Early Childhood Longitudinal Study, Kindergarten Class of 2010-11 (ECLS-K:2011) Spring Fifth-Grade National Data Collection

APPENDIX G
FIFTH-GRADE
SCHOOL ADMINISTRATOR QUESTIONNAIRE

Early Childhood Longitudinal Study, Kindergarten Class of 2010-11
(ECLS-K:2011)

Spring Fifth-Grade National Data Collection

OMB Clearance Package
#1850-0750 v.18

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Spring 2016
School Administrator Questionnaire
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
OR AN ECLS-K:2011 STAFF MEMBER. DO NOT MAIL THIS
QUESTIONNAIRE UNLESS YOU ARE ASKED TO DO SO BY STUDY
STAFF AND ARE PROVIDED WITH AN ENVELOPE FOR MAILING.

S_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 voluntary survey is
1850-0750. Approval expires XX/XX/XXXX. The time required to complete this
survey is estimated to average 60 minutes per response, including the time to
review instructions, search existing data resources, gather the data needed,
and complete and review the survey. If you have any comments concerning
the accuracy of the time estimate or suggestions for improving this survey, or
any comments or concerns regarding the status of your individual submission
of this survey, please write to: Early Childhood Longitudinal Study, National
Center for Education Statistics, 1990 K Street, N.W., Washington, D.C. 200065574.

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The collection of information in this survey is authorized by 20 U.S.
Code, Section 9543. Participation is voluntary. You may skip questions
you do not wish to answer; however, we hope that you will answer 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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Dear School Administrator,
This questionnaire is an important part of a major longitudinal study of children's early educational experiences
beginning with kindergarten and continuing through grade 5. The Early Childhood Longitudinal Study,
Kindergarten Class of 2010-2011 (ECLS-K:2011) is collecting information from schools attended by children
who are in the study to investigate the relationship between children's academic progress and various school,
classroom, teacher, and child characteristics. You have received this questionnaire because one or more of the
children in your school are participants in this study.
This questionnaire contains several brief sections:
a) School characteristics
b) School-family-community connections
c) School policies and practices
d) School programs for particular populations
e) Federal programs: Title I, Adequate Yearly Progress (AYP), and Title III
f ) Staffing and teacher characteristics
g) School administrator characteristics
This information is vital to the study. Please feel free to ask other knowledgeable members of your staff to
provide the information necessary to complete various sections of the questionnaire. However, we ask that you,
yourself, please complete the final section, which is about your own background and 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. 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 information
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 described in the
instructions 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:
 Kindergarten: Traditional year of school primarily for 5-year-olds prior to first grade.
 Transitional (or readiness) kindergarten: Extra year of school for kindergarten-age eligible children who
are judged not ready for kindergarten.
 Transitional first (or prefirst) grade: Extra year of school for children who have attended kindergarten but
have been judged not ready for first grade.
 Ungraded: A classroom containing children with an age span of two or more years, not formally identified
by grade(s).

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Special programs. Reference is made in this questionnaire to Title I and Title III programs, individualized
education programs (IEP), Section 504 plans, and Response to Intervention (RtI). For this study, the following
definitions apply:
 Title I: "Improving the Academic Achievement of the Disadvantaged." Title I is a program of the
Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the No Child Left
Behind Act of 2001. The purpose of this program is to ensure that all children have a fair, equal, and
significant opportunity to obtain a high-quality education and reach, at a minimum, proficiency on
state academic achievement standards and state academic assessments.
 Title III: "Language Instruction for Limited English Proficient and Immigrant Students." Title III is a
program of the Elementary and Secondary Education Act (ESEA) of 1965, as reauthorized under the
No Child Left Behind Act of 2001. One of the main purposes of this program is to help ensure that
children who have limited proficiency in English, including immigrant children and youth, attain
English proficiency, develop high levels of academic attainment in English, and meet the same state
academic content and student academic achievement standards as all students are expected to meet.
 Individualized Education Program (IEP): A written statement of the educational program designed to
meet the individual needs of a school-aged child with a disability that is judged to affect the child's
educational performance. Children who receive special education services under the Individuals with
Disabilities Education Act (IDEA) are expected to have an IEP.
 Section 504 plan: A written plan to provide appropriate services to a child with a disability, whether or
not the disability is judged to affect the child's educational performance. Speech therapy services may
often be specified as part of a Section 504 plan.
 Response to Intervention (RtI): A multi-step approach to providing early and progressively intensive
intervention and monitoring within the general education setting. In principle, RtI begins with
research-based instruction and behavioral support provided to students in the general education
classroom, followed by screening of all students to identify those who may need systematic progress
monitoring, intervention, or support. Students who are not responding to the general education
curriculum and instruction are provided with increasingly intensive interventions through a "tiered"
system, and they are regularly monitored to assess their progress and inform the choice of future
interventions, including possibly special education for students determined to have a disability.

