ECLS-K:2011 Spring 4th Grade Cognitive Interviews and Timing Tests

NCES Cognitive, Pilot, and Field Test Studies System

Appendix A ECLS-K-2011 Spring 4th Grade Cog Lab - Subject-Specific Teacher Questionnaires redacted

ECLS-K:2011 Spring 4th Grade Cognitive Interviews and Timing Tests

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⚠️ Notice: This form may be outdated.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:
Subject-Specific Teacher Questionnaires
REDACTED VERSION

Items to be Included in the Cognitive Labs
Reading Questionnaire:
•

C1: Peer group evaluation

•

C5: Peer relationships

•

E1a-g: Reading skills

•

E2e-m: Reading activities

Math Questionnaire:
•

B1a-i: Math skills

•

B2b, i, and m: Math activities

Supplemental Questions for Math Teachers Only:
•

Communication with parents

•

School liking

•

Peer relationships

Science Questionnaire:
•

B1a-f: Science skills

•

B2g and l: Science activities

Supplemental Questions for Science Teachers Only:
•

Communication with parents

•

School liking

•

Peer group evaluation

A-1

GRADE 4
Reading and Language Arts
Teacher Questionnaire

Draft

PILOT TEST

Child Level
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
Rockville, Maryland
Use a black or blue ball point pen to complete this questionnaire.

RETURN THIS COMPLETED QUESTIONNAIRE IN THE SEALED
TYVEK® ENVELOPE DIRECTLY TO YOUR SCHOOL COORDINATOR
ORAN ECL
S‐
K:
2011STAF
FMEMBER.
DONOTMAI
LTHIS
QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY
STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

S_ID
C_ID

T_ID

According to the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is XXXX18500750. Approval expires XX/XX/XXXX.
12/31/2016. The time required to complete this
XXXX.
information collection is estimated to average XX
20
20 minutes per response,
including the time to review instructions, search existing data resources,
gather the data needed, and complete and review the information requested.
If you have any comments concerning the accuracy of the time estimate or
suggestions for improving the survey instrument, please write to: U.S.
Department of Education, Washington, D.C. 20202-4537. If you have
comments or concerns regarding the status of your individual response to this
survey, write directly to: National Center for Education Statistics, 1990 K
Street, N.W., Room 9086, Washington, D.C. 20006-5574.

The collection of information in this survey is authorized by 20 U.S.
Code, Section 9543. Participation is voluntary. You may skip questions
y
ou
do
not
wi
sh
t
o
answer
;
howev
er
,
we
hope
t
hat
y
ou
wi
l
l
ans
wer
as
many questions as you can. Your responses are protected from
disclosure by federal statute (20 U.S. Code, Section 9573). All
responses that relate to or describe identifiable characteristics of
individuals may be used only for statistical purposes and may not be
disclosed, or used, in identifiable form for any other purpose except as
required by law. Data will be combined to produce statistical reports. No
individual data that links your name, address, telephone number, or
identification number with your responses will be included in the
statistical reports.

Draft

Dear Teacher,
Thi
s
quest
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
s
t
udy
of
c
hi
l
dr
en’
s
ear
l
y
educat
i
onal
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach reading and language arts to fourth grade students.
 As you complete this questionnaire, please think about a child who is currently in your fourth
grade reading and language arts class.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
c
hi
l
dr
en’
s
academi
c
pr
ogr
ess
and
var
i
ous
school
,
c
l
as
sr
oom,
t
eac
her
,
and home characteristics.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you do
not want to answer. However, only you can provide this information. Although we realize you are very
busy, we urge you to complete this questionnaire as completely and accurately as possible. The
information you provide is being collected for research purposes only and will be protected from
disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. §
9573). Information from multiple individuals will be combined to
pr
oduce
st
at
i
s
t
i
cal
r
epor
t
s;
no
i
nf
or
mat
i
on
that identifies you will be included in any reports or provided to students, their parents, or other school
staff.
Please record your answers directly on the questionnaire by marking the appropriate answer (as
instructed on page 5) or by writing your responses in the space provided. Your best estimates are
acceptable answers.

DEFINITIONS
For the purposes of this study, the following definitions apply:
 Individualized Education Program (IEP): A written statement of the educational program designed to
t
he
i
ndi
vi
dual
needs
of
a
s
chool

aged
chi
l
d
wi
t
h
a
di
sabi
l
i
t
y
t
hat
i
s
j
udged
t
o
af
f
ect
t
he
c
hi
l
d’
s
meet
educational performance. Children who receive special education services under the Individuals with
Disabilities Act (IDEA) are expected to haven an IEP.
 English language learner (ELL): A student whose native language is one other than English and
whose skills in listening, speaking, reading, or writing English are such that he or she has difficulty
understanding school instruction in English.

Draft
1

TYPES OF LANGUAGE INSTRUCTION EDUCATIONAL PROGRAMS (LIEPS)
Programs that focus on developing students' literacy in two languages

Two-way immersion program (TWI) or two-way bilingual program: The goal of these programs is to
develop strong skills and proficiency in both students' home language and English. These programs may
also be called dual language programs. These programs include students whose native language is not
English (but who all speak the same non-English language) and students whose native language is English.
Instruction is provided in both languages, typically starting with a smaller proportion of instruction in
English, and gradually moving to half of the instruction in each language. Students typically stay in these
programs throughout elementary school.
Developmental bilingual program, late exit transitional program, or maintenance bilingual education
program: The goal of these programs is to develop some skills and proficiency in students' home language
and strong skills and proficiency in English. Content is taught in both languages by teachers fluent in both
languages. These programs may also be called dual language programs. Instruction at lower grades is in
the students' home language with a gradual transition to English. Students typically transition into
mainstream classrooms with their English-speaking peers. The programs can vary in the focus placed on
acquiring literacy in students' home language, but students generally do continue to receive some degree
of support in their home language after the transition to English classrooms.
Transitional program, early exit bilingual program, or early exit transitional program: The goal of these
programs is to develop English proficiency skills as soon as possible, without delaying learning of
academic core content. Instruction begins in students' home language but rapidly moves to English.
Students typically are transitioned into mainstream classrooms with their English-speaking peers as soon
as possible.
Heritage language program or indigenous language program: The goal of these programs is to develop
literacy in two languages. Content is taught in both languages by teachers fluent in both languages.
These programs typically target non-English speakers with weak literacy skills in their home language.
Programs that focus on developing students' literacy solely in English
Sheltered English instruction or content-based English as a Second Language (ESL) program: The goal of
these programs is to develop proficiency in English while learning content in an all-English setting.
Students from various linguistic and cultural backgrounds can be in the same class. Instruction is adapted
to students' proficiency in English and is supported by visual aids and support in the students' home
languages as available. Fully developed prototypes of this program include Sheltered Instruction
Observational Protocol (SIOP) and Specially Designed Academic Instruction in English (SDAIE).
Structured English Immersion (SEI): The goal of SEI is to develop fluency in English. This program usually
serves only English language learners. All instruction is in English, though the instruction is adjusted to the
English proficiency level of students so subject matter is comprehensible. Teachers may have some
receptive skills in the students' home language(s) and generally use sheltered instructional techniques.
Pull-out English as a Second Language (ESL) or English Language Development (ELD): The goal of
these programs is to develop fluency in English. ELL students leave their mainstream classroom for part
of the day to receive ESL instruction, which generally focuses on grammar, vocabulary, and
communication skills, not academic content. There typically is no support provided for students' home
languages.
Push-in English as a Second Language (ESL) program: The goal of push-in ESL is to develop fluency in
English. Students receive ESL instruction in a mainstream classroom, with instruction in English with some
native language support if needed. The ESL teacher or an instructional aide provides clarification,
translation if needed, and uses ESL strategies.

