Impact Study to Inform the Teacher and School Leader Incentive Program

APPENDIX C

School Information Questionnaire

OMB No.: xxxx-xxxx

Expiration Date: xx/xx/xxxx

Impact Evaluation to Inform the Teacher and School Leader Incentive Program

Conducted on behalf of the U.S. Department of Education

SCHOOL INFORMATION QUESTIONNAIRE

principal first name principal last name school name

district name

| | | | - | | | | - | | | | | ________________________________________

principal phone number principal email address

best time during the day to reach you by phone

Please provide the name and contact information for someone at your school who will serve as the primary point of contact for the study team. This person will help the study team communicate with participating teachers and support study activities in the school.

study contact first name study contact last name

| | | | - | | | | - | | | | | ________________________________________

study contact phone number study contact email address

The following questions will provide the study team a better understanding of the schools in the study. Please answer these questions as best you can about your school’s teacher composition and your current thinking about selecting teacher leaders. Your responses will not affect which schools are selected by lottery to be in the study’s teacher leader group or in the comparison group.

1. For the 2020–2021 school year, for 3rd grade, will the same teachers teach both math and English language arts (ELA) in each grade (self-contained classes), or will different teachers teach math or English language arts (departmentalized classes)? Please complete the appropriate column(s) below about your 3rd grade teachers.

□ Check here if your school does not include 3rd grade. Go to Question 2.

	1 □ Same teachers teach math and ELA (self-contained)	2 □ Different teachers teach math or ELA (departmentalized)
	Please complete the questions below about your 3rd grade teachers	Please complete the questions below about your 3rd grade math teachers	Please complete the questions below about your 3rd grade ela teachers
	A. SELF-CONTAINED	B. DEPARTMENTALIZED MATH	C. DEPARTMENTALIZED ELA
a. Number of 3rd grade teachers	|__|__|	|__|__|	|__|__|
b. How many of these positions are currently vacant?	|__|__|	|__|__|	|__|__|
c. Are any 3rd grade classes specialized groupings of students?	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|
d. Do any 3rd grade classes have different teacher configurations (e.g., co-teachers)?	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No
e. Do any 3rd grade teachers also teach 4th or 5th grade classes?		□ Also teach 4th grade math □ Also teach 5th grade math	□ Also teach 4th grade ELA □ Also teach 5th grade ELA

2. For the 2020–2021 school year, for 4th grade, will the same teachers teach both math and English language arts (ELA) in each grade (self-contained classes), or will different teachers teach math or English language arts (departmentalized classes)? Please complete the appropriate column(s) below about your 4th grade teachers.

□ Check here if your school does not include 4th grade. Go to Question 3.

	1 □ Same teachers teach math and ELA (self-contained)	2 □ Different teachers teach math or ELA (departmentalized)
	Please complete the questions below about your 4th grade teachers	Please complete the questions below about your 4th grade math teachers	Please complete the questions below about your 4th grade ela teachers
	A. SELF-CONTAINED	B. DEPARTMENTALIZED MATH	C. DEPARTMENTALIZED ELA
a. Number of 4th grade teachers	|__|__|	|__|__|	|__|__|
b. How many of these positions are currently vacant?	|__|__|	|__|__|	|__|__|
c. Are any 4th grade classes specialized groupings of students?	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|
d. Do any 4th grade classes have different teacher configurations (e.g., co-teachers)?	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No
e. Do any 4th grade teachers also teach 3rd or 5th grade classes?		□ Also teach 3rd grade math □ Also teach 5th grade math	□ Also teach 3rd grade ELA □ Also teach 5th grade ELA

3. For the 2020–2021 school year, for 5th grade, will the same teachers teach both math and English language arts (ELA) in each grade (self-contained classes), or will different teachers teach math or English language arts (departmentalized classes)? Please complete the appropriate column(s) below about your 5th grade teachers.

□ Check here if your school does not include 5th grade. Go to Question 4.

	1 □ Same teachers teach math and ELA (self-contained)	2 □ Different teachers teach math or ELA (departmentalized)
	Please complete the questions below about your 5th grade teachers	Please complete the questions below about your 5th grade math teachers	Please complete the questions below about your 5th grade ela teachers
	A. SELF-CONTAINED	B. DEPARTMENTALIZED MATH	C. DEPARTMENTALIZED ELA
a. Number of 5th grade teachers	|__|__|	|__|__|	|__|__|
b. How many of these positions are currently vacant?	|__|__|	|__|__|	|__|__|
c. Are any 5th grade classes specialized groupings of students?	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|	□ Honors/Gifted # of classes: |__| □ Special Education # of classes: |__| □ English Language Learners/Bilingual # of classes: |__| □ Other # of classes: |__|
d. Do any 5th grade classes have different teacher configurations (e.g., co-teachers)?	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No	□ Yes # of classes: |__| □ No
e. Do any 5th grade teachers also teach 3rd or 4th grade classes?		□ Also teach 3rd grade math □ Also teach 4th grade math	□ Also teach 3rd grade ELA □ Also teach 4th grade ELA

