Attachment 39. FACES 2019 spring 2022 special teacher sampling form from Head Start staff_clean

ATTACHMENT 39

FACES 2019 SPRING 2022 SPECIAL TEACHER SAMPLING FORM FROM HEAD START CENTER STAFF

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NOTE: For each center, a FACES study liaison will request from a designated Head Start staff member (typically the on-site coordinator, known as the OSC) a list of all lead teachers providing in-person instruction to Head Start-funded children. Home visitors and teachers who only teach virtually/remotely should not be included on this list of lead teachers. The attached teacher sampling form is an example of the information required for teacher sampling. The liaison will request this information via a secure file sharing website. The liaison will enter the information into a web-based sampling program. For each teacher, the liaison will obtain their first and last name, their email address, and the number of classrooms they have. For each classroom a teacher has, we will also obtain the instruction schedule (AM, PM, or full day), and the primary language of instruction (English, Spanish, or other). The study liaison will enter this information into a web-based sampling program that will include fields that match those on the attached form. The sampling program will randomly select about two teachers per selected center for participation in the study. Then, if the teacher instructs more than one group of children, the sampling program will sub-sample one group for the classroom observation to take place during the data collection visit.

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FACES 2019

SPRING 2022 SPECIAL TEACHER SAMPLING FORM

Program: [HS Program]	OSC: [OSC Name]
Center:	OSC Phone: [Phone #]
[Center Name]	Liaison
	(Please Print Your Name)
Center Phone: [Phone #]

INSTRUCTIONS: Please provide the information below for each teacher providing in-person instruction in this center for one or more Head Start funded children. Do not include home visitors or teachers who only teach virtually/remotely. For each teacher, please list information on each of their classrooms that receives in-person instruction, including the instruction schedule (AM, PM, or Full Day), and what the primary language of instruction is (English, Spanish, Other).

A	B	C	D	E
Lead Teacher (Lead teachers are the head or primary teachers for a group of children.)	Lead Teacher Email Address	Number of classrooms for this teacher	Instruction Schedule (Indicate for each classroom)	Primary Language of Instruction (Indicate for each classroom)
First Name Last Name			AM, PM, Full Day	English, Spanish, Other
1.	1.	1.	1a.____________________ 1b. ____________________	1a.____________________ 1b. ____________________
2.	2.	2.	2a.____________________ 2b. ____________________	2a.____________________ 2b. ____________________
3.	3.	3.	3a.____________________ 3b. ____________________	3a.____________________ 3b. ____________________
4.	4.	4.	4a.____________________ 4b. ____________________	4a.____________________ 4b. ____________________
5.	5.	5.	5a.____________________ 5b. ____________________	5a.____________________ 5b. ____________________
6.	6.	6.	6a.____________________ 6b. ____________________	6a.____________________ 6b. ____________________
7.	7.	7.	7a.____________________ 7b. ____________________	7a.____________________ 7b. ____________________
8.	8.	8.	8a.____________________ 8b. ____________________	8a.____________________ 8b. ____________________
9.	9.	9.	9a.____________________ 9b. ____________________	9a.____________________ 9b. ____________________
10.	10.	10.	10a.____________________ 10b. ____________________	10a.____________________ 10b. ____________________
11.	11.	11.	11a.____________________ 11b. ____________________	11a.____________________ 11b. ____________________
12.	12.	12.	12a.____________________ 12b. ____________________	12a.____________________ 12b. ____________________
13.	13.	13.	13a.____________________ 13b. ____________________	13a.____________________ 13b. ____________________
14.	14.	14.	14a.____________________ 14b. ____________________	14a.____________________ 14b. ____________________

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to provide descriptive information about Head Start programs and the families they serve. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-0151, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Lizabeth Malone, Mathematica, 1100 1st Street, NE, 12th Floor, Washington, DC 20002

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