Language. Reference is made to English language learners (ELL), as well as to instructional programs for ELL
students in this questionnaire. For this study, the following definitions apply:
 Language-minority (LM) student: A student in whose home a non-English language typically is spoken.
This group includes students whose English is fluent enough to benefit from instruction in academic
subjects offered in English as well as students who are English language learners.
 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.

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MARKING DIRECTIONS
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MARKING BOXES
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Shown below is the correct way to mark your answers, along with examples of incorrect ways.
Correct Mark:

Incorrect Marks:
Light and thin, outside the box, thick or scrawled.

How to Change an Answer:
Completely black out the box of the incorrect answer and mark an “X” in the box next to the
correct answer.

PRINTING ANSWERS IN BOXES:
Answers should be printed clearly and should not touch or cross any of the box lines. Do not
cross zeroes or sevens. That is, do not write a zero with a line through it like this –
write a seven with a line through it like this – 7.
Write one number per box like this:

1

2

3

4

5

6

Write words like this:

John Smith

5

7

8

9

0

0, and do not

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SECTION A. SCHOOL CHARACTERISTICS
A1.

How many instructional days will this school provide during this academic year? WRITE IN NUMBER
BELOW. IF THIS IS A YEAR-ROUND SCHOOL, PLEASE PROVIDE THE NUMBER OF INSTRUCTIONAL DAYS A
GIVEN CHILD WOULD ATTEND.
Number of instructional days

A2.

School enrollment. WRITE IN THE APPROXIMATE NUMBER OF CHILDREN FOR EACH OF THE
FOLLOWING. IF NO CHILDREN HAVE LEFT OR ENROLLED IN YOUR SCHOOL SINCE OCTOBER 1, WRITE
"0" ON THE APPLICABLE LINE.
Number of
children
a. Total enrollment in fifth grade in your school around October 1, 2015, or
the date nearest to that for which data are available
b. Total enrollment in your school (across all grades) around October 1, 2015,
or the date nearest to that for which data are available
c. Number of children who have enrolled in your school since October 1, 2015
d. Number of children who have left your school since October 1, 2015, and
have not returned

A3.

Approximately what is the Average Daily Attendance for your school this year? WRITE IN PERCENT
OR NUMBER BELOW. TO CALCULATE PERCENT, DIVIDE THE NUMBER OF STUDENTS ATTENDING ON AN
A
AVERAGE DAY BY THE NUMBER OF STUDENTS ENROLLED AND THEN MULTIPLY BY 100.
% Average Daily Attendance
That is,  
OR

number of students attending on an average day  
number of students enrolled

X 100

Average Number Attending Daily

A4.

How many children is this school site designed to accommodate? WRITE IN NUMBER BELOW.
Number of children

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A5.

A6.

Mark all grade levels included in your school. PLEASE SEE PAGE 3 OF THIS QUESTIONNAIRE FOR
DEFINITIONS OF DIFFERENT TYPES OF CLASSES AND GRADE LEVELS.
Ungraded

1st

7th

Prekindergarten

2nd

8th

Transitional (or readiness) kindergarten

3rd

9th

Kindergarten

4th

10th

Transitional first (or prefirst) grade

5th

11th

6th

12th

Which of the following characterizes your school? MARK ALL THAT APPLY.
Regular public school (not including magnet school)
Public magnet school
Charter school
Catholic school
Diocesan
Parish
Private order
Other private school, religious affiliation
Private school affiliated with NAIS, no religious affiliation
Other private school, no religious or NAIS affiliation
Early Childhood Center (school/center includes preschool and/or early grades)
Special education school – primarily serves children with disabilities
Year-round school
Bureau of Indian Education (BIE) or tribal school

IF YOU MARKED "CHARTER SCHOOL" IN Q A6, GO TO Q A7.
IF YOU DID NOT MARK "CHARTER SCHOOL," THEN SKIP TO Q A9.
A7.

