWER.

CLQGLB010

INACTIVITY SETTINGS
AFTER 15 SECONDS OF IDLE TIME ON ONE SCREEN, THE FOLLOWING MESSAGE SHOULD APPEAR AT THE
BOTTOM CENTER OF THE SCREEN AND BE READ ON AUDIO.
Please use the stylus pen to pick an answer or touch the "Next" button.

CLQGLB015

CONFIRMATION SCREEN
IF THE CHILD TOUCHES THE NEXT BUTTON BEFORE TOUCHING AN ANSWER TO A QUESTION, THEN ACASI
SHOULD MOVE TO THE CONFIRMATION SCREEN.
DISPLAY QUESTION AT THE TOP CENTER OF THE SCREEN. DISPLAY RESPONSE OPTIONS IN THE MIDDLE OF
THE SCREEN BELOW THE QUESTION.
ACASI READS QUESTION: You did not answer the question. Why not?
ACASI READS RESPONSE OPTIONS:
I do not want to answer (1=ACASI CODES RF FOR "REFUSED")

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I do not know the answer (2=ACASI CODES DK FOR "DON'T KNOW")
I really meant to answer (3)
Please use the stylus pen to touch the "Next" button and move to the next screen.
IF THE CHILD CHOOSES 1 OR 2, THEN ACASI MOVES TO THE NEXT SCREEN.
IF THE CHILD CHOOSES 3, THEN ACASI MOVES TO THE PREVIOUS SCREEN.
PLACE A NEXT BUTTON AT THE BOTTOM RIGHT OF THE SCREEN.

CLQGLB020

CHANGE RESPONSE PROCEDURE
THE CHILD'S ANSWER SELECTION SHOULD ALWAYS BE READ ON AUDIO, HIGHLIGHTED, AND REMAIN
HIGHLIGHTED.
IF THE CHILD WANTS TO CHANGE AN ANSWER, HE OR SHE CAN TOUCH THE "Erase" BUTTON AND THEN
TOUCH HIS/HER NEW ANSWER. ACASI SHOULD DO THE FOLLOWING:
UNHIGHLIGHT THE PREVIOUS RESPONSE
HIGHLIGHT THE NEW RESPONSE
READ THE NEW RESPONSE
THE CHILD CAN CHANGE AN ANSWER MULTIPLE TIMES. ACASI SHOULD ACCEPT THE LAST ANSWER.

CLQGLB025

DISPLAY INSTRUCTIONS
EACH RESPONSE OPTION (NOT AT ALL TRUE, A LITTLE BIT TRUE, MOSTLY TRUE, VERY TRUE, NEVER,
RARELY, SOMETIMES, OFTEN, VERY OFTEN, NOT AT ALL, A LITTLE BIT, SOMEWHAT, QUITE A BIT, VERY
MUCH) SHOULD BE HIGHLIGHTED AS EACH IS READ OVER AUDIO.

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CLQGLB030

AUDIO INSTRUCTIONS
WORDS IN ALL CAPS SHOULD BE EMPHASIZED WHEN READ OVER AUDIO.

CLQGBL035

ADMINISTRATION TIMING

FOR CQ ENTIRE ADMINISTRATION TIMINGS, BEGIN TIMING WHEN THE OPENING SCREEN FOR THE
ASSESSOR APPEARS (CLQ005) AND END TIMING WHEN THE ASSESSOR PRESSES 1 & ENTER TO LEAVE THE
CLOSING SCREEN (CLQ285).

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File Type	application/pdf
File Title	Microsoft Word - Appendix A_Child Questionnaire
Author	Jill.McCarroll
File Modified	2012-12-20
File Created	2012-12-20