THANK YOU VERY MUCH FOR YOUR HELP.
1

National Clearinghouse for English Language Acquisition. (n.d.). Types of language instruction educational programs (LIEPs).
Retrieved [January 6, 2012] from http://www.ncela.gwu.edu/files/uploads/5/Language_Instruction_Educational_Programs.pdf.

Draft

Copyright Language to Use in Reading/Language Arts Teacher Questionnaire
Social Skills
Twenty-six items ask teachers to rate children in their classroom on social skills (including their ability to
exercise self-control, interact with others, resolve conflict, and participate in group activities);
problem behaviors (e.g., fighting, bullying, arguing, anger, depression, low self-esteem, impulsiveness,
etc.); and learning dispositions or “approaches to learning” (e.g., curiosity, self-direction, and
inventiveness). The social skills items and the problem behavior items are not listed as they are
copyright protected. The learning disposition items are not copyright protected and are listed below.
Source: Social Skills Rating System (SSRS). Copyright © 1990 NCS Pearson. Adapted with permission. All rights
reserved.

Learning Disposition (Approaches to Learning) Scale items
The teacher indicated how frequently the child exhibited the following behaviors. The response scale
included four points ranging from “never” to “very often,” and there was also a “no opportunity to observe”
option.
•
•
•
•
•
•
•

Keeps belongings organized
Shows eagerness to learn new things
Works independently
Easily adapts to changes in routine
Follows classroom rules
Persists in completing tasks
Pays attention well

Draft

Please indicate how often each of these items applies to the child identified on the cover of this
questionnaire. MARK ONE RESPONSE ON EACH ROW.

A2.

Doesn't apply
Sometimes applies
Certainly applies

Child seldom displays this behavior
Child occasionally displays this behavior
Child often displays this behavior
Doesn't apply

Sometimes applies

Certainly applies

﴾
s
el
dom di
s
pl
ay
s
t
hi
sbehav
i
or
﴿

﴾
oc
c
as
i
onal
l
ydi
s
pl
ay
s
t
hi
sbehav
i
or
﴿

﴾
of
t
endi
s
pl
ay
s
t
hi
sbehav
i
or
﴿

a. Likes to come to school
b. Dislikes school
c. Has fun at school
d. Likes being in school
e. Seems unhappy in school
f.

Enjoys most classroom activities

g. Groans or complains about suggested activities
Source: Teacher version of the School Liking and Avoidance Questionnaire ﴾
SL
AQ;Adapt
edf
r
om L
add& Pr
i
c
e,1987;L
add,1990﴿

Draft

SECTION B. CLASSROOM BEHAVIORS
Please continue to think about the child identified on the cover of this questionnaire.
B1.

Please read each statement and decide whether it is a "true" or "untrue" description of this child's
reaction to a number of situations within the past six months. If you cannot answer one of the
items because you have never seen the child in that situation, then mark "not applicable."

The child:

Almost
always
untrue

Usually
untrue

Sometimes
true,
sometimes
untrue

Usually
true

Almost
always
true

Not
applicable

a. Is easily distracted when listening
to a story.
b. Can stop him/herself when s/he is
told to stop.
c.

Looks around the room when doing
school work.

d. Can stop him/herself from doing
things too quickly.
e. When working on an activity, has a
hard time keeping her/his mind on it.
f.

Has an easy time waiting.

g. Has a hard time paying attention.
h. Has a hard time waiting his/her turn
to talk when excited.
i.

Needs to be told to pay attention.

Gets distracted when trying to pay
attention in class.

k. Likes to plan carefully before doing
something.
l.

Is good at following directions.

m. Has a hard time slowing down
when rules say to walk.

Source: Adapted from the Temperament in Middle Childhood Questionnaire. © 2004 Jennifer Simonds and Mary K. Rothbart, University of
Oregon. Used with permission.

Draft

SECTION C. PEER RELATIONSHIPS
C1.

For the items below, please think about the friends with whom the child identified on the cover of
this questionnaire has associated the most during the past month or two. Please indicate how
often you think each of these items applies to this group of children. MARK ONE RESPONSE ON
EACH ROW.
Almost
always
untrue

Usually
untrue

Sometimes
true,
sometimes
untrue

Usually
true

Almost
always
true

These kids are excellent students

g. These kids are hard workers
h. This child has a fun time with this group of children
i.

Most of these kids are kind to other children

Sour
c
e:Vandel
l
,
Debor
ahL
owe ﴾
2001﴿
.Rel
at
i
ons
hi
psWi
t
hPeer
s
:Par
tD﴾
Teac
her
﴿
.Unpubl
i
s
heds
c
al
e,NI
CHDSt
udyofEar
l
yChi
l
dCar
eand
Youth Development, Form FLV18G3.

Draft

C2.

Please indicate how often each of these items applies to this child, particularly in the context of
his or her behavior with peers. MARK ONE RESPONSE ON EACH ROW.
Doesn't apply

Sometimes applies

Certainly applies

﴾
s
el
dom di
s
pl
ay
s
t
hi
sbehav
i
or
﴿

﴾
oc
c
as
i
onal
l
ydi
s
pl
ay
s
t
hi
sbehav
i
or
﴿

﴾
of
t
endi
s
pl
ay
s
t
hi
sbehav
i
or
﴿

a. Seems concerned when other
children are distressed.
b. Is not chosen as playmate by peers.
c. Peers avoid this child.
d. Is kind toward peers.
e. Is excluded from peers' activities.
f.

Is cooperative with peers.

g.Showsc
onc
er
nf
ormor
ali
s
s
ues﴾
f
or
ex
ampl
e,
f
a
i
r
nes
s
,
wel
f
a
r
eofot
her
s
﴿
.
h. Is ignored by peers.
i.

Offers help or comfort when other
children are upset.

Source: Adapted from the Child Behavior Scale © Gary W. Ladd. Used with permission.

Draft

C3.

During this school year, how often have other students ... MARK ONE RESPONSE ON EACH ROW.
Never

Rarely

Sometimes

Often

Very often

a. Teased, made fun of, or called
this student names?
b. Told lies or untrue stories about
this student?
c. Pushed, shoved, slapped, hit, or
kicked this student?
d. Intentionally excluded or left this
student out from playing with
them?
C4.

During this school year, how often has this student ... MARK ONE RESPONSE ON EACH ROW.
Never

Rarely

Sometimes

Often

Very often

a. Teased, made fun of, or called
other students names?
b. Told lies or untrue stories about
other students?
c. Pushed, shoved, slapped, hit, or
kicked other students?
d. Intentionally excluded or left other
students out from playing with him
or her?
Sour
c
e:Es
pel
age,D.L
.& Hol
t
,M.﴾
2001﴿
.Bul
l
y
i
ngandpeerv
i
c
t
i
mi
z
at
i
ondur
i
ngear
l
yadol
es
c
enc
e:Peeri
nf
l
uenc
esandps
yc
hos
oc
i
al
142.Adapt
eda
ndus
edwi
t
hper
mi
s
s
i
on.
correlates. Journal of Emotional Abuse,
2,123‐

C5.