In what year did this school start providing instruction as a public CHARTER school? WRITE IN
YEAR BELOW.

YEAR
A8.

Which of the following characterizes your public CHARTER school? MARK ONE RESPONSE.
For profit
Not for profit

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A9.

Approximately how many or what percentage of the children in your school belongs to each of the
following racial/ethnic groups? COMPLETE EITHER THE NUMBER OR PERCENT COLUMN. ENTER "0" IF
YOUR SCHOOL HAS NO CHILDREN IN THAT RACIAL/ETHNIC GROUP. THE NUMBER COLUMN SHOULD
ADD TO YOUR TOTAL SCHOOL ENROLLMENT OR THE PERCENT COLUMN SHOULD ADD TO 100%.
Number
of children

OR

Percent

a. Hispanic/Latino of any race

%

b. American Indian or Alaska Native, not Hispanic or
Latino

%

c. Asian, not Hispanic or Latino

%

d. Black or African American, not Hispanic or Latino

%

e. Native Hawaiian or Other Pacific Islander, not Hispanic
or Latino

%

f.

%

White, not Hispanic or Latino

g. Two or more races, not Hispanic or Latino

%

1 0 0 %

h. Total school enrollment (sum of a through g)
A10.

If your school is a private, magnet, or charter school, please mark here and SKIP TO Q A13.

A11.

About what percentage of the children enrolled in this school attend from outside of this school's
assigned attendance area because... WRITE IN PERCENTAGES BELOW. IF NONE, WRITE "0."
Percent

Don't know

a. They have special needs (gifted and talented, children with
disabilities, etc.) and attend to receive a specialized program or
service?

%

b. They transferred into the school because their previous school
did not make adequate yearly progress (AYP)? (Adequate yearly
progress is your state's measure of yearly progress toward
achieving state academic standards.)

%

c. They attend this school under public school choice for reasons
other than their assigned school did not make AYP (that is,
excluding those who are reported in b)?

%

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A12.

About what percentage of the children enrolled in this school are from the surrounding
neighborhood? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

A13.

About what percentage of the children enrolled in this school are eligible for free or reducedprice lunch? WRITE IN PERCENTAGE BELOW. IF NONE, WRITE "0."
Percentage of children

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SECTION B. SCHOOL-FAMILY-COMMUNITY CONNECTIONS
B1.

Are any of the following programs for fifth-grade children and their families at your school site?
Please include programs run by the school and those run by outside groups. MARK YES OR NO ON
EACH ROW.
Yes

No

a. Before-school child care
b. After-school child care
c. Hearing screening
d. Vision screening

B2.

Are any of the following programs or services for parents and families available at your school
site? Please include programs run by the school and those run by outside groups. MARK YES OR
NO ON EACH ROW.
Yes
a. Parenting education programs (for example, classes on child
development, education in being a parent, understanding
children with special needs)
b. Adult literacy program (including Adult Basic Education)
c. Family literacy program
d. Health or social services offered collaboratively by service
agencies such as hospitals
e. Orientation to school setting for new families
f.

Child care so that parents can attend school parent meetings or
events

g. Programs to learn English for parents or families whose native
language is not English

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No

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B3.

Please indicate how often each of the following activities is provided by your school. MARK ONE
RESPONSE ON EACH ROW.

Never

Once
a year

2 to 3
times
a year

4 to 6
times
a year

7 or more
times
a year

a. PTA, PTO, or Parent-Teacher-Student
organization meetings
b. Reports (report cards) of child's
performance provided to parents
c. Information on the child's standardized
assessment scores provided to parents
d. Teacher-parent conferences
e. School performances to which parents
are invited
f.

B4.

