1

No

STOP: Do not complete this survey. Please pass the survey on to this student's main language arts teacher. If you do not know who the student’s main language arts teacher is, please return the survey in the enclosed envelope.

2

Yes

Please GO on to Section A below.

1

Classroom setting PLEASE CONTINUE WITH QUESTION A2.

2

Individually PLEASE GO TO QUESTION A6, PAGE 3.

0

Ungraded

4

4th grade

9

9th grade

K

Kindergarten

5

5th grade

10

10th grade

1

1st grade

6

6th grade

11

11th grade

2

2nd grade

7

7th grade

12

12th grade

3

3rd grade

8

8th grade

Number

Teachers

Teacher aides

One-to-one instructional assistants assigned to a specific student

General education students

Special education students

Number of students

Much above average

Somewhat above average

Average

Somewhat below average

Much below average.

1

Student’s classroom teacher for other parts of the day

2

Provide related services directly to this student

PLEASE GO TO QUESTION A8.

3

Provide only Language Arts/Reading instruction to this student.

4

Provide consultation services to student’s teacher(s)

5

Provide case-management for this student

PLEASE GO TO QUESTION A9.

6

Program administrator

7

Other:___________________________________________________________________

1

General education grade-level curriculum materials are used without modification.

PLEASE GO TO SECTION B, PAGE 5

2

Some modifications in general education curriculum materials have been made (e.g., modified content expectations, below grade level curriculum used).

3

Substantial modifications in general education curriculum materials have been made (e.g., very different content expectations, significantly below grade level curriculum used).

PLEASE ANSWER QUESTION A10

4

Specialized curriculum or materials are used (e.g., parallel curriculum, individualized curriculum or materials).

1

Reading at grade level

2

Improving general reading skills, but not necessarily to reach grade level

3

Developing functional reading skills, such as word recognition for daily living.

4

Building pre-reading skills (i.e., letter recognition, auditory discrimination of sounds, matching words, etc.)

5

No goals regarding reading achievement

1

Yes PLEASE CONTINUE WITH QUESTION B2.

2

No PLEASE GO TO SECTION C, PAGE 11

The class as a whole

This student

Never

Occasionally

Frequently

Never

Occasionally

Frequently

a.

Textbooks

1

2

3

1

2

3

b.

Printed materials to supplement textbooks (i.e., literature selections)

1

2

3

1

2

3

c.

Worksheets or workbooks

1

2

3

1

2

3

d.

Hands-on materials or objects

1

2

3

1

2

3

e.

Computers for writing and other language arts activities

1

2

3

1

2

3

f.

Computers for Internet use

1

2

3

1

2

3

g.

Specialized skill-building curricula (i.e., phonics program, corrective reading programs)

1

2

3

1

2

3

The class as a whole

This student

Never

Occasionally

Frequently

Never

Occasionally

Frequently

a.

Responds orally to questions

1

2

3

1

2

3

b.

Take quizzes or tests

1

2

3

1

2

3

c.

Participates in class discussion

1

2

3

1

2

3

d.

Completes a reading assignment

1

2

3

1

2

3

e.

Works on a project or presentation

1

2

3

1

2

3

f.

Completes a writing assignment

1

2

3

1

2

3

g.

Works on a written report

1

2

3

1

2

3

h.

Reads silently

1

2

3

1

2

3

i.

Receives skill-building instruction

1

2

3

1

2

3

The class as a whole

This student

Never

Occasionally

Frequently

Never

Occasionally

Frequently

a.

Work with a peer partner

1

2

3

1

2

3

b.

Whole class instruction

1

2

3

1

2

3

c.

Instruction within small groups

1

2

3

1

2

3

d.

Individual instruction from you

1

2

3

1

2

3

e.

Individual instruction from another adult

1

2

3

1

2

3

The class as a whole

This student

Not at all important

Somewhat important

Very important

Not at all important

Somewhat important

Very important

a.

Results of tests

1

2

3

1

2

3

b.

Improvement over past performance

1

2

3

1

2

3

c.

Performance relative to a set standard

1

2

3

1

2

3

d.

Performance relative to the rest of the class.

1

2

3

1

2

3

e.

Class participation

1

2

3

1

2

3

f.

Homework

1

2

3

1

2

3

g.

Attendance

1

2

3

1

2

3

h.

Performance on projects or practical exercises

1

2

3

1

2

3

i.

Attitude/behavior

1

2

3

1

2

3

j.

Items in student portfolios

1

2

3

1

2

3

999

I do not provide progress reports for this student

1

The same

2

Somewhat different

3

Very different

4

I do not discipline this student

5

Student does not or rarely requires disciplining from adults

1

an IEP or 504 plan ® ® ® ® ® ® ® ® ® PLEASE GO TO SECTION D, PAGE 13.