Please evaluate the performance of the child identified on the cover of this questionnaire in the
following areas, using the categories below. MARK ONE RESPONSE ON EACH ROW.
Very
poor

Somewhat
poor

Average

Good

Very
good

a. Understands others' feelings
b. Accurately interprets what a peer is
trying to do
c. Generates good quality solutions to
interpersonal problems
d. Is aware of the effects of his/her
behavior on others
Sour
c
e:Pi
er
c
e,K.M.
,Hamm,J
.V.
,& Vandel
l
,
D.L
.﴾
1999﴿
.Ex
per
i
enc
esi
naf
t
er
‐
s
c
hoolpr
ogr
amsandc
hi
l
dr
en'
sadj
us
t
menti
nf
i
r
s
t
‐
gr
ade
classrooms. Child Development, 70,
756‐
767.

Draft

SECTION D. STUDENT INFORMATION
Please continue to think about the child identified on the cover of this questionnaire.
D1.

How long has this child been in your reading class this school year until now? MARK ONE RESPONSE.
Entire school year until now
More than one semester but less than the entire school year until now
More than one quarter but less than one semester
Less than one quarter of the school year

D2.

Please indicate the total number of absences for this child for the current school year. MARK ONE
RESPONSE.
No absences
1 to 4 absences
5 to 7 absences
8 to 10 absences
11 to 19 absences
20 or more absences

D3.

Doest
hi
sc
hi
l
dr
ec
ei
ve﴾
orhashe/
s
her
ec
ei
veddur
i
ngt
hi
ss
c
hoolyear
﴿i
ns
t
r
uc
t
i
oni
nanyof
the following types of programs in your school? MARK YES OR NO ON EACH ROW.
Yes
a. Individual tutoring or remedial program in reading/language arts
b. Gifted and talented program in reading/language arts
c. Gifted and talented program with no specific content focus

D4.

Is English this child's native language? MARK ONE RESPONSE.
SKI
PTO QD10﴿
Yes ﴾
No
Don't know

Draft

D5.

Does this child participate in an instructional program designed to teach English language
skills to children with limited English proficiency? MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO Q D10﴿

D6.

Woul
dyous
ayt
hei
ns
t
r
uc
t
i
ont
hi
sc
hi
l
dr
ec
ei
vesi
spr
i
mar
i
l
y… MARK ONE RESPONSE.
EXAMPLES OF THE PROGRAMS INCLUDED IN EACH CATEGORY ARE PROVIDED BELOW.
SEE PAGE 4 FOR DEFINITIONS OF THESE EXAMPLES.
Programs that focus on developing students' literacy in two languages. For example:






Two‐
wayi
mmer
s
i
onpr
ogr
am ort
wo‐
waybi
l
i
ngua
lpr
ogr
am
Developmental bilingual program, late exit transitional program, or
maintenance bilingual education program
Transitional program, early exit bilingual program, or early exit transitional program
Heritage language program or indigenous language program

Programs that focus on developing students' literacy solely in English. For example:






Shel
t
er
edEngl
i
s
hi
ns
t
r
uc
t
i
onorc
ont
ent
‐
bas
edEngl
i
s
hasaSec
ond
L
a
nguage﴾
ESL
﴿pr
ogr
am
St
r
uc
t
ur
edEngl
i
s
hI
mmer
s
i
on﴾
SE
I
﴿
Pul
l
‐
outEngl
i
s
hasaSec
ondL
anguage﴾
ESL
﴿orE
ngl
i
s
hL
a
nguageDev
el
opment﴾
EL
D﴿
Pus
h‐
i
nESLpr
ogr
am

Ot
herpr
ogr
am﴾
s
﴿(PLEASE SPECIFY)

Nos
pec
i
al
i
z
edl
anguagepr
ogr
am i
spr
ovi
dedt
ot
hi
sc
hi
l
d.﴾
SKI
PTOQ D9﴿

D7.

How often does this child usually receive specialized language instruction of the following program
types? MARK ONE RESPONSE ON EACH ROW.
Less
than
once
1 day
2 days
3 days
4 days
5 days
a week a week a week a week
Never
a week a week
a. Program that focuses on
developing students' literacy in
two languages
b. Program that focuses on
developing students' literacy
solely in English
c. Other program

Draft

D8.

On the days when this child receives specialized language instruction, for how much time does
he/she receive instruction of the following program types? MARK ONE RESPONSE ON EACH ROW.
Not
Less
applicable/ than ½
never
hour

½ hour
to less 1 to less
than 1 than 1 ½
hour
hours

1 ½ to
less
than 2
hours

2 to less
than 2 ½
hours

2 ½ to
less
than 3
hours

a. Program that focuses on
developing students'
literacy in two languages
b. Program that focuses on
developing students'
literacy solely in English
c. Other program

D9.

During this school year, how often is this child's reading instruction provided in his/her native
language? MARK ONE RESPONSE.
None of the time
Less than half of the time
Half of the time
More than half of the time
Almost all the time

D10.

Does this child have an IEP on record with the school? MARK ONE RESPONSE.
Yes
No

D11.

Does this child receive instruction in any of the following types of programs in your school?
MARK YES OR NO ON EACH ROW.
Yes
a
. Speec
h‐
l
anguaget
her
apyf
orc
hi
l
dr
enwi
t
hs
peec
horl
a
nguage
disorders/impairments
b. Special education services, not including speech therapy, whether
pr
ov
i
dedi
nt
hec
l
as
s
r
oom ori
napul
l
‐
outs
et
t
i
ng

3 hours
or more

Draft

D12.

Overall, how would you rate this child's academic skills in each of the following areas, based
on curriculum standards for his/her current grade level? MARK ONE RESPONSE ON EACH ROW.
Below
grade
level

About on
grade
level

Above
grade
level

a. Reading
b. Writing
c. Oral language
d. Social Studies

D13.

How often does this child work to the best of her/his ability in reading and language arts?
MARK ONE RESPONSE.
Never
Seldom
Usually
Always

D14.

How many instructional groups based on achievement or ability levels in READING do you
currently have in this child's class? MARK ONE RESPONSE.
I do not use instructional groups for reading

﴾
SKI
PTO Q D16﴿

Two
Three
Four
Five or more

D15.

In which reading instructional group is this child currently placed? USE "1" FOR THE
HIGHEST INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL
GROUP BELOW.
Instructional Group

Draft

D16.

How involved at the school would you say this child's parents/guardians are? MARK ONE
RESPONSE.
Not involved at all
Somewhat involved
Very involved
Don't know

D17.

Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON
EACH ROW.
Yes
a. Reading/Language Arts
b. Mathematics
c. Science
d. Social Studies

PART 2.
Draft

SECTION E. READING AND LANGUAGE ARTS INSTRUCTION
Please answer the following questions for the reading class in which the child identified on the cover of this
questionnaire receives reading and language arts instruction.
E1.