4. We would like to know which teachers in your school you believe would benefit most from coaching by teacher leaders for the 2020–2021 school year and which would benefit the least. For example, teachers who might benefit the most from this type of coaching could include:

• Novice and struggling teachers

• Those new to your school or to the grade/subject they’ll be teaching

• Those who would be particularly open or receptive to additional coaching

• Those facing particular challenges, such as having to implement a new curriculum or set of standards

• Those teaching a challenging group of students

• Those to be hired for vacant positions

For each grade, please list every teacher expected to be teaching math or ELA in 3rd through 5th grades in 2020–2021 and indicate the degree to which they would benefit from coaching. Include the grade(s) and subject(s) they are likely to teach in 2020–2021. For teachers not yet hired, write “TBD new hire.” If a single teacher is teaching across multiple grades, please list them for every grade they will be teaching.

		MARK ONE BOX IN EACH ROW
		How much would coaching benefit this teacher?
Teacher name	Subjects	Benefit most	Benefit more than the average teacher	Benefit less than the average teacher	Benefit very litte
Third Grade
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
Fourth Grade
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
Fifth Grade
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4
	□ Math □ ELA	□ 1	□ 2	□ 3	□ 4

5. What factor(s) are you using to consider teachers most likely to benefit from coaching by a teacher leader in 2020–2021?

MARK up to THREE responses

1 □ First-year teacher

2 □ Early career (that is, up to three years of experience)

3 □ New to school

4 □ New to grade or subject

5 □ Adopting new curriculum or new standards

6 □ Below-average teacher evaluation rating

7 □ Concerns from past observations or classroom issues

8 □ Receptivity or openness to feedback

9 □ Teaching challenging group of students

10 □ Other (specify)

11 □ Other (specify)

12 □ Other (specify)

6. If your school is selected for the teacher leader group, which two grades or grade and subject combinations are you most likely to designate to work with a teacher leader?

These will typically be teams of three to six teachers (including the teacher leader) who all have the same teaching responsibilities (for example, all 4th grade teachers or all 5th grade ELA teachers). Only 3rd through 5th grade teachers teaching math and/or ELA are eligible.

Team 1: ______________________________________________

Team 2: ______________________________________________

7. Which teachers do you expect would be interested and good candidates for the teacher leader roles? Please list a teacher for each grade (3rd through 5th) or each subject (math and ELA).

This will not affect the teacher leader application and selection process in your school if selected for the teacher leader group.

Self-contained Departmentalized

3rd grade: _____________________________ Math: ________________________________

4th grade: _____________________________ ELA: _________________________________

5th grade: _____________________________

8. Please rank the top five characteristics that you think are most important in a teacher leader. Use 1 to indicate the most important characteristic, 2 for the next most important, and so on.

Write in rank from 1 (most important) to 5, and leave the rest blank:

a ____ Effectiveness as a teacher

b ____ Ability to teach adults

c ____ Relationships with other teachers

d ____ Years of teaching experience

e ____ Seniority at school

f ____ Experience leading teachers in other activities

g ____ Supportive or non-judgmental personality

h ____ Analytical thinking

i ____ Level of academic degree or other continuing education training or certification

9. Please rank the top five topics you would most like teacher leaders to focus on in their support of other teachers on their team. Use 1 to indicate the most important, 2 for the next most important, and so on.

Write in rank from 1 (most like to focus on) to 5, and leave the rest blank:

a ____ Improving classroom management

b ____ Improving math scores

c ____ Improving ELA scores

d ____ Improving instruction

e ____ Using data to drive instruction

f ____ Coaching novice teachers

g ____ Coaching struggling teachers

h ____ Leading team meetings

i ____ Providing professional development for team

j ____ Implementing a new curriculum or other recent change in responsibilities
(write in N/A if there are no applicable changes in your school)

10. To what extent do the following statements characterize your school?

	MARK ONE BOX IN EACH ROW
	not at all	to a small extent	to a moderate extent	to a large extent
a. Teachers formally visit each other’s classrooms (e.g., when it is planned in advance for specific purposes)	□ 1	□ 2	□ 3	□ 4
b. Teachers informally visit each other’s classrooms on a regular basis	□ 1	□ 2	□ 3	□ 4
c. Opportunities for teacher collaboration are built into the school schedule (e.g., professional learning communities or common planning time)	□ 1	□ 2	□ 3	□ 4
d. Teachers would be receptive to receiving feedback on their teaching from one of their peers	□ 1	□ 2	□ 3	□ 4

Please sign below to indicate your agreement to have your school participate in the study.

I understand the scope of this study and my school’s participation in it. I understand that if my school is selected into the teacher leader group that I will select teacher leaders and support their efforts in accordance with the study’s requirements. I will select the grade and/or subject teams to participate in the study and expect all included teachers to participate in coaching efforts. If my school is selected into the comparison group, I will encourage a group of teachers identified by the study team to complete study surveys. I commit to communicating with my teachers about the study and fully supporting my teachers’ participation in the study’s activities described above, including data collection and training and support activities. I will participate in all principal-related activities required by the study.

principal name (please print)

principal signature date

thank you for completing this questionnaire!