Classroom programs like class plays,
book nights, or family math nights

During this school year, how often has your school used the following ways to communicate with
all parents? MARK ONE RESPONSE ON EACH ROW.
More
than
once a
week
a. Electronic communication to all parents,
such as group emails, electronic
newsletters, website postings,
"robocalls" (mass automated phone
calls), text alerts, or other electronic
notices for all parents
b. Non-electronic communication to all
parents, such as letters, newsletters,
phone calls, or other non-electronic
messages for all parents

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Once a
week

Several
times a
month

Once a
month

Less than
once a
month
or never

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B5.

During this school year, has your school used an online tool or website that is available to the
general public and that parents can access without a login or password? MARK ONE RESPONSE.
Yes
No

B6.

During this school year, has your school (or any teacher) used an online tool or website that parents
can only access with a login and password to get information about their child, the child's class, or
the school? MARK ONE RESPONSE.
Yes
No (SKIP TO Q B8)

B7.

Have the following types of information been provided in the online tool or website that parents
can only access with a login and password? MARK YES OR NO ON EACH ROW.
Yes

No

a. Classroom-specific assignments, including homework
b. Child- or parent-specific information, such as progress reports
between grading periods

B8.

How much of a problem are the following in the neighborhood where this school is located? MARK
ONE RESPONSE ON EACH ROW.
Big
problem
a. Tensions based on racial, ethnic, or
religious differences
b. Selling or using drugs or excessive
drinking in public
c. Gangs
d. Vacant houses and buildings
e. Crime in the neighborhood
f.

Violence in the neighborhood

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Somewhat of
a problem

No
problem

Don't
know

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B9.

To the best of your knowledge how often do the following types of problems occur at your school?
MARK ONE RESPONSE ON EACH ROW.
Happens Happens
at least
at least Happens
Happens once a
on
once a
daily
week
month occasion

Never
happens

a. Children bringing weapons to school
b. Theft
c. Physical conflicts among students
d. Children bringing in or using alcohol
at school
e. Children bringing in or using illegal
drugs at school
f.

Vandalism of school property

g. Student bullying
h. Widespread disorder in classrooms
i.

B10.

Class cutting

Does your school take any of the following measures to ensure the safety of children? MARK YES
OR NO ON EACH ROW.
Yes
a. Security guards, unarmed
b. Security guards, armed
c. Metal detectors
d. Locked doors during the school day
e. A requirement that visitors sign in
f.

Intercoms or telephones in classrooms

g. Other (PLEASE SPECIFY)

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No

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B11.

To what extent is each of the following matters a problem in this school? Indicate whether each is
a SERIOUS problem, a MODERATE problem, a MINOR problem, or NOT a problem in this school.
MARK ONE RESPONSE ON EACH ROW.
Serious
problem

Moderate
problem

Minor
problem

Not a
problem

a. Student tardiness
b. Student absenteeism
c. Student aggressive or disruptive behavior
d. Teacher absenteeism
e. Teacher turnover
f.

B12.

Overcrowding

During the past year, to what extent did any of the following changes occur at your school? MARK
ONE RESPONSE ON EACH ROW.
Not
at all
a. Funding levels decreased
b. Enrollment increased
c. Enrollment decreased
d. The number of students receiving free
or reduced-price lunch increased
e. Student mobility increased (that is, the
number of students transferring in and
out of the school increased)
f.

There has been a reduction in staffing

g. Class sizes increased
h. Class sizes decreased
i.

Salaries increased

j.

Salaries decreased

k. Number of English language learners
increased

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Small
extent

Moderate
extent

Large
extent

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B13.

During the past year, were salaries frozen at your school? MARK ONE RESPONSE.
Yes
No

IF YOUR SCHOOL IS A PRIVATE, MAGNET, OR CHARTER SCHOOL, SKIP TO Q C1.
IF YOUR SCHOOL IS NOT A PRIVATE, MAGNET, OR CHARTER SCHOOL, GO TO Q B14.

B14.

During the past year, were changes made to your school's assigned attendance area? MARK ONE
RESPONSE.
Yes
No

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SECTION C. SCHOOL POLICIES AND PRACTICES
C1.

Which of the following statements describe your school's grade promotion and retention
practices or policies? MARK TRUE OR FALSE ON EACH ROW.
True

False

a. This school has a formal retention policy.
b. Children can be retained more than once in each grade.

