OMB #:
Expiration
Date:
Evaluation of the DC Opportunity Scholarship Program
Elementary School (Grades 4-5)
Student Questionnaire
Spring 2013
According to the Paperwork
Reduction Act of 1995, no persons are required to respond to a
collection of information unless such collection displays a valid
OMB control number. The valid OMB control number for this
information collection is xxxx-xxxx. Public reporting burden
for this collection is estimated to average 15
minutes per
response, including the time to review instructions, search existing
data resources, gather the data needed, and complete and review the
information collection. Completion of this survey is required
to obtain or retain benefits, per the SOAR Act Sec. 3009(a)(3)(C).
All
information from this study will be kept confidential as required by
the Education Sciences Reform Act of 2002 (Title I, Part E, Section
183). To ensure privacy, no personally identifiable information
will be disclosed as part of the evaluation. All of the
information that is collected will be stored separately from school
records in a secure location. Responses to this data collection will
be used only for statistical purposes. The reports prepared for
this study will summarize findings across the sample and will not
associate responses with a specific school or individual. We will
not provide information that identifies you or your school to anyone
outside the study team, except as required by law. Send
comments regarding the burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden to the U.S. Department of Education, 400 Maryland Avenue,
S.W., LBJ, Room 2E117, Washington, DC 20210-4537 or send
electronically through the Federal eRulemaking Portal at
http://www.regulations.gov
by selecting the Docket ID number. .
Please answer all the questions.
Part 1: About You
This first section asks questions about you.
Q1. Are you a ….
( Check one)
Boy or 1
Girl? 2
Q2. How often do you read books that are not assigned by your teacher?
( Check one)
Every day 1
Most days 2
Some days 3
Never 4
Q3. How far do you expect to go in school?
( Check one)
Less than high school completion 1
Complete a high school diploma, GED or alternative high school credential 2
Complete a certificate or diploma from a school that provides occupational training 3
Complete an Associate’s degree 4
Complete a Bachelor’s degree 5
Complete a Master’s degree 6
Complete a Ph.D., M.D., law degree, or other high level professional degree 7
Q4. During this year, have you done any of the following?
( Check yes or no on each row)
|
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
Q5. On a regular school day, how long are you at home after school with no adult there?
( Check one)
None 0
Less than 1 hour 1
1-2 hours 2
2-3 hours 3
More than 3 hours 4
Q6. Do any of the following encourage you to work harder in school?
( Check one box on each row)
|
A Lot |
A Fair Amount |
A Little Bit |
Not At All |
a. Pressure from my parents |
1 |
2 |
3 |
4 |
b.Pleasing my parents by getting good grades |
1 |
2 |
3 |
4 |
c.Teacher expectations |
1 |
2 |
3 |
4 |
d.Pleasing my teacher |
1 |
2 |
3 |
4 |
e.Encouragement from my teachers |
1 |
2 |
3 |
4 |
f.Learning the material |
1 |
2 |
3 |
4 |
g.Interest in the subject |
1 |
2 |
3 |
4 |
h.Keeping up with my friends |
1 |
2 |
3 |
4 |
i.Getting a better job |
1 |
2 |
3 |
4 |
j.Getting into college |
1 |
2 |
3 |
4 |
k.Pressure from my friends |
1 |
2 |
3 |
4 |
l.Not embarrassing my family |
1 |
2 |
3 |
4 |
Part 2: About Your School and Classes
This section asks questions about your school and classes, support from teachers and other adults in the school and other students’ attitudes.
Q7. Do you agree or disagree with these statements about your school?
( Check one box on each row)
|
Agree strongly |
Agree |
Disagree |
Disagree strongly |
a.Students are proud to go to this school |
1 |
2 |
3 |
4 |
b.Students at this school have a lot of opportunities to learn |
1 |
2 |
3 |
4 |
c.Rules of behavior are strict |
1 |
2 |
3 |
4 |
d.People at my school are supportive of each other |
1 |
2 |
3 |
4 |
e.I feel lonely at my school |
1 |
2 |
3 |
4 |
f.I enjoy going to school |
1 |
2 |
3 |
4 |
g.There is respect, among students and teachers, for other religions and cultures, at my school |
1 |
2 |
3 |
4 |
h.Students are taught to be kind and responsible for their actions |
1 |
2 |
3 |
4 |
Q8. Overall, how safe do you feel your school is?
