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

Appendix D:
Teacher Background Questionnaire

D-1

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GRADE 4
Teacher Questionnaire
PILOT TEST

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

T_ID

T

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 both the
XXXX.
classroom and subject questionnaires is estimated to average XX
30 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.

1

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.

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2

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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

st
udy

of

chi
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 fourth grade students.
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 
chi
l
dr
en’
s

academi
c 
pr
ogr
es
s 
and 
v
ar
i
ous

sc
hool
,

c
l
ass
r
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).
I
nf
or
mat
i
on 
f
r
om 
mul
t
i
pl
e 
i
ndi
vi
dual
s 
wi
l
l

be 
c
ombi
ned 
t
o 
pr
oduc
e 
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 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

t
he 
i
ndi
v
i
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.

THANK YOU VERY MUCH FOR YOUR HELP.

3

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4

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SECTION A. STUDENT, SCHOOL AND STAFF ACTIVITIES
A1.

Which of the following subjects do you teach to fourth grade students during this school year?
MARK ONE RESPONSE ON EACH ROW.
Yes

No

a. Reading/Language Arts
b. Mathematics
c. Science
d. Social Studies

A2.

How often does the typical child in this grade usually work on lessons or projects in the following
general subject areas, whether as a whole class, in small groups, or in individualized arrangements?
MARK ONE RESPONSE ON EACH ROW.

Never

Less than
once a 1 day a
week
week

a. Reading and language arts
b. Mathematics
c.

Social Studies

d. Science
e. Music
f.

Art

g. Physical education
h. Dance/creative movement
i.

Theater/creative dramatics

j.

F
or
ei
gnl
a
nguage﴾
ex
c
l
udi
ng
Engl
i
s
hf
orE
L
Ls
t
udent
s
﴿

5

2 days
a week

3 days
a week

4 days
a week

5 days
a week

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A3.

On the days children work in these areas, how much time does the typical child in this grade usually
work on lessons or projects in the following general subject areas? MARK ONE RESPONSE ON EACH
ROW.
Less
Not
than ½
applicable/ hour a
never
day

½ hour
to less
than 1
hour

1 to less
than 1
½ hours

1 ½ to
less
than 2
hours

a. Reading and
language arts
b. Mathematics
c. Social Studies
d. Science
e. Music
f.

Art

g. Physical education
h. Dance/creative
movement
i. Theater/creative
dramatics
j. Foreign language
﴾
ex
c
l
udi
ngEngl
i
s
h
for E
L
Ls
t
udent
s
﴿
A4.

How many days a week do children have recess? MARK ONE RESPONSE.
o﴾
nor
ec
es
sonanyday
﴿﴾
Zer
SKI
PTO QA6﴿
One
Two
Three
Four
Five
Other/Varies by week

6

2 to less
than 2
½ hours

2 ½ to
less
than 3
hours

3 hours
or more

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A5.

On days when children have recess, between the school day starting time and the dismissal time,
how many times a day do children have recess? MARK ONE RESPONSE.
One
Two
Three
Four
Five
Other/Varies by day

A6.

How i
mpor
t
anti
seac
hoft
hef
ol
l
owi
ngi
neval
uat
i
ngt
hec
hi
l
dr
eni
nyourc
l
as
s
﴾
es
﴿f
orr
epor
t
i
ng
to parents? MARK ONE RESPONSE ON EACH ROW.
Not
important

Somewhat
important

Very
important

Extremely
important

a. Individual child's achievement
relative to the rest of the class
b. Individual child's achievement
relative to local, state, or
professional standards
c. Individual improvement or
progress over past performance
d. Effort
e. Class participation
f.

Daily attendance

g. Classroom behavior or
conduct
h. Cooperativeness with other
children
i.
A7.

Ability to follow directions

Whatper
cent
ageofc
hi
l
dr
eni
nyourc
l
as
s
﴾
es
﴿havepar
ent
swhopar
t
i
c
i
pat
ei
nt
hef
ol
l
owi
ng
activities? MARK ONE RESPONSE ON EACH ROW.
76% or
0%
1‐
25%
26‐
50% 51‐
75%
more
a. At
t
endt
eac
her
‐
par
entc
onf
er
enc
es
b. Volunteer regularly to help in your
classroom or another part of the
school
c. Attend open houses or parties
d. Attend art/music events or
demonstrations

7

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A8.