C2.

How many fourth-grade children were retained at their current grade level last school year? WRITE
NUMBER BELOW. IF NONE, WRITE "0." IF YOUR SCHOOL DOES NOT HAVE FOURTH-GRADE STUDENTS,
MARK THE "NOT APPLICABLE" BOX.
Number of fourth-grade children retained last year

C3.

How many fifth-grade children were retained at their current grade level last school year? WRITE
NUMBER BELOW. IF NONE, WRITE "0." IF YOUR SCHOOL DOES NOT HAVE FIFTH-GRADE STUDENTS, MARK
THE "NOT APPLICABLE" BOX.
Number of fifth-grade children retained last year

C4.

Not applicable

Not applicable

Is a school-wide positive behavioral intervention and support program (for example, Positive Behavioral
Support, Positive Behavioral Intervention System) implemented at your school? MARK ONE RESPONSE.
Yes
No

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C5.

For each of the following statements about READING and MATH, indicate how strongly you agree or
disagree. MARK ONE RESPONSE ON EACH ROW.
Neither
Strongly
agree nor
Strongly Don't
disagree Disagree disagree
know
Agree
agree
For READING
a. This school has a set of clear,
predetermined, grade-level benchmarks
(that is, cut scores, goals/targets, or
percentiles) that are used to determine
which students are struggling or at risk
of failure in READING.
b. At this school, we use data from
screening tests to determine if core
instruction in READING is meeting the
needs of most of our students.
For MATH
c. This school has a set of clear,
predetermined, grade-level benchmarks
(that is, cut scores, goals/targets, or
percentiles) that are used to determine
which students are struggling or at risk
of failure in MATH.
d. At this school, we use data from
screening tests to determine if core
instruction in MATH is meeting the
needs of most of our students.

C6.

Is Response to Intervention (RtI) currently used at your school in fifth grade, either partially or
fully implemented? MARK ONE RESPONSE.
RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION
SETTING. SEE PAGE 4 FOR A COMPLETE DEFINITION OF RTI.
Yes
No (SKIP TO Q C8)

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C7.

Is Rtl currently implemented at your school in fifth grade in the following areas? MARK ONE
RESPONSE ON EACH ROW.
Yes, fully
implemented
in fifth grade

Yes, partially
implemented
in fifth grade

No, not
implemented
in fifth grade

a. Math
b. Reading
c. Writing
d. Behavior/Social skills

C8.

Has your school implemented the Common Core State Standards at any grade(s)? MARK ONE
RESPONSE.
Yes
No (SKIP TO Q D1)

C9.

Are the Common Core State Standards currently implemented at your school in fifth grade in the
following areas? MARK ONE RESPONSE ON EACH ROW.
Yes, fully
implemented
in fifth grade

Yes, partially
implemented
in fifth grade

No, not
implemented
in fifth grade

a. Reading and Language Arts
b. Mathematics

C10.

Approximately how many years ago did your school begin implementing the Common Core
State Standards in any grade or subject? MARK ONE RESPONSE.
Less than 1 year ago
1 to 2 years ago
More than 2 years ago

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SECTION D. SCHOOL PROGRAMS FOR PARTICULAR POPULATIONS
Language-Minority Students and Families
D1.

Do any of the children in this school come from a home where a language other than English is
spoken? MARK ONE RESPONSE.
Yes
No (SKIP TO Q D5)

PLEASE NOTE THE FOLLOWING DEFINITION
THAT IS RELEVANT TO QUESTIONS D2 and D3 BELOW:
English language learners (ELL) 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 school instruction in English.

D2.

What percentage of children in this school are English language learners (ELL)? WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

% ELL among all students in school

D3.

What percentage of children in fifth grade are English language learners (ELL)? WRITE IN THE
PERCENTAGE BELOW. IF NONE, WRITE "0."

% ELL among all students in fifth grade

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D4.

Are any of the following services provided to families of children from households where a
language other than English is spoken? MARK YES OR NO ON EACH ROW.
Yes

No

a. Translators are made available to parents for parent/teacher and
parent/school staff meetings and/or meetings are conducted in
the parents' non-English language.
b. Translations of written communications are provided to these
families.
c. Home visits are made to families of these children.