From the first day of school until today, please indicate how many days each of the following 4th
grade READING AND LANGUAGE ARTS skills and concepts have been covered in this class. Please
include the time during which you provide direct instruction as well as the time you spend
supervising students as they work. MARK ONE RESPONSE ON EACH ROW.
Not
taught

a. Understanding key ideas and details,
including identifying the main idea or theme
in a text; drawing inferences from details in
text; explaining procedures in a scientific or
technical text
b. Understanding craft and structure,
including describing how the narrator's point
of view influences the story; comparing
different perspectives of the same event in
t
het
ex
t
﴾
s
﴿
;
des
c
r
i
bi
ngs
t
r
uc
t
ur
a
lel
ement
sof
poems and of dramas
c. Integration of knowledge and ideas,
including comparing and integrating
information from two different texts;
explaining how an author uses evidence to
support a point; comparing a text to a visual
presentation of the text such as a movie
d. Writing narratives, opinion pieces, and
informational text with facts and details
e. Writing about topics covered in other
subjects, like math, science or social studies
f. Developing and strengthening writing by
planning, drafting, revising, and editing
g. Building vocabulary by studying words and
their meanings in text; learning about roots,
prefixes and suffixes; using context clues to
derive meaning

On
1‐
10
days

On
11‐
20
days

On
21‐
40
days

On
On more
41‐
80 than 80
days
days

Draft

E2.

How often do the children in this class engage in the following reading and language arts activities?
MARK ONE RESPONSE ON EACH ROW.
Almost
every
day
a. Read silently
b. Read books they have chosen themselves
c. Talk with others about what they have read
d. Do a group activity or project about what they
have read
e. Discuss different interpretations of what they
have read
f.

Look up assigned vocabulary words and write
definitions
g. Use assigned vocabulary words orally in class or
in written assignments

h. Write in a journal
i.

When given specific questions, write responses that
are at least 3 to 4 sentences long

Write responses to questions that are related to
math, social studies, or science instruction

k. Do research using books and/or the internet to
gather evidence as they are writing
l.

Spend at least a week writing and revising things
that they have written

m. Edit other students' writing

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never

Draft

SECTION F. CLASSROOM AND STUDENT CHARACTERISTICS
Please answer the following questions about the specific class in which the child identified on the cover of this
questionnaire receives instruction from you.
F1.

Asoft
oday'
sdat
e,how manyc
hi
l
dr
en…
WRITE NUMBER IN BOX. IF THERE ARE NO CHILDREN IN A PARTICULAR CATEGORY, WRITE "0."
Number of
children
a. Are currently enrolled in this class?
b. Are boys?
c.

F2.

Are girls?

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade
b. 3rd grade
c.

4th grade

d. 5th grade
e. 6th grade or higher

F3.

How many of the children in this class are repeating this grade this year? WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of children repeating this grade

Draft

F4.

How many children in this class ...
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of
children
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented program?

F5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children absent, on an average day

F6.

How many children in this class are below grade level, about on grade level, or above grade
level in each of the following subjects?
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
I do not teach
this subject

Below
grade level

About on
grade level

Above
grade level

a. English reading skills?
b. Mathematics skills?
c. Science?

F7.

At this point in the school year, how would you rate the behavior of the children in this class?
MARK ONE RESPONSE.
Group misbehaves very frequently and is almost always difficult to handle.
Group misbehaves frequently and is often difficult to handle.
Group misbehaves occasionally.
Group behaves well.
Group behaves exceptionally well.

Draft

F8.

Approximately what percentage of the students in this classroom demonstrates the following
problems? MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
b. L
a
c
ks
el
f
‐
c
ont
r
ol
﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
c.

Are rejected by peers

d. Do not accept authority
Sour
c
e:Abr
y
,T.
,Swans
on,J
.
,andFabes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

F9.

How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children

F10.

Doyouhaveanyc
hi
l
dr
enwhoar
eEngl
i
s
hl
anguagel
ear
ner
si
nt
hi
sc
l
as
s
?﴾
Engl
i
s
hl
anguage
learners are children whose native language is one other than English and whose skills in
listening, speaking, reading, or writing English are such that they have difficulty understanding
s
chooli
ns
t
r
uc
t
i
oni
nEngl
i
s
h.
﴿MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO Q G1﴿

F11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of ELL children

Draft

SECTION G. CLASSROOM INSTRUCTION
Please continue to think about the specific reading class in which the child identified on the cover of this questionnaire
receives instruction from you.
G1.

In a typical day, how much time do children in this class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.
No
time

Half
hour or
less

About
one
hour

About
two
hours

About
Four
three hours or
hours
more

a. Working independently
b. Working on individual tasks under
teacher direction
c. Working with peers under teacher
direction
d. Working in small groups with
teacher
e. Teacher lecture with large group
and/or large group discussion led
by teacher

G2.

Do any of the following staff members provide direct instruction to students in this class who
are struggling or at risk of failure in reading? INCLUDE STAFF OTHER THAN YOURSELF WHO
PROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
OUTS
E
TTI
NG.E
XCL
UDE
PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes
a. A READING specialist/interventionist who has specialized
training in reading instruction
b. A special education teacher

Draft

G3.

In this class, how frequently do you or your students use computers or the following electronic
devices for reading instructional purposes? Please include any desktop, laptop, or other
c
omput
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
Not
Often
Never
Rarely
Sometimes
available
a
. Comput
er﴾
des
k
t
op,
l
a
pt
opor
ot
herc
omput
er
‐
t
y
pedev
i
c
e
s
uc
ha
sat
abl
et
﴿
b. LCD or DLP projector
c. I
nt
er
ac
t
i
v
ewhi
t
eboar
d﴾
f
or
example, SMART Board,
Ac
t
i
v
boar
d﴿
d.Di
gi
t
alc
a
mer
a﴾
s
t
i
l
lorv
i
deo﴿
e. CD player or MP3 player/iPod
f.

DVD player or VCR

g. TV
h. Other electronic devices
﴾
PL
E
ASESPECI
F
Y﴿

G4.

In an average week, how many days a week is reading homework assigned in this class? Please
count homework assigned over the weekend as one day. MARK ONE RESPONSE.
SKI
PTO Q H1﴿
0 days ﴾
1 day
2 days
3 days
4 days
5 days

G5.

On days when homework is assigned, how much time do you expect children in this class to
spend on homework in the following areas? MARK ONE RESPONSE ON EACH ROW.
I do not
teach this
subject

I never
assign
homework

a. Reading and language arts
b. Math
c. Science
d. Social studies

1 to 10
minutes

11 to 20
minutes

21 to 30
minutes

More
than 30
minutes

Draft

SECTION H. EVALUATION AND GRADING PRACTICES
Please continue to think about the specific class in which the child identified on the cover of this questionnaire receives
instruction from you.
H1.

In this class, how often do you use a formal assessment in READING for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

a. To evaluate how well each
student is responding to the
core curriculum provided in
the general education
classroom
b. To monitor each student's
progress on specific skills
over the school year
c. To identify the deficits in
specific skills of struggling
students
d. To monitor the progress of
students who fall below
benchmark levels
e. To determine whether
students need placement in a
more or less intensive level of
instruction

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

H2.

For each of the following statements about READING, indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree

Agree

Strongly
agree

a. This school has a set of clear,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
el
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
reading in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
intervention f
our
t
h‐
gr
ade
students will receive in reading.
c. This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a reading intervention.

H3.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Don't
know

Draft

For Office Use Only
Comp
Ref

Draft

GRADE 4
Math
Teacher Questionnaire

Draft

PILOT TEST

Child Level
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
Rockville, Maryland
Use a black or blue ball point pen to complete this questionnaire.