2

for special education services

3

Yes, this student has a 504 plan. ® ® ® PLEASE GO TO QUESTION B8.

9

Don’t know

1

Special materials to use with the student

2

In-service training on the needs of this student

3

Special procedures to use with the student

4

Consultation services

5

Teacher aides or instructional assistants

6

Smaller student load or class size

7

Other:____________________________________________________________

8

None of these

9

No assistance necessary

1

This student’s IEP goals

2

This student’s academic abilities or previous academic performance

3

This student’s social/behavioral needs

4

Instructional modifications or adaptations needed by this student

5

Grading modifications needed by this student

6

Behavioral support plans that apply to this student

7

None of these

Accommodations/modifications

1

More time in taking tests

2

Test read to student

3

Modified tests

4

Modified grading standards

5

Slower-paced instruction

6

Additional time to complete assignments

7

Shorter assignments

8

Physical adaptations (e.g., preferential seating, special desks)

Additional Personnel

7

Reader or interpreter

8

Teacher aides or instructional assistants

Additional Supports & Assistance

9

Student progress monitored by special education teacher

10

Tutoring by special education teacher

11

Behavior management program

12

Learning strategies/study skills assistance

Learning Aids

14

Books on tape

15

Communication aids (e.g., Touch Talker, manual printing board)

16

Use of spell checker

17

Computer software designed for children with disabilities

18

19

Other:___________________________________________________________

20

None of these provided

1

Yes

2

No

® ® ® PLEASE GO TO B13.

1

Yes

2

No

1

Very appropriate

2

Somewhat appropriate

3

Not very appropriate

4

Not at all appropriate

9

Not sure

1

Very adequate

2

Somewhat adequate

3

Not very adequate

4

Not at all adequate

9

Not sure

Number of Students

999

Not applicable; this student is instructed when no other students are present.

____________

Autism

____________

Deaf-blindness

____________

Developmental delay

____________

Emotional or behavioral impairment

____________

Hearing impairment/deafness

____________

Learning disability

____________

Mental retardation

____________

Orthopedic impairment

____________

Other health impairment

____________

Multiple disabilities

____________

Speech or language impairment

____________

Traumatic brain injury

____________

Visual impairment/blindness

____________

Other:____________________________________________________

Frequently

Occasionally

Rarely/Never

a.

Work with a peer partner

1

2

3

b.

Whole class instruction

1

2

3

d.

Instruction within small groups

1

2

3

c.

Individual instruction from you

1

2

3

e.

Individual instruction from another adult

1

2

3

Frequently

Occasionally

Rarely/Never

a.

Textbooks

1

2

3

b.

Printed materials to supplement textbooks (i.e., literature selections)

1

2

3

c.

Worksheets or workbooks

1

2

3

d.

Hands-on materials or objects

1

2

3

e.

Computers for writing and other language arts activities

1

2

3

f.

Computers for Internet use

1

2

3

g.

Specialized skill-building curricula (i.e., phonics program, corrective reading programs)

1

2

3

Frequently

Occasionally

Rarely/Never

a.

Responds orally to questions

1

2

3

b.

Take quizzes or tests

1

2

3

c.

Participates in class discussion

1

2

3

d.

Completes a reading assignment

1

2

3

e.

Works on a project or presentation

1

2

3

f.

Completes a writing assignment

1

2

3

g.

Works on a written report

1

2

3

h.

Reads silently

1

2

3

i.

Receives skill-building instruction

1

2

3

Not at all Important

Somewhat Important

Very Important

a.

Results of tests

1

2

3

b.

Improvement over past performance

1

2

3

c.

Performance relative to a set standard

1

2

3

d.

Performance relative to the rest of the class.

1

2

3

e.

Class participation

1

2

3

f.

Homework

1

2

3

g.

Attendance

1

2

3

h.

Effort

1

2

3

i.

Performance on projects or practical exercises

1

2

3

j.

Attitude/behavior

1

2

3

k.

Items in student portfolios

1

2

3

999

I do not provide grades or formal progress reports for this student

Accommodations/modifications

1

More time in taking tests

2

Test read to student

3

Modified tests

4

Modified grading standards

5

Slower-paced instruction

6

Additional time to complete assignments

7

Shorter assignments

8

Physical adaptations (e.g., preferential seating, special desks)

Additional Supports & Assistance

9

Reader or interpreter

10

Teacher aides or instructional assistants

11

Student progress monitored by special education teacher

12

Tutoring by special education teacher

13

Behavior management program

14

Learning strategies/study skills assistance

Learning Aids

15

Books on tape

16

Communication aids (e.g., Touch Talker, manual printing board)