Children with Special Needs
D5.

Since the beginning of this school year (2015-2016), how many students have been NEWLY
evaluated at your school to determine if they are eligible for an IEP? WRITE NUMBER IN BOX.
Total number of newly evaluated students at your school

D6.

Of those students who have been NEWLY evaluated at your school this school year (2015-2016),
how many were found eligible for an IEP, including those who may have an IEP for speech only?
WRITE NUMBER IN BOX.
Total number of newly evaluated students found eligible at your school

D7.

What method(s) are used in your school to determine special education ELIGIBILITY for students
with learning disabilities? MARK YES OR NO ON EACH ROW. IF A COMBINATION OF THESE METHODS
IS USED AT YOUR SCHOOL, MARK YES FOR BOTH A AND B.
RESPONSE TO INTERVENTION (RTI) IS A MULTI-STEP APPROACH TO PROVIDING EARLY AND
PROGRESSIVELY INTENSIVE INTERVENTION AND MONITORING WITHIN THE GENERAL EDUCATION
SETTING. SEE PAGE 4 FOR A MORE COMPLETE DEFINITION OF RTI.
Yes
a. IQ-achievement discrepancy model which shows whether there
is a discrepancy between expected performance and actual
performance
b. Response to Intervention (RtI) model

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No

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D8.

Approximately what percentage of your fifth-graders are in each of the following instructional
programs? WRITE PERCENTAGES IN BOXES. IF NONE, WRITE "0" AND INDICATE IF THE PROGRAM IS
NOT OFFERED IN FIFTH GRADE OR IN ANY GRADE IN YOUR SCHOOL.
Not offered
in fifth grade

Percent

D9.

a. Special education with an Individualized
Education Program (IEP)

%

b. Receive accommodations through a 504
plan

%

c. Reading instruction for students
performing below grade level in reading

%

d. Math instruction for students
performing below grade level in math

%

e. A gifted and talented program

%

Not offered
in any grade

Where are children with Individualized Education Programs (IEPs) typically served in this school?
MARK ONE RESPONSE.
Children with IEPs are not served in this school.
Children with IEPs typically spend most of their day in separate classes.
Children with IEPs typically spend most of their day in the regular classroom.

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SECTION E. FEDERAL PROGRAMS: TITLE I, ADEQUATE YEARLY PROGRESS, AND TITLE III

1

The following items pertain to public schools only.
IF YOURS IS A PRIVATE SCHOOL MARK HERE

E1.

(SKIP TO Q F1)

Did your school receive Federal Title I funds for this school year? MARK ONE RESPONSE.
Yes
No (SKIP TO Q E3)

PLEASE NOTE THE FOLLOWING DEFINITIONS
THAT ARE RELEVANT TO QUESTION E2 BELOW:
A targeted assistance program uses Title I funds to provide supplemental
academic services (usually in reading and/or math) to specific students, sometimes
referred to as "Title I students," who have been identified as low achieving.
A schoolwide program may use Title I funds to improve the quality of educational
programs and services throughout the school. A school may use Title I funds for a
schoolwide program if at least 40 percent of its students are from low-income
families, or if it receives a waiver permitting it to operate a schoolwide program.

E2.

Is your school operating a Title I targeted assistance or schoolwide program? MARK ONE RESPONSE.
Targeted assistance program
Schoolwide program

E3.

Did your school receive Federal Title III funds for this school year? (Title III is "Language Instruction
for Limited English Proficient and Immigrant Students.") MARK ONE RESPONSE.
Yes
No

1

Title I and Title III and their accompanying requirements are programs of the Elementary and Secondary Education Act of 1965 (ESEA), as
reauthorized by the No Child Left Behind Act of 2001. See the introductory section of this questionnaire for more information on these
programs.

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Federal Requirements
E4.

At the end of the LAST school year (2014-2015), did this school make Adequate Yearly Progress
(AYP)? (Adequate Yearly Progress is your state's measure of yearly progress toward achieving
state academic standards.) MARK ONE RESPONSE.
Yes (SKIP TO Q F1)
No
Not applicable (SKIP TO Q F1)

E5.