S_ID
C_ID

T_ID

Draft

Dear Teacher,
Thi
s
ques
t
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
s
t
udy
of
c
hi
l
dr
en’
s
ear
l
y
educ
at
i
onal
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach mathematics to fourth grade students.
 As you complete this questionnaire, please think about a child who is currently in your fourth
grade mathematics class.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
c
hi
l
dr
en’
s
ac
ademi
c
pr
ogr
ess
and
var
i
ous
s
chool
,
cl
as
sr
oom,
t
eacher
,
and home characteristics.
Taking part in the study is voluntary. You may stop at any time or choose not to ans wer a question you do
not want to answer. However, only you can provide this information. Although we realize you are very
busy, we urge you to complete this questionnaire as completely and accurately as possible. The
information you provide is being collected for research purposes only and will be protected from
disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. §
9573). Information from multiple individuals will be combined to produce statistical reports;
no
i
nf
or
mat
i
on
that identifies you will be included in any reports or provided to students, their parents, or other school
staff.
Please record your answers directly on the questionnaire by marking the appropriate answer (as
instructed on page 4) or by writing your responses in the space provided. Your best estimates are
acceptable answers.
DEFINITIONS
For the purposes of this study, the following definitions apply:
 Individualized Education Program (IEP): A written statement of the educational program designed to
meet
t
he
i
ndi
vi
dual
needs
of
a
sc
hool

aged
chi
l
d
wi
t
h
a
di
sabi
l
i
t
y
t
hat
i
s
j
udged
t
o
af
f
ec
t
t
he
chi
l
d’
s
educational performance. Children who receive special education services under the Individuals with
Disabilities Act (IDEA) are expected to haven an IEP.
 English language learner (ELL): A student whose native language is one other than English and
whose skills in listening, speaking, reading, or writing English are such that he or she has difficulty
understanding school instruction in English.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

PART 1.
Draft

SECTION A. STUDENT INFORMATION
Please answer the following questions about the child identified on the cover of this questionnaire.
A1.

How long has this child been in your math class this school year until now? MARK ONE RESPONSE.
Entire school year until now
More than one semester but less than the entire school year until now
More than one quarter but less than one semester
Less than one quarter of the school year

A2.

A3.

Doest
hi
sc
hi
l
dr
ec
ei
ve﴾
orhashe/
s
her
ec
ei
veddur
i
ngt
hi
ss
c
hoolyear
﴿i
ns
t
r
uc
t
i
oni
nanyof
the following types of programs in your school? MARK YES OR NO ON EACH ROW.
Yes
a. Individual tutoring or remedial program in mathematics
b. Gifted and talented program in mathematics

A4.

Is English this child's native language? MARK ONE RESPONSE.
SKI
PTO Q A6﴿
Yes ﴾
No
Don't know

Draft

A5.

During this school year, how often is this child's mathematics instruction provided in his/her
native language? MARK ONE RESPONSE.
None of the time
Less than half of the time
Half of the time
More than half of the time
Almost all the time

A6.

Overall, how would you rate this child's academic skills in MATH, based on curriculum standards for
his/her current grade level? MARK ONE RESPONSE.
Below grade level
About on grade level
Above grade level

A7.

How often does this child work to the best of her/his ability in math? MARK ONE RESPONSE.
Never
Seldom
Usually
Always

A8.

How many instructional groups based on achievement or ability levels in MATHEMATICS do
you currently have in this child's class? MARK ONE RESPONSE.
I do not use instructional groups for mathematics
Two
Three
Four
Five or more

﴾
SKI
PTO QA10﴿

Draft

A9.

In which mathematics instructional group is this child currently placed? USE "1" FOR THE
HIGHEST INSTRUCTIONAL GROUP. WRITE THE NUMBER OF THE CHILD'S INSTRUCTIONAL
GROUP BELOW.
Instructional Group

A10.

Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON
EACH ROW.
Yes
a. Reading/Language Arts
b. Mathematics
c. Science
d. Social Studies

PART 2.
Draft

SECTION B. MATHEMATICS INSTRUCTION

Please answer the following questions for the math class in which the child on the cover of this questionnaire receives
mathematics instruction.
B1.

From the first day of school until today, please indicate how many days each of the following 4th
grade MATHEMATICS skills and concepts have been covered in this class. Please include the time
during which you provide direct instruction as well as the time you spend supervising students as
they work. MARK ONE RESPONSE ON EACH ROW.
On
On
On
On
On more
Not
20
40
1‐
10
11‐
21‐
41‐
80 than 80
taught
days
days
days
days
days

a. Operations, including solving problems by
multiplying or dividing two whole numbers;
s
ol
v
i
ngmul
t
i
pl
e‐
s
t
epwor
dpr
obl
emst
hatus
e
several different operations; interpreting
remainders; finding factor pairs
b. Algebraic thinking, including solving word
problems by representing the problem as an
equation with a symbol for the unknown number
c. Understand place value, including reading and
wr
i
t
i
ngmul
t
i
pl
e‐
di
gi
twhol
enumber
sus
i
ng
e‐
t
ennumer
al
s
;
c
ompar
i
ngt
womul
t
i
pl
e‐
di
gi
t
bas
numbers based on meanings of the digits in each
place; using place value understanding to round
mul
t
i
pl
e‐
di
gi
twhol
enumber
st
oanypl
ac
e
d. Addands
ubt
r
ac
tmul
t
i
pl
e‐
di
gi
tnumber
susing
strategies based on place value and properties of
operations
e. Understand fractions, including comparing
fractions with different numerators and different
denominators; adding and subtracting fractions;
multiplying fractions by whole numbers;
understanding the relationship between decimals
and fractions with a denominator of 10 or 100
f. Solve problems involving measurement,
including understanding the relative size of
measurements within one system of units such
as seconds, minutes, hours; finding the area or
perimeter of geometric shapes
g. Represent and interpret data, including making
line plots to display fractions of a unit; using
addition and subtraction of fractions to answer
questions about a line plot
h. Understand concepts of angles, including
measuring angles; adding and subtracting
angle measures
i. Draw and identify lines and angles, including
drawing points, lines, line segments, rays, angles,
perpendicular and parallel lines; recognizing
right triangles; understanding lines of symmetry

Draft

B2.

How often do the children in this class engage in the following mathematics activities? MARK ONE
RESPONSE ON EACH ROW.
Almost
every
day
a. Solve mathematics problems from textbooks or
worksheets
b. Solve mathematics problems from the
blackboard, whiteboard/SMART Board®, or
projector
c. Solve mathematics problems in small groups or
with a partner
d. Wor
kwi
t
hmea
s
ur
i
ngi
ns
t
r
ument
s﴾
f
orex
ampl
e
r
ul
er
s
,c
ompas
s
es
,
pr
ot
r
ac
t
or
s
﴿
e. Wor
kwi
t
hmani
pul
a
t
i
v
es﴾
f
orex
ampl
e,
geomet
r
i
c
pes
﴿
s
ha
f.

Use a calculator

g. Take mathematics tests/quizzes
h. Write a few sentences about how to solve a
mathematics problem
i.