17

Use of spell checker

18

Computer software designed for children with disabilities

19

20

Other:___________________________________________________________

21

None of these provided

00

Pre-reading

6

6th grade level

0

Kindergarten level

7

7th grade level

1

First grade level

8

8th grade level

2

2nd grade level

9

9th grade level

3

3rd grade level

10

10th grade level

4

4th grade level

11

11th grade

5

5th grade level

12

12th grade or higher

999

Ungraded

1

Mostly As OR

6

Mostly "excellent"

2

Mostly Bs

7

Mostly "good"

3

Mostly Cs

8

Mostly "fair"

4

Mostly Ds

9

Mostly "needs improvement"

5

Mostly Fs

1

Native English-speaker ® ® ® PLEASE GO TO QUESTION D4

2

both first language and English)

3

Limited-English-proficient PLEASE GO TO QUESTION D3b

4

Non-English speaker

1

Yes

2

No

Never

Sometimes

Very Often

N/A

Don’t Know

a.

*****

1

2

3

4

5

b.

*****

1

2

3

4

5

c.

*****

1

2

3

4

5

d.

*****

1

2

3

4

5

e.

*****

1

2

3

4

5

f.

*****

1

2

3

4

5

g.

*****

1

2

3

4

5

h.

*****

1

2

3

4

5

i.

*****

1

2

3

4

5

j.

*****

1

2

3

4

5

k.

*****

1

2

3

4

5

l.

*****

1

2

3

4

5

m.

*****

1

2

3

4

5

n.

*****

1

2

3

4

5

o.

*****

1

2

3

4

5

p.

*****

1

2

3

4

5

q.

*****

1

2

3

4

5

r.

Do things on his or her own even if they are hard

1

2

3

4

5

s.

Keeps at a task until s/he is finished, even if it takes a long time

1

2

3

4

5

t.

*****

1

2

3

4

5

u.

*****

1

2

3

4

5

v.

*****

1

2

3

4

5

w.

*****

1

2

3

4

5

x.

*****

1

2

3

4

5

0

Never

1

Once

2

A few times over the school year

3

Once a month

4

Once a week or several times a month

5

Every day or several times a week

1

Yes

2

No

3

Not applicable. We do not have parent conferences or "back-to-school" night.

9

Don't know

1

Not at all involved

2

Not very involved

3

Fairly involved

4

Very involved

9

Don’t know

1

Full-time general education teacher

2

Full-time special education teacher

3

Part-time general education teacher

4

Part-time special education teacher

5

Itinerant teacher (i.e., you to provide instruction at more than one school)

6

Long-term substitute (i.e., fills the role of a regular teacher on a long-term basis, but still considered a substitute)

7

Other:_____________________________________________________________

1

YES

2

NO

_________

Total students taught per week

_________

Years in teaching

_________

Years in teaching special education students

1

Bachelor’s degree

2

At least 1 year of course work beyond a bachelor’s but not a graduate degree

3

Master’s degree

4

Education specialist or professional diploma with at least 1 year of course work past a master’s degree

5

Doctorate degree

6

Other (please specify) ________________________________________________

1

Regular or standard or advanced certificate

2

Probationary certificate

3

Provisional (or other type given to persons who are still participating in an "alternative certification program").

4

Temporary certificate (requires some additional coursework and/or student teaching).

5

Emergency certificate or waiver

6

Other

1

General education credential

2

Disability-specific credential or endorsement

3

Special education credential or endorsement (for more than one disability category)

4

Speech/language

5

Physical therapy license

6

Occupational therapy license

7

Other:____________________________________________________________________

9

None of these

1

Yes

2

No

1

Teach language arts, reading, English, or writing

2

Work with students who are considered to be "at-risk"

3

Work with students with disabilities

4

Classroom management

5

None of these

Very well prepared

Well prepared

Somewhat prepared

Not at all prepared

a.

Motivate students to participate in academic tasks

1

2

3

4

b.

Use technology in instruction

1

2

3

4

c.

Adapt instruction and/or materials to address varying needs and achievements of individual students

1

2

3

4

d.

Teach reading skills

1

2

3

4

e

Teach English at this student’s grade level

f

Monitor students’ progress

1

2

3

4

g

Adjust instruction based on student progress

1

2

3

4

h

Manage behavior

1

2

3

4

Strongly Agree

Agree

Disagree

Strongly Disagree

Not Applicable

a.

I am given the support I need to teach students with special needs

1

2

3

4

8

b.

I have adequate training for teaching students with disabilities.

1

2

3

4

8

c.

The school leadership has high expectations and standards for students and teachers

1

2

3

4

8

d.

The principal promotes instructional improvement among school staff.

1

2

3

4

8

e.

This school is a safe place for students.

1

2

3

4

8

1

African-American or Black

2

American Indian or Alaskan Native

3

Asian

4

Caucasian or white

5

Hispanic, Latino, or other Spanish origin

6

Native Hawaiian

7

Other Pacific Islander

8

Other:________________________________________________________