CLIO Parent Interview (Kindergarten 2007 and First Grade 2008)

OMB#:

Expiration Date:

Spring 2007

FOLLOW-UP

PARENT INTERVIEW

Kindergarten

Interview for sibling in household: 		Date:_______________________
ID of first sibling:_______________________		Interviewer: ________________________________

Westat

NOTICE: 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 information collection is xxxxxxxx (expires xx/xx/xxxx). The time required to complete this information collection is estimated to average 30 minutes per response, including time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Introduction

Thank you for agreeing to talk with me. The purpose of this study is to find out which family literacy programs work best for Even Start families.

For this interview, I will ask you questions and write down your answers. You may stop me at any time, or go back to earlier questions to change your answers. Only the CLIO study team will see or hear your answers. Your participation is completely voluntary. You do not have to answer any question that you do not want to answer. You will not be penalized in any way if you decide to skip questions.

After the interview, you will receive $15 as a thank you for your time.

Will the interview be completed in whole or in part with an interpreter?

YES………………………………………... 1 Go to box below

NO…………………………………………. 2

IF YES: HAVE INTERPRETER SIGN CONFIDENTIALITY FORM BEFORE INTERVIEW AND STAPLE FORM TO THIS BOOKLET.

WHAT LANGUAGE WILL BE USED? ____________________________________

SCREENER

First, I need to double check the information we already have about you and [CHILD].

A1. Is [CHILD] the correct name of your child? (CHECK SPELLING)

yes 1 (GO TO A3)

no 2

A2. What is your child’s correct name?

Name:

A3. We want to interview the person most responsible for [CHILD]’s care. Are you that person?

yes 1 (GO TO A6)

no 2

A4. Who is most responsible for [CHILD]’s care?

Name:

Address:

Phone:

A5. Is that person available to talk with me now?

yes 1 (RESTART

INTERVIEW)

no 2 (RESCHEDULE
INTERVIEW WITH A4 PERSON)

A6. What is your relationship to [CHILD]?

Bio/Adoptive Mother 01 Stepmother. 03 Grandmother. 05 Great Grandmother 07 Sister/stepsister 09 Other Relative or In-law (Female) 11 Foster Parent (Female) 13 Other Non-relative (Female) 15 Parent’s Partner (Female) 17

Bio/Adoptive Father. 02 Stepfather 04 Grandfather 06 Great Grandfather 08 Brother/stepbrother 10 Other Relative or In-law (Male) 12 Foster Parent (Male). 14 Other Non-relative (Male) 16 Parent’s Partner (Male) 18

CHILD DEMOGRAPHICS

B1. What is [CHILD]’s birth date?

|___|___| |___|___| |___|___|___|___|

MONTH DAY YEAR

B2. Is [CHILD] a boy or a girl?

boy 1

gIrl 2

B3. Is [CHILD] Hispanic or Latino?

YES 1

NO 2

B4. What is [CHILD]’s race? Please select one or more. (CIRCLE ONE OR MORE)

a. American Indian or Alaska Native 1

b. Asian 2

c. Black or African American 3

d. Native Hawaiian or Other Pacific Islander 4

e. White 5

B5. In what country was [CHILD] born?

USA 1 (GO TO B7)

Other (specify country) 2

_________________________

B6. How many years has [CHILD] lived in the United States?

|___|___| YEARS

B7. What grade in school or if not in school, what type of child care program is [CHILD] attending? Is s/he in... (CIRCLE ONLY ONE)

Kindergarten or transitional kindergarten

program 01 (GO TO B8)

Even Start 02 (GO TO B8)

Head Start, pre-kindergarten, or any other
type of center-based child care program 03 (GO TO B8)

Other (SPECIFY)_______________________ 04 (GO TO B12)

B8. For how many days a week does [CHILD] go to this program?

|____| DAYS

B9. How many hours per week is [CHILD] at this program?

|___|___| HOURS

B10. Since the beginning of this school year, has [CHILD] been in the same school?

YES 1 (GO TO B12)

NO 2

DON’T KNOW 8 (GO TO B12)

B11. How many different schools has [CHILD] attended?

|_____|_____| NUMBER

B12. Will [CHILD] attend any of the following in the Fall?

Kindergarten 1

First grade 2

Neither 3 (GO TO B15)

B13. What is the complete name of the school you think [CHILD] will attend?

SCHOOL NAME:

B14. What district, city, and state is the school located in?

District:

City:

State:

B15. During the current school year, is anyone in your family receiving services from Even Start?

YES 1 (GO TO B16)

NO 2 (GO TO C1)

DON’T KNOW 8

B16. During the current school year, what kind of Even Start services do they receive? (CIRCLE ALL THAT APPLY.)