Talk to the class about their mathematics work

Discuss solutions to mathematics problems with
other students

k. Work on and discuss mathematics problems that
r
ef
l
ec
tr
ea
l
‐
l
i
f
es
i
t
ua
t
i
ons
l
. Us
eac
omput
erf
ormat
h﴾
bey
ondus
i
nga
c
omput
er
'
sc
al
c
ul
at
or
﴿
m.I
nt
er
pr
etv
i
s
ualr
epr
es
ent
at
i
ons﴾
f
orex
ampl
e,
di
a
gr
ams
,
t
abl
es
,
model
s
﴿
n. Cr
ea
t
ev
i
s
ualr
epr
es
ent
at
i
ons﴾
f
orex
a
mpl
e,
di
a
gr
ams
,
t
abl
es
,
model
s
﴿

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never
\\\\\\\\\\\

Draft

SECTION C. CLASSROOM AND STUDENT CHARACTERISTICS
Please answer the following questions about the specific class in which the child identified on the cover of this
questionnaire receives instruction from you.
C1.

C2.

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher

C3.

How many of the children in this class are repeating this grade this year? WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of children repeating this grade

Draft

C4.

How many children in this class ...
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of
children
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented program?

C5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children absent, on an average day

C6.

Below
grade level

About on
grade level

Above
grade level

a. English reading skills?
b. Mathematics skills?
c. Science?

C7.

Draft

C8.

Approximately what percentage of the students in this classroom demonstrates the following
problems? MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
a
c
ks
el
f
‐
c
ont
r
ol﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
b.L
c. Are rejected by peers
d. Do not accept authority
Sour
c
e:Abr
y,
T.
,Swans
on,J
.
,andFabes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

C9.

How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children

C10.

hi
l
dr
enwhoar
eEngl
i
s
hl
anguagel
ear
ner
si
nt
hi
sc
l
as
s
?﴾
Engl
i
s
hl
anguage
Doyouhaveanyc
learners are children whose native language is one other than English and whose skills in
listening, speaking, reading, or writing English are such that they have difficulty understanding
s
c
hooli
ns
t
r
uc
t
i
oni
nEngl
i
s
h.
﴿MARK ONE RESPONSE.
Yes
No ﴾
PTO Q D1﴿
SKI

C11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of ELL children

Draft

SECTION D. CLASSROOM INSTRUCTION
Please continue to think about the specific math class in which the child identified on the cover of this questionnaire
receives instruction from you.
D1.

In a typical day, how much time do children in this class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.
No
time

Half
hour or
less

About
one
hour

About
two
hours

About
Four
three hours or
hours
more

D2.

Do any of the following staff members provide direct instruction to students in this class who
are struggling or at risk of failure in math? INCLUDE STAFF OTHER THAN YOURSELF WHO
PROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
OUTS
E
TTI
NG.E
XCL
UDE
PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes
a. A MATH specialist/interventionist who has specialized
training in math instruction
b. A special education teacher

Draft

D3.

In this class, how frequently do you or your students use computers or the following electronic
devices for math instructional purposes? Please include any desktop, laptop, or other
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
c
omput
Not
available

Never

Rarely

Sometimes

Often

a. Comput
er﴾
des
k
t
op,
l
apt
opor
omput
er
‐
t
y
pedev
i
c
e
ot
herc
s
uc
ha
sat
a
bl
et
﴿
b. LCD or DLP projector
c
.I
nt
er
ac
t
i
v
ewhi
t
eboar
d﴾
f
or
example, SMART Board,
Ac
t
i
v
boar
d﴿
d.Di
gi
t
alc
amer
a﴾
s
t
i
l
lorv
i
deo﴿
e. CD player or MP3 player/iPod
f.

DVD player or VCR

g. TV
h. Other electronic devices
﴾
PL
E
ASESPECI
F
Y﴿

D4.

In an average week, how many days a week is math homework assigned in this class? Please
count homework assigned over the weekend as one day. MARK ONE RESPONSE.
SKI
PTO Q E1﴿
0 days ﴾
1 day
2 days
3 days
4 days
5 days

D5.

On days when homework is assigned, how much time do you expect children in this class to
spend on homework in the following areas? MARK ONE RESPONSE ON EACH ROW.
I do not
teach this
subject

I never
assign
homework

a. Reading and language arts
b. Math
c. Science
d. Social studies

1 to 10
minutes

11 to 20
minutes

21 to 30
minutes

More
than 30
minutes

Draft

SECTION E. EVALUATION AND GRADING PRACTICES
Please continue to think about the specific class in which the child identified on the cover of this questionnaire receives
instruction from you.
E1.

In this class, how often do you use a formal assessment in MATHEMATICS for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

E2.

For each of the following statements about MATHEMATICS indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree

Agree

Strongly
agree

a. This school has a set of clear,
pr
edet
er
mi
ned,
gr
ade‐
l
ev
el
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
math in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
i
nt
er
v
ent
i
onf
our
t
h‐
gr
a
de
students will receive in math.
c. This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a math intervention.

E3.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Don't
know

Draft

For Office Use Only
Comp
Ref

Draft

GRADE 4
Science
Teacher Questionnaire

Draft

PILOT TEST

Child Level
Prepared for the U.S. Department of Education
National Center for Education Statistics by:
Westat
Rockville, Maryland
Use a black or blue ball point pen to complete this questionnaire.

S_ID
C_ID

T_ID

Draft

Dear Teacher,
s
ques
t
i
onnai
r
e
i
s
an
i
mpor
t
ant
par
t
of
a
maj
or
l
ongi
t
udi
nal
s
t
udy
of
c
hi
l
dr
en’
s
ear
l
y
educat
i
onal
Thi
experiences beginning with kindergarten and continuing through grade 5. You have received this
questionnaire because you teach science to fourth grade students.
 As you complete this questionnaire, please think about a child who is currently in your fourth
grade science class.
The Early Childhood Longitudinal Study, Kindergarten Class of 2010-2011 (ECLS-K:2011) is
collecting information from teachers of children who are in the study to investigate the relationship
bet
ween
c
hi
l
dr
en’
s
ac
ademi
c
pr
ogr
ess
and
var
i
ous
school
,
c
l
ass
r
oom,
t
eacher
,
and home characteristics.
Taking part in the study is voluntary. You may stop at any time or choose not to answer a question you do
not want to answer. However, only you can provide this information. Although we realize you are very
busy, we urge you to complete this questionnaire as completely and accurately as possible. The
information you provide is being collected for research purposes only and will be protected from
disclosure to the fullest extent allowable by law (Education Sciences Reform Act of 2002, 20 U.S.C. §
9573)
.
I
nf
or
mat
i
on
f
r
om
mul
t
i
pl
e
i
ndi
vi
dual
s
wi
l
l
be
combi
ned
t
o
pr
oduc
e
st
at
i
s
t
i
c
al
r
epor
t
s;
no
i
nformation
that identifies you will be included in any reports or provided to students, their parents, or other school
staff.
Please record your answers directly on the questionnaire by marking the appropriate answer (as
instructed on page 4) or by writing your responses in the space provided. Your best estimates are
acceptable answers.
DEFINITIONS
For the purposes of this study, the following definitions apply:
 Individualized Education Program (IEP): A written statement of the educational program designed to
meet
t
he
i
ndi
v
i
dual
needs
of
a
sc
hool

aged
c
hi
l
d
wi
t
h
a
di
s
abi
l
i
t
y
t
hat
i
s
j
udged
t
o
af
f
ect
t
he
chi
l
d’
s
educational performance. Children who receive special education services under the Individuals with
Disabilities Act (IDEA) are expected to haven an IEP.
 English language learner (ELL): A student whose native language is one other than English and
whose skills in listening, speaking, reading, or writing English are such that he or she has difficulty
understanding school instruction in English.