Very safe 1
Somewhat safe 2
Not safe 3
Q9. Did the following ever happen to you at school this year?
( Check one box on each row)
|
Never |
Once or twice |
3 times or more |
|
1 |
2 |
3 |
|
1 |
2 |
3 |
|
1 |
2 |
3 |
|
1 |
2 |
3 |
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1 |
2 |
3 |
|
1 |
2 |
3 |
|
1 |
2 |
3 |
|
1 |
2 |
3 |
Q10. Do you agree or disagree with these statements about the teachers and other adults at your
school?
( Check one box on each row)
|
Agree strongly |
Agree |
Disagree |
Disagree strongly |
At my school, there is a teacher or some other adult who… |
|
|
|
|
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
Q11. During the current school year (2012-2013), have teachers and other school staff provided you with support? If they did, was it helpful?
( Check two boxes on each row)
|
Yes |
No |
Very Helpful |
Somewhat Helpful |
Not Helpful |
|
1 |
2 |
1 |
2 |
3 |
|
1 |
2 |
1 |
2 |
3 |
Q12. Do you agree or disagree with these statements about the students at your school?
( Check one box on each row)
|
Agree strongly |
Agree |
Disagree |
Disagree strongly |
At my school, students… |
|
|
|
|
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
Q13. What overall grade would you give your school?
( Check one)
A-Excellent 1
B-Good 2
C-Fair 3
D-Unsatisfactory 4
F-Failing 5
Q14. During this year, have you taken classes in?
( Check yes or no on each row)
|
Yes |
No |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
|
1 |
2 |
Q15. How much do you agree or disagree with the following statements about your teacher? Remember, your teacher and your principal will not see any of the answers you provide. Your teacher…
( Check one box on each row)
|
Agree strongly |
Agree |
Disagree |
Disagree strongly |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
|
1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
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1 |
2 |
3 |
4 |
Q16. To what extent do you understand what is being taught in class?
None of the time 1
Less than half the time 2
About half the time 3
More than half the time 4
All the time 4
Q17. How many students are in your class? _______________________
(your best guess is fine)
Q18. On average, how many minutes do you spend doing homework per day?
( Check one)
0 minutes 0
1 to 10 minutes 1
11 to 20 minutes 2
21 to 30 minutes 3
31 to 60 minutes 4
More than 60 minutes 5
Part 3: About Your Friends
This section asks questions about your friends.
Q19. How many of your close friends do your parents know by name?
( Check one)
All of them 1
Most of them 2
Some of them 3
None of them 4
Q20. Think about your close friends. How many of them do the following?
( Check one box on each row)
|
All of them |
Some of them |
A few of them |
None |
a.Use bad language regularly |
1 |
2 |
3 |
4 |
b.Smoke cigarettes regularly |
1 |
2 |
3 |
4 |
c.Drink beer or alcohol regularly |
1 |
2 |
3 |
4 |
d.Use illegal drugs regularly |
1 |
2 |
3 |
4 |
e.Talk about college and careers |
1 |
2 |
3 |
4 |
f.Talk about classes in school and what they are learning |
1 |
2 |
3 |
4 |
g.Talk about what could be done to improve the neighborhoods and the city |
1 |
2 |
3 |
4 |
Q21. How important do your school friends think it is to:
( Check one box on each row)
|
Very important |
Somewhat important |
Not too important |
Not at all important |
a.Study hard to get good grades |
1 |
2 |
3 |
4 |
b.Talk/hang out with friends |
1 |
2 |
3 |
4 |
c.Participate in class |
1 |
2 |
3 |
4 |
Q22. Which group of friends do you listen to the most when you think about school?
( Check one box)
Friends from your neighborhood 1
Friends from school 2
My
neighborhood friends are the same
as my school friends 3
Thank you, please hand in your survey.
File Type | application/msword |
Author | Mike Puma |
Last Modified By | Ingalls, Katrina |
File Modified | 2016-03-09 |
File Created | 2016-03-09 |