Adult education (such as GED or
ESL classes 01

Parenting education classes 02

Home visits 03

Preschool services for 0-5 year old
children 04

Parent and child activities 05

Before school or after school services
for school age children 06

Other (specify __________________) 07

REFER TO QB7: IF RESPONDENT ANSWERED “OTHER”, SKIP TO SECTION E.

School communication and involvement

C1. For each statement that I read you, please tell me how well [CHILD]’s school has been doing the following things during the school year:

[IF NECESSARY, READ AFTER EACH STATEMENT: Would you say [CHILD]’s school does this very well, just OK, or doesn’t do it at all? (CIRCLE ONE RESPONSE FOR EACH ITEM]

	Does it very well	Just OK	Does not do it at all	Don’t know
a. Lets you know (between report cards) how [CHILD] is doing in school	1	2	3	8
b. Helps you understand what children at [CHILD]’s age are like	1	2	3	8
c. Makes you aware of chances to volunteer at the school	1	2	3	8
d. Provides workshops, materials, or advice about how to help [CHILD] learn at home	1	2	3	8
e. Provides information on community services to help [CHILD] or your family	1	2	3	8
f. Understands the needs of families who don’t speak English	1	2	3	8

C2. In general how often and in what way do you usually have contact with [CHILD]’s teacher about his/her daily activities or behavior? (CIRCLE ONE RESPONSE FOR EACH ITEM)

	Daily	Weekly	Monthly	Less than Monthly	Never
a. Talk to the teacher in person	1	2	3	4	5
b. Teacher calls you	1	2	3	4	5
c. Receive written notes from teacher	1	2	3	4	5
d. Schedule meetings or conferences with teacher	1	2	3	4	5
e. Teacher conducts home visits	1	2	3	4	5
f. Teacher sends home examples of [CHILD]’s work	1	2	3	4	5

C3. During this school year, about how many times have you gone to meetings or participated in activities at [CHILD]’s school?

|____|____| NUMBER OF TIMES

C4. When you visit the school, do the people there make you feel welcome?

YES 1

NO 2

REFER TO QB7: IF RESPONDENT ANSWERED “OTHER”, SKIP TO SECTION E.

TEACHER FEEDBACK ON CHILD’S SCHOOL PERFORMANCE AND BEHAVIOR

Here are some things teachers tell parents about how their children are doing in school. For each one, please tell me if a teacher said something like this about [CHILD], or wrote it in a note or on a report card during this school year, even if you didn’t agree. (CIRCLE YES OR NO FOR EACH ITEM)

D1. Since the beginning of this school year, has a teacher said or written that [CHILD]...

	YES	NO
a. Has been doing really well in school	1	2
b. Has not been learning up to (his/her) ability	1	2
c. Doesn’t concentrate or does not pay attention for long	1	2
d. Has been acting up in school or disrupting the class	1	2
e. Has often seemed sad or unhappy	1	2
f. Has been very restless, fidgets all the time, or doesn’t sit still	1	2
g. Has been having trouble taking turns, sharing, or cooperating with other children	1	2
h. Gets along with other children or works well in a group	1	2
i. Is very enthusiastic and interested in different things	1	2
j. Lacks confidence in learning new things or taking part in new activities	1	2
k. It’s hard to understand what (he/she) is saying	1	2
l. Is often sleepy or tired in class	1	2
m. Likes to express (his/her) ideas	1	2
n. Is often bored in class	1	2

D2. How well does this school or program meet your child’s needs?

Very well, 1

OK, 2

Not very well 3

D3. As far as you know, is [CHILD] going to be promoted to the next grade this coming fall or will he/she spend another year in (kindergarten, first grade, other program)?

Yes, will be promoted 1

No, will spend another year in the same grade 2

No, will go to a transitional class 3

CHILD’S ACCOMPLISHMENTS

These next questions are about things that different children do at different ages. These things may or may not be true for [CHILD].

E1. Can [CHILD] recognize…

All of the letters of the alphabet,. 1

Most of them, 2

Some of them, or 3

None of them.. 4

E2. How high can [CHILD] count? Would you say…

Not at all, 1

Up to five, 2

Up to ten, 3

Up to twenty,. 4

Up to fifty, or. 5

Up to 100 or more. 6

E3. How often does [CHILD] like to write or pretend to write? Would you say…

Never, 1 (GO TO E5)

Has done it once or twice, 2

Once or twice in the past month, or 3

One or more times in the past week 4

E4. Can [CHILD] write (his/her) first name even if some of the letters are backward?

yes 1

no 2

E5. Does [CHILD] trip, stumble, or fall easily?

yes 1

no 2

E6. When [CHILD] speaks, is (he/she) understandable to a stranger?

yes 1

no 2

E7. Does [CHILD] stutter or stammer?

yes 1

no 2

E8. How often does [CHILD] pretend to read out loud?