THANK YOU VERY MUCH FOR YOUR HELP.

Draft

PART 1.
Draft

SECTION A. STUDENT INFORMATION
Please answer the following questions about the child identified on the cover of this questionnaire
A1.

How long has this child been in your science class this school year until now? MARK ONE RESPONSE.
Entire school year until now
More than one semester but less than the entire school year until now
More than one quarter but less than one semester
Less than one quarter of the school year

A2.

A3.

Is English this child's native language? MARK ONE RESPONSE.
PTO Q A5﴿
SKI
Yes ﴾
No
Don't know

A4.

During this school year, how often is this child's science instruction provided in his/her
native language? MARK ONE RESPONSE.
None of the time
Less than half of the time
Half of the time
More than half of the time
Almost all the time

Draft

A5.

Overall, how would you rate this this child's academic skills in SCIENCE based on curriculum
standards for his/her current grade level? MARK ONE RESPONSE.
Below grade level
About on grade level
Above grade level

A6.

How often does this child work to the best of her/his ability in science? MARK ONE RESPONSE.
Never
Seldom
Usually
Always

A7.

Are you this child's primary teacher in the following subject areas? MARK YES OR NO ON
EACH ROW.
Yes
a. Reading/Language Arts
b. Mathematics
c. Science
d. Social Studies

PART 2.
Draft

SECTION B. SCIENCE INSTRUCTION
Please answer the following questions for the science class in which the child identified on the cover of this
questionnaire receives science instruction.
B1.

From the first day of school until today, please indicate how many days each of the following 4th
grade SCIENCE skills and concepts have been covered in this class. Please include the time during
which you provide direct instruction as well as the time you spend supervising students as they
work. MARK ONE RESPONSE ON EACH ROW.
Not
taught

a. Physical science, including understanding
properties of electricity and magnetism
b. Life science, including learning about
organisms, life cycles, food chains and
ecosystems
c. Earth science, including learning about
rocks and minerals, weather, erosion
d. Observations and hypotheses, including
understanding the difference between
observations and inferences, formulating
predictions that can be tested
e. Scientific testing, including planning and
conducting investigations, measuring using
appropriate tools, demonstrating safe behavior
f. Analysis and conclusions, including
analyzing the results of a scientific
investigation and determining whether the
results support the initial prediction

On
1-10
days

On
11-20
days

On
21-40
days

On
41-80
days

On more
than 80
days

Draft

B2.

How often do the children in this class engage in the following science activities? MARK ONE
RESPONSE ON EACH ROW.
Almost
every
day
a. Read a science textbook
b. Discuss science in the news
c. Work with other children on a science activity or
project
d. Us
es
c
i
enc
eequi
pment﴾
e.
g.
,ma
gni
f
y
i
nggl
as
s
,
s
c
al
es
,
t
her
momet
er
s
﴿
e. Prepare a written science report
f
. Engagei
nhands
‐
onac
t
i
v
i
t
i
esori
nv
es
t
i
gat
i
ons
in science
g. Talk about measurements and results from
c
hi
l
dr
en’
shands
‐
onac
t
i
v
i
t
i
es
h. Take a science test or quiz
i.

Use library resources for science

Use computers for science

k. Use the Internet for science
l.

Generate and test hypotheses about particular
phenomena

Once or
twice a
week

Once or
twice a
month

Less than
once a
month or
never

Draft

C2.

What grade levels are included in this class? MARK ALL THAT APPLY.
a. 2nd grade
b. 3rd grade
c. 4th grade
d. 5th grade
e. 6th grade or higher

C3.

How many of the children in this class are repeating this grade this year? WRITE NUMBER IN
BOX. IF NONE, WRITE "0."
Number of children repeating this grade

Draft

C4.

How many children in this class ...
WRITE NUMBER IN BOX. IF NONE, WRITE "0."
Number of
children
a. Are classified as Gifted and Talented?
b. Are participating in a Gifted and Talented program?

C5.

How many children in this class are absent on an average day? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children absent, on an average day

C6.

Below
grade level

About on
grade level

Above
grade level

a. English reading skills?
b. Mathematics skills?
c.

C7.

Science?

Draft

C8.

Approximately what percentage of the students in this classroom demonstrates the following
problems? MARK ONE RESPONSE ON EACH ROW.
0%

1‐
10%

11‐
25%

26‐
50% 51‐
75% 76‐
100%

a. Have difficulty paying attention in class
b.L
a
c
ks
el
f
‐
c
ont
r
ol﴾
di
s
r
upt
i
v
ebehav
i
or
﴿
c. Are rejected by peers
d. Do not accept authority
Sour
c
e:Abr
y,
T.
,Swans
on,J
.
,andFabes
,R.A.﴾
2012﴿
.The Classroom Environment Student Difficulties Scale. Arizona State University,
Unpublished measure. Adapted with permission.

C9.

How many children in this class have a diagnosed disability? WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of children

C10. Doyouhaveanyc
hi
l
dr
enwhoar
eEngl
i
s
hl
anguagel
ear
ner
si
nt
hi
sc
l
as
s
?﴾
Engl
i
s
hl
anguage
learners are children whose native language is one other than English and whose skills in
listening, speaking, reading, or writing English are such that they have difficulty understanding
s
c
hooli
ns
t
r
uc
t
i
oni
nEngl
i
s
h.
﴿MARK ONE RESPONSE.
Yes
No ﴾
SKI
PTO Q D1﴿

C11. How manyEngl
i
s
hl
anguagel
ear
ner
s﴾
EL
Ls
﴿doyouhavei
nt
hi
sc
l
as
s
?WRITE NUMBER IN BOX. IF
NONE, WRITE "0."
Number of ELL children

Draft

SECTION D. CLASSROOM INSTRUCTION
Please continue to think about the specific science class in which the child identified on the cover of this questionnaire
receives instruction from you.
D1.

In a typical day, how much time do children in this class spend in the following activities?
MARK ONE RESPONSE ON EACH ROW. DO NOT INCLUDE LUNCH OR RECESS BREAKS.
No
time

Half
hour or
less

About
one
hour

About
two
hours

About
Four
three hours or
hours
more

a. Working independently
b. Working on individual tasks under
teacher direction
c.

Working with peers under teacher
direction

d. Working in small groups with
teacher
e. Teacher lecture with large group
and/or large group discussion led
by teacher

D2.

Do any of the following staff members provide direct instruction to students in this class who
are struggling or at risk of failure in science? INCLUDE STAFF OTHER THAN YOURSELF WHO
PROVI
DEDI
RE
CTI
NS
TRUCTI
ONE
I
THE
RI
NTHI
SCL
AS
SORI
NAPUL
L
‐
OUTS
E
TTI
NG.EXCL
UDE
PARAPROFESSIONALS/AIDES. MARK YES OR NO ON EACH ROW.
Yes
a. A SCIENCE specialist/interventionist who has specialized
training in science instruction
b. A special education teacher

Draft

D3.