At the end of the LAST school year (2014-2015), was this school identified for improvement due to
Adequate Yearly Progress (AYP) requirements? (A school is identified for improvement if it does
not make Adequate Yearly Progress for two consecutive years or more in the same content area.)
MARK ONE RESPONSE.
Yes
No

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SECTION F. STAFFING AND TEACHER CHARACTERISTICS
F1.

Approximately how many staff members does your school currently have in the following
categories?
PLEASE PROVIDE RESPONSES IN COLUMN (1) FOR STAFF MEMBERS WHO WORK FULL TIME AT YOUR
SCHOOL AND IN COLUMN (2) FOR STAFF WHO WORK PART TIME AT YOUR SCHOOL. IF A STAFF
MEMBER IS SHARED WITH OTHER SCHOOLS, COUNT THAT PERSON AS "PART TIME" IN YOUR SCHOOL.
PLACE EACH STAFF MEMBER IN ONLY ONE STAFF CATEGORY; IF A STAFF MEMBER FITS MORE THAN
ONE CATEGORY, PICK THE CATEGORY MOST DESCRIPTIVE OF HIS/HER WORK.
WRITE NUMBERS IN BOXES. IF THERE ARE NO STAFF IN YOUR SCHOOL IN A CATEGORY, WRITE "0."

a. Regular classroom teachers
b. ESL/bilingual education/language immersion/ELL
instruction teachers
c. Drama, music, or art teachers
d. Gym/PE or health teachers
e. Special education teachers and related service
providers (for example, speech therapist, physical
therapist, adaptive physical education, etc.)
f.

Paraprofessionals (for example, classroom aides)

24

(1)

(2)

Number who
work full time in
your school

Number who
work part time
in your school

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F2.

Does your school currently have any staff members (full- or part-time) in the following
categories? MARK YES OR NO ON EACH ROW. INCLUDE THOSE WHO ARE FULL- OR PART-TIME STAFF
MEMBERS AT YOUR SCHOOL.
Yes
No
a. Teachers of gifted/talented students
b. Reading specialists and interventionists
c. Math specialists and interventionists
d. School nurses or health professionals
e. School psychologists or social workers
f.

Guidance counselors

g. Library media specialists/librarians
h. Computer/technology teachers or support staff

F3.

Does your school currently have any staff members who do the following as their primary role or
one of their primary roles? MARK YES OR NO ON EACH ROW. INCLUDE THOSE WHO ARE FULL- OR
PART-TIME STAFF MEMBERS AT YOUR SCHOOL.
Yes

No

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

F4.

Please indicate the number of regular classroom teachers who have joined or left your school
since October 1, 2015. WRITE IN THE APPROXIMATE NUMBERS FOR EACH OF THE FOLLOWING. IF
NO TEACHERS HAVE LEFT OR STARTED AT YOUR SCHOOL SINCE OCTOBER 1, WRITE "0" ON THE
APPLICABLE LINE.
Number
of teachers
a. Number of regular classroom teachers who have begun teaching in your
school since October 1, 2015
b. Number of regular classroom teachers who have left your school since
October 1, 2015, and have not returned

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F5.

What percentage of your part-time and full-time teachers, including regular classroom,
ESL/bilingual, remedial, special education, art, music, and physical education teachers, belongs to
each of the following racial/ethnic groups?
COMPLETE EITHER THE NUMBER OR PERCENT COLUMN. ENTER "0" IF YOUR SCHOOL HAS NO TEACHERS
IN THAT RACIAL/ETHNIC GROUP. THE NUMBER COLUMN SHOULD ADD TO YOUR TOTAL NUMBER OF
TEACHERS OR THE PERCENT COLUMN SHOULD ADD TO 100%.
Number of
teachers

OR

Percent

a. Hispanic/Latino of any race

%

b. American Indian or Alaska Native, not Hispanic or Latino

%

c. Asian, not Hispanic or Latino

%

d. Black or African American, not Hispanic or Latino

%

e. Native Hawaiian or Other Pacific Islander, not Hispanic
or Latino

%

f.

%

White, not Hispanic or Latino

g. Two or more races, not Hispanic or Latino

%

1 0 0 %

h. Total number of teachers (sum of a through g)

F6.