Never 1 (GO TO E10)

H as done it once or twice 2

Once or twice in the past month 3 (GO TO E9)

One or more times in the past week 4

E9. When (he/she) pretends to read a book, does it sound like a connected story, or does (he/she) tell what’s in each picture without much connection between them?

Sounds like connected story 1

Tells what’s in each picture 2

Does both 3

E10. How often does your child look at books alone or with another child?

Never 1

Has done it once or twice 2

Once or twice in the past month 3

One or more times in the past week 4

E11. Does [CHILD] recognize (his/her) own first name in writing or in print?

yes 1

no 2

E12. Can [CHILD] identify the colors red, yellow, blue, and green by name? Would you say…

None of them 1

Some of them, or 2

All of them 3

E13. Can [CHILD] recognize shapes such as a circle, square, triangle, or rectangle?

None of them 1

Some of them, or 2

All of them 3

HOUSEHOLD RULES

Now I’d like to ask you a few questions about rules and setting limits in the home.

F1. In your house, are there rules or routines about. . .

YES NO

a. What TV programs [CHILD] can watch? 1 2

b. How many hours [CHILD] can watch TV? 1 2

c. What time [CHILD] eats? 1 2

d. What time [CHILD] goes to bed? 1 2

F2. About how many hours does [CHILD] usually watch TV in your home each day?

|____|____| HOURS

aCTIVITIES WITH YOUR CHILD

Now I have some questions about things you do with [CHILD] when he/she is at home.

G1. How many times have you or someone in your family read to [CHILD] in the past week? Would you say... (CIRCLE ONE RESPONSE)

Not at all, 1

Once or twice, 2

Three or more times, or 3
Every day 4

G2. For about how long does [CHILD] enjoy being read to at a sitting? PROBE: About how many minutes?

|____|____| MINUTES

G3. How often did your child ask you to read books in the past week? Was it... (CIRCLE ONE RESPONSE)

Not at all, 1

Once or twice, 2

Three or more times, or 3
Every day 4

G4. How often does your child show interest in reading labels, people’s names, or signs (such as signs for McDonald’s)? Would you say... (CIRCLE ONE RESPONSE)

Never, 1

Once or twice so far, 2

Once or twice in the past month, or 3
Once or twice in the past week 4

G5. Now I am going to ask you some questions about what you do with your child at home. How often do you or someone in your household do each of the following reading and language activities with [CHILD]? (USE RESPONSE CARD) (CIRCLE ONE RESPONSE FOR EACH ITEM)

	Never	Has done it once or twice	Once or twice in the past month	One or more times in the past week
a. Work on learning the names of the letters	1	2	3	4
b. Practice writing the letters of the alphabet	1	2	3	4
c. Discuss new words	1	2	3	4
d. Have [CHILD] tell you a story	1	2	3	4
e. Practice the sounds that letters make	1	2	3	4
f. Listen to you read stories where (he/she) sees the print such as Big Books	1	2	3	4
g. Listen to you read stories where (he/she) doesn’t see the print	1	2	3	4
h. Retell or make up stories	1	2	3	4
i. Show [CHILD] how to read a book or magazine (the way to hold it, point to words).	1	2	3	4
j. Have [CHILD] practice writing or spelling (his/her) name	1	2	3	4
k. Learn about rhyming words and word families such as cat, mat, sat	1	2	3	4
l. Practice or teach directional words such as over, up, or in.	1	2	3	4

G6. How often do you work with [CHILD] on things he/she learned in school?

Never 1

Has done it once or twice 2

Once or twice in the past month 3

One or more times in the past week 4

G7. How often have you read books, magazines, or the newspaper, during the past week? Was it …. (CIRCLE ONE RESPONSE.)

Not at all, 1

Once or twice, 2

Three or more times, or 3

Every day? 4

G8. Which of the following do you have in your home?

	YES	NO
a. Comic books	1	2
b. Books for children	1	2
c. Magazines for children	1	2
d. Magazines for adults, like Newsweek or People or Sports Illustrated	1	2
e. Newspapers	1	2
f. Catalogs	1	2
g. Religious books like a bible or prayer book	1	2
h. Dictionaries or encyclopedias	1	2
i. Other books like novels, biographies, or non-fiction	1	2

G9. In the past month did you take any books home from the library or buy any books?

YES 1

NO 2

G10. Can you tell me the names of three things you've read to your child in the past week?

ITEM #1:

ITEM #2:

ITEM #3:

G11. Can you tell me the names of your child's three favorite books?