Did you participate in any professional development* within the last 12 months? MARK ONE
RESPONSE.
Yes
No ﴾
PTO QA10﴿
SKI
* Professional development may include continuing formal education; courses, conferences,
wor
k
s
hops
,
ori
n‐
s
er
v
i
c
et
r
ai
ni
ng;
s
t
a
f
fmeet
i
ngst
hati
nc
l
udes
t
af
fdev
el
opmenta
c
t
i
v
i
t
i
es
;
and
receiving coaching or mentoring.

A9.

How often did you participate in professional development activities covering the following topics
in the last 12 months? MARK ONE RESPONSE ON EACH ROW.

Never
a. How to use assessment data to identify
students who are struggling or at risk of
failure in READING
b. How to use assessment data to identify
students who are struggling or at risk of
failure in MATH
c. How to use assessment data to identify
students who are struggling or at risk of
failure in SCIENCE
d. How to use and apply assessment data
to guide READING instruction
e. How to use and apply assessment data
to guide MATH instruction
f. How to use and apply assessment data
to guide SCIENCE instruction
g. How to implement the READING
curriculum
h. How to implement the MATH curriculum
i.

How to implement the SCIENCE
curriculum

8

Once

2 times

3 to 4
times

More
than 4
times

Draft

A10.

Have you received support from any of the following staff members during the current academic
year? MARK ONE RESPONSE ON EACH ROW. IF THE RESOURCE IS NOT AVAILABLE TO YOU, MARK THE
LAST COLUMN.

Yes,
support
received
a. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective READING
instruction
b. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective MATH instruction
c. A school or district staff member whose role is to
provide ongoing training and support to classroom
teachers in the delivery of effective SCIENCE
instruction
d. A school or district staff member who provides
ongoing training and support to classroom teachers
in the delivery of effective behavioral supports
e. A school or district staff member to support teachers
in collecting, organizing, and managing assessment
data
f. A school or district staff member to support teachers
in the interpretation and use of assessment data to
guide instruction

9

No, support
not received
but
available

Resource
not
available

Draft

SECTION B. VIEWS ON SCHOOL CLIMATE AND SCHOOL ENVIRONMENT
B1.

Please indicate the extent to which you agree or disagree with each of the following statements
about your school. MARK ONE RESPONSE ON EACH ROW.
Strongly
disagree

Disagree

Neither
agree nor
disagree

Agree

Strongly
agree

a
. Thel
ev
elofc
hi
l
dmi
s
behav
i
or﴾
f
or
example, noise, horseplay, or fighting
i
nt
heha
l
l
sorc
a
f
et
er
i
a﴿i
nt
hi
ss
c
hool
interferes with my teaching.
b. Many of the children I teach are not
capable of learning the material I am
supposed to teach them.
c. Parents are supportive of school staff.
d. There is a great deal of cooperative
effort among the staff members.
e. There is a consensus among
administrators and teachers on goals
and expectations.
f.

The academic standards at this
school are too low.

g. The school administrator sets
priorities, makes plans, and sees
that they are carried out.
h. The school administration's
behavior toward the staff is
supportive and encouraging.
B2.

To what extent do you agree or disagree with each of the following statements? MARK ONE
RESPONSE ON EACH ROW.
Neither
Strongly
Strongly
agree nor
disagree Disagree disagree
Agree
agree
a. The attitudes and habits students bring
t
omyc
l
as
s
﴾
es
﴿gr
eat
l
yr
educ
et
hei
r
chances for academic success.
b. My success or failure in teaching is due
primarily to factors beyond my control
rather than to my own effort or ability.
c. The amount a student can learn is
primarily related to family background.
d. I really enjoy my present teaching job.
e. If I could start over, I would choose
teaching again as my career.

10

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SECTION C. TEACHER BACKGROUND
C1.

What is your gender? MARK ONE RESPONSE.
Male
Female

C2.

In what year were you born? WRITE IN YEAR BELOW.

1 9
YEAR
C3.

Are you Hispanic or Latino? MARK ONE RESPONSE.
Yes
No

C4.