Are monetary incentives such as cash bonuses, salary increases, or different steps on the salary
schedule used in your school to reward teachers for… MARK YES OR NO ON EACH ROW.
Yes
a. Improved student performance on state tests?
b. Reaching target goals on state tests?

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No

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F7.

Did this school's principal (or head administrator) complete the majority of the previous sections
or was the majority completed by someone else? MARK ONE RESPONSE.
Principal (SKIP TO Q G1)
Someone else

F8.

If a person other than the school's principal (or head administrator) has completed the previous
sections, please write in the name and title of the person who completed the majority of the
sections. PLEASE PRINT.

LAST NAME

FIRST NAME

MIDDLE INITIAL

TITLE

F9.

How long has the individual listed above been employed at this school? WRITE YEARS AND MONTHS
BELOW.

YEAR(S)

MONTH(S)

The principal or head administrator should complete the remainder of
this questionnaire. If a designee is chosen to complete this in his or her
place, please be sure that the background and education characteristics
provided are about the school's principal or head administrator.

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SECTION G. SCHOOL ADMINISTRATOR CHARACTERISTICS
G1.

What is your gender? MARK ONE RESPONSE.
Male
Female

G2.

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

1 9
YEAR
G3.

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

G4.

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

G5.

How many years of experience do you have in each of the following positions, including years in
which you worked part time? WRITE THE NUMBER OF YEARS TO THE NEAREST FULL SCHOOL YEAR. IF
THIS IS YOUR FIRST YEAR, WRITE "1."
Number
of years
a. Years as a teacher before becoming a school administrator
b. Total number of years as a school administrator
c. Number of years as school administrator at this school

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G6.

Through which, if any, of the types of training programs below did you receive preparation for
fulfilling your role as a school administrator? MARK YES OR NO ON EACH ROW.
Yes

No

a. Traditional university-based training and certification program
b. District-based training program (for example, the Boston Principal
Fellowship, New York City Leadership Academy's Aspiring Principals
Program, Chicago's LAUNCH program)
c. City-based training program (for example, Cleveland's First Ring
Leadership Academy)
d. State-based training program (for example, New Jersey EXCEL)
e. Training and/or certification program run by a national non-profit
organization (for example, KIPP School Leadership Program, New
Leaders for New Schools)
f.

G7.

Another school administration preparation program

What is the highest level of education you have completed? MARK ONE RESPONSE.
High school diploma or equivalent/GED
Associate’s degree
Bachelor’s degree
At least one year of coursework beyond a Bachelor’s degree but not a graduate degree
Master’s degree
Education specialist or professional diploma based on at least one year of coursework past a
Master's degree level
Doctorate or an advanced professional degree beyond a Master's degree (for example, MD, Ed.D.)

G8.

What was your major field(s) of study in the highest degree you completed? MARK YES OR NO ON
EACH ROW.
Yes
No
a. Early childhood education
b. Elementary education
c. Education administration/management
d. Special education
e. Other education-related major (such as secondary
education, educational psychology, science education,
music education, etc.)
f.

Non-education major (such as history, English, etc.)

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G9.

What is your best estimate of the percentage of children in your school you know by name?
MARK ONE RESPONSE.
Nearly every child
76% or more
51% to 75%
26% to 50%
25% or less

G10.

During school hours, do you speak a language other than English with students at your school
whose native language is not English? MARK ONE RESPONSE.
Yes
No

G11.

Do you speak a language other than English with students' families whose native language is not
English? MARK ONE RESPONSE.
Yes
No

G12.

If you do not speak a language other than English with EITHER students OR students'
families whose native language is not English, mark here and SKIP TO Q G14.

G13.

What language(s) other than English do you speak with students at your school or with their
families? MARK ALL THAT APPLY.
Spanish
Vietnamese
A Chinese language
Japanese
Korean
A Filipino language
Arabic
Other (PLEASE SPECIFY)

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G14.

Date Questionnaire Completed:

2 0 1 6
MONTH

DAY

YEAR

Questionnaire completed by:

LAST NAME

FIRST NAME

THANK YOU FOR YOUR COOPERATION!

31

MIDDLE INITIAL

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For Office Use Only
C - No DR

C - DR Comp

C - DR Ref

Ref

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