In this class, how frequently do you or your students use computers or the following electronic
devices for science instructional purposes? Please include any desktop, laptop, or other
c
omput
er
‐
t
ypedevi
c
es
.MARK ONE RESPONSE ON EACH ROW.
Not
available

Never

Rarely

Sometimes

Often

a. Comput
er﴾
des
k
t
op,
l
apt
opor
ot
herc
omput
er
‐
t
y
pedev
i
c
e
s
uc
hasat
abl
et
﴿
b. LCD or DLP projector
c
.I
nt
er
a
c
t
i
v
ewhi
t
eboar
d﴾
f
or
example, SMART Board,
Ac
t
i
v
boar
d﴿
d. Di
gi
t
alc
amer
a﴾
s
t
i
l
lorv
i
deo﴿
e. CD player or MP3 player/iPod
f.

DVD player or VCR

g. TV
h. Other electronic devices
﴾
PL
EASESPECI
F
Y﴿

D4.

In an average week, how many days a week is science homework assigned in this class? Please
count homework assigned over the weekend as one day. MARK ONE RESPONSE.
SKI
PTO Q E1﴿
0 days ﴾
1 day
2 days
3 days
4 days
5 days

D5.

On days when homework is assigned, how much time do you expect children in this class to
spend on homework in the following areas? MARK ONE RESPONSE ON EACH ROW.
I do not
teach this
subject

I never
assign
homework

a. Reading and language arts
b. Math
c. Science
d. Social studies

1 to 10
minutes

11 to 20
minutes

21 to 30
minutes

More
than 30
minutes

Draft

SECTION E. EVALUATION AND GRADING PRACTICES
Please continue to think about the specific class in which the child identified on the cover of this questionnaire receives
instruction from you.
E1.

In this class, how often do you use a formal assessment in SCIENCE for the following purposes?
MARK ONE RESPONSE ON EACH ROW.

Never

Once a
year

3 to 4
2 times times a
a year
year

5 to 8
times a
year

1 to 2
times a
month

1 to 2
times a
week

Draft

E2.

For each of the following statements about SCIENCE indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
disagree Disagree disagree

Agree

Strongly
agree

a. This school has a set of clear,
pr
edet
er
mi
ned,
gr
ade‐
l
evel
benc
hmar
k
s﴾
t
hati
s
,
c
ut
scores, goals/targets, or
per
c
ent
i
l
es
﴿t
hatar
eus
edt
o
determine which students are
struggling or at risk of failure in
science in fourth grade.
b. This school has clear,
predetermined criteria for
determining the level of
i
nt
er
vent
i
onf
our
t
h‐
gr
ade
students will receive in science.
c.

E3.

This school has clear,
predetermined criteria for
det
er
mi
ni
ngwhenf
our
t
h‐
grade students no longer
need a science intervention.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

Don't
know

Draft

For Office Use Only
Comp
Ref

Draft

SUPPLEMENTAL QUESTIONS FOR MATH TEACHERS
Communication with Parents
1. During this school year, has your school used the following ways to communicate with parents?
MARK ONE RESPONSE ON EACH ROW.
At least

Once a

Several

Once a

Less

once a

week

times a

month

than

week

month

once a
month
or never

a. Electronic communication to all parents,
such as group emails, electronic newsletters,
or other notices sent to all parents
b. Electronic communication with individual
parents, such as individual emails or texts
from the school
c. Non-electronic communication to all
parents, such as letters, newsletters, or other
notices sent to all parents
d. Non-electronic communication with
individual parents, such as written notes,
individual letters, or telephone calls from the
school

2. During this school year, has your school used an online tool or website for parents to log in to, to
get information from the school? MARK ONE RESPONSE.
Yes (CONTINUE)
No (SKIP TO QUESTION 4)

A-1

3. Has the information provided in the online tool or website included any of the following types of
information? MARK ONE RESPONSE ON EACH ROW.
Y
Yes

a. School policies or practices
b. School events
c. Classroom-specific assignments, including homework
d. Child- or parent-specific information, such as progress reports
between grading periods (with family privacy protected)

A-2

4. Please indicate how often each of these items applies to the child identified on the cover of this
questionnaire. MARK ONE RESPONSE ON EACH ROW.

a. Likes to come to
school

Doesn't apply
﴾seldom displays
this behavior﴿

Sometimes applies
﴾occasionally displays
this behavior﴿

Certainly applies
﴾often displays
this behavior﴿

b. Dislikes school
c. Has fun at school
d. Likes being in school
e. Seems unhappy in
school
f. Enjoys most
classroom activities
g. Groans or complains
about suggested
activities
Source: Teacher version of the School Liking and Avoidance Questionnaire ﴾SLAQ; Adapted from Ladd &
Price, 1987; Ladd, 1990﴿

A-3

5. Please evaluate the performance of the child identified on the cover of this questionnaire in the
following areas, using the categories below. MARK ONE RESPONSE ON EACH ROW.
a. Understands
others’ feelings
b. Accurately
interprets what a
peer is trying to
do
c. Generates
good quality
solutions to
interpersonal
solutions
d. Is aware of the
effects of his/her
behavior on
others

Very poor

Somewhat poor

Average

Good

Very good

Source: Pierce, K. M., Hamm, J. V., & Vandell, D. L. ﴾1999﴿. Experiences in after‐school programs and
children's adjustment in first‐grade classrooms. Child Development, 70, 756‐767.

A-4

SUPPLEMENTAL QUESTIONS FOR SCIENCE TEACHERS
Communication with Parents
1. During this school year, has your school used the following ways to communicate with parents?
MARK ONE RESPONSE ON EACH ROW.
At least

Once a

Several

Once a

Less

once a

week

times a

month

than

week

month

once a
month
or never

2. During this school year, has your school used an online tool or website for parents to log in to, to
get information from the school? MARK ONE RESPONSE.
Yes (CONTINUE)
No (SKIP TO QUESTION 4)

A-5

3. Has the information provided in the online tool or website included any of the following types of
information? MARK ONE RESPONSE ON EACH ROW.
Y
Yes

A-6

4. Please indicate how often each of these items applies to the child identified on the cover of this
questionnaire. MARK ONE RESPONSE ON EACH ROW.

a. Likes to come to
school

Doesn't apply
﴾seldom displays
this behavior﴿

Sometimes applies
﴾occasionally displays
this behavior﴿

Certainly applies
﴾often displays
this behavior﴿

A-7

5. For the items below, please think about the friends with whom the child identified on the cover of
this questionnaire has associated the most during the past month or two. Please indicate how
often you think each of these items applies to this group of children. MARK ONE RESPONSE ON
EACH ROW.
Almost always
untrue

Usually untrue

a. This is a good
group of kids
b. I worry when
this child is with
this group of kids
c. Some of these
kids are a bad
influence on this
child
d. These kids
must be closely
supervised by an
adult
e. These kids are
often in trouble
f. These kids are
excellent
students
g. These kids are
hard workers
h. This child has
a fun time with
this group of
children
i. Most of these
kids are kind to
other children

Sometimes true,
sometimes
untrue

Usually true

Almost
always true

Source: Vandell, Deborah Lowe (2001). Relationships With Peers: Part D (Teacher). Unpublished scale,
NICHD Study of Early Child Care and Youth Development, Form FLV18G3.

A-8

File Type	application/pdf
File Title	Appendix A ECLS-K: 2011 4th Grade Cog Labs Subject-Specific Questionnaires
Subject	Appendix A ECLS-K: 2011 4th Grade Cog Labs Subject-Specific Questionnaires
File Modified	2014-02-04
File Created	2014-01-30