Which best describes your race? MARK ONE OR MORE RESPONSES TO INDICATE WHAT YOU CONSIDER
YOURSELF TO BE.
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

11

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C5.

Counting this school year, how many years have you taught each of the following grades and
programs, including years in which you taught part time?
WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF THIS IS YOUR FIRST YEAR
TEACHING, WRITE "1." WRITE "0" IF YOU HAVE NEVER TAUGHT THE GRADE OR PROGRAM LISTED.
Total years grade
or program taught
a. Preschool or kindergarten
b. First grade
c. Second grade
d. Third grade
e. Fourth grade
f.

Fifth grade

g. Sixth grade or higher
ngl
i
s
ha
saSec
ondL
anguage﴾
ESL
﴿
,
bi
l
i
ngual
h. E
education, and/or dual language program

C6.

i.

Special education program

j.

Program for gifted children

Counting this school year, how many total years have you been a schoolteacher, including years in
which you taught part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF
THIS IS YOUR FIRST YEAR, WRITE "1."
Year
﴾
s
﴿

C7.

Is this school year the first year you have taught in this school? MARK ONE RESPONSE.
Yes
No

12

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C8.

What is the highest level of education you have completed? MARK ONE RESPONSE.
SKI
PTO Q C11﴿
Did not complete high school ﴾
SKI
PTO Q C11﴿
High school diploma or equivalent/GED ﴾
SKI
PTO Q C11﴿
Some college or technical or vocational school ﴾
Associate's degree
Bachelor's degree
Master's degree
Anadv
anc
edpr
of
es
s
i
onaldegr
eebey
ondamas
t
er
'
sdegr
ee﴾
f
orex
ampl
e,
Ph.
D.
,
MD﴿

C9.

If you have an associate's or bachelor's degree, indicate your undergraduate major field of study.
MARK YES OR NO ON EACH ROW.
Yes
a. Early childhood education
b. Elementary education
c. English
d. Reading and/or language arts
e. Curriculum and instruction
f.

Mathematics education

g. Mathematics
h. Science education
i.

Life science

j.

Physical science

k. Earth science
l.

Special education

hereduc
a
t
i
on‐
r
el
a
t
edmaj
or﴾
s
uc
hass
ec
ondar
y
m. Ot
education, educational psychology, administration,
i
ceduc
a
t
i
on,
et
c
.
﴿
mus
n. Non‐
educ
a
t
i
onmaj
or﴾
s
uc
hashi
s
t
or
y
,
et
c
.
﴿

13

No

Draft

C10.

If you have a graduate degree, indicate the major field of study of your highest level graduate
degree. MARK YES OR NO ON EACH ROW.
Yes

No

a. Early childhood education
b. Elementary education
c. English
d. Reading and/or language arts
e. Curriculum and instruction
f.

Mathematics education

g. Mathematics
h. Science education
i.

Life science

j.

Physical science

k. Earth science
l.

Special education

m. Ot
hereduc
at
i
on‐
r
el
at
edmaj
or﴾
s
uc
hass
ec
ondar
y
education, educational psychology, administration,
mus
i
ceduc
at
i
on,
et
c
.
﴿
n. Non‐
educ
at
i
onma
j
or﴾
s
uc
ha
shi
s
t
or
y
,
et
c
.
﴿

C11.

Have you ever taken a college course that addressed issues related to the following? MARK YES OR
NO ON EACH ROW.
Yes
a. Using published research evidence to identify and select effective
interventions and supports for students
b. Using formal assessment data to inform the choice of READING
interventions and supports for students
c. Using formal assessment data to inform the choice of MATH
interventions and supports for students
d. Using data to inform the choice of behavioral interventions and
supports for students

14

No

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C12.

Which of the following describes the teaching certificate you currently hold in THIS state? MARK
ONE RESPONSE.
Regular or standard state certificate or advanced professional certificate
Certificate issued after satisfying all requirements except the completion of a probationary
period
Certificate that requires some additional coursework, student teaching, or passage of a test
before regular certification can be obtained
Certificate issued to persons who must complete a certification program in order to continue
teaching
I do not hold any of the above certifications in THIS state.

C13.

Date Questionnaire Completed:

2 0 1 5
MONTH

DAY

YEAR

THANK YOU FOR YOUR COOPERATION!

15

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16

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For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

17

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