BOOK #1:

BOOK #2:

BOOK #3:

PARENT DEMOGRAPHICS

RESPONDENT IS: (CIRCLE ONE)

CHILD’S BIO/ADOPTIVE MOTHER 1 (ASK QUESTIONS ABOUT RESPONDENT,

GO TO H2)

NOT CHILD’S BIO/ADOPTIVE MOTHER 2 (ASK QUESTIONS ABOUT MOTHER,

GO TO H1)

Now I’m going to ask you some questions about (you/[CHILD]’s mother).

H1. Is [child]’s mother in your household?

MOTHER IN HOUSEHOLD 1

MOTHER NOT IN HOUSEHOLD 2

MOTHER DECEASED 3

H2. What is (your/her) birth date?

_______/______ /19 ______

MONTH DAY YEAR

H3. (Are you/Is she) Hispanic or Latino?

YES 1

NO 2

H4. What is (your/her) race? Please select one or more. (CIRCLE ONE OR MORE)

a. American Indian or Alaska Native 1

b. Asian 2

c. Black or African American 3

d. Native Hawaiian or Other Pacific Islander 4

e. White 5

H5. In what country (were you/was she) born?

USA 1 (GO TO H7)

Other (specify country) 2

_________________________

H6. How many years (have you/has she) lived in the United States?

|_____|_____|

YEARS

H7. Did (you/she) attend school in the United States or in another country? Would you say… (CIRCLE ONE)

All or most of (my/her) schooling was in the United States 1

All or most of (my/her) schooling was outside the United States 2

Attended schools both in and outside the United States 3

H8. What is the highest grade or year of school that (you/she) completed (either in the United States or in another country)? (Circle one)

NO SCHOOLING 01

GRADE 1 02

GRADE 2 03

GRADE 3 04

GRADE 4 05

GRADE 5 06

GRADE 6 07

GRADE 7 08

GRADE 8 09

GRADE 9 10

GRADE 10 11

GRADE 11 12

ATTENDED GRADE 12, BUT DID NOT COMPLETE HIGH SCHOOL OR GED 13

RECEIVED SPECIAL EDUCATION DIPLOMA (NOT A HIGH SCHOOL DIPLOMA) 14

RECEIVED HIGH SCHOOL DIPLOMA (NOT A SPECIAL EDUCATION DIPLOMA) 15

COMPLETED GED CERTIFICATE 16

ATTENDED SOME COLLEGE 17

COMPLETED COLLEGE DEGREE OR HIGHER 18

REFER TO H1: IF CHILD’S MOTHER IS DECEASED,

CHECK THIS BOX

AND SKIP TO BOX H15

H9. What is (your/her) current marital status?

MARRIED 1

SEPARATED 2

DIVORCED 3

WIDOWED 4

NEVER MARRIED 5

H10. Currently, (do you/does she) have any of the following diplomas, degrees, or job-related licenses?

		YES	NO
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H11. (Are you/is she) now working toward a certificate, diploma, or degree?

YES 1

NO 2 (GO TO H13)

H12. Which certificate, diploma, or degree (are you/is she) working toward?

		Yes	No
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H13. (Are you/Is she) currently working full-time, working part-time, looking for work, in school, in a training program, keeping house, or doing something else? (circle ONE)

WORKING FULL-TIME (35 HOURS OR MORE PER WEEK) 01 WORKING PART-TIME 02 LOOKING FOR WORK 03 LAID OFF FROM WORK 04 IN SCHOOL/TRAINING 05 KEEPING HOUSE 06 SOMETHING ELSE (SPECIFY) _____________________________________ 07

GO TO BOX H15

H14. How many hours per week is (your/her) main job?

|_____|_____|_____| HOURS

BOX H-15

RESPONDENT IS: (CIRCLE ONE)

CHILD’S BIO/ADOPTIVE FATHER 1 (ASK QUESTIONS ABOUT RESPONDENT,

GO TO H16)

NOT CHILD’S BIO/ADOPTIVE FATHER 2 (ASK QUESTIONS ABOUT FATHER,

GO TO H15)

Now I’m going to ask you some questions about ([CHILD]’s father/about you).

H15. Is [child]’s father in your household?

FATHER IN HOUSEHOLD 1

FATHER NOT IN HOUSEHOLD 2

FATHER DECEASED 3

H16. What is (his/your) birth date?

_______/______ /19 _____

MONTH DAY YEAR

H17. (Is he/are you) Hispanic or Latino?

YES 1

NO 2

H18. What is (his/your) race? Please select one or more. (CIRCLE ONE OR MORE)

a. American Indian or Alaska Native 1

b. Asian 2

c. Black or African American 3

d. Native Hawaiian or Other Pacific Islander 4

e. White … 5

H19. In what country (was he/were you) born?

USA 1 (GO TO H21)

Other (specify country) 2

_________________________

H20. How many years (has he/have you) lived in the United States?

|_____|_____|

YEARS

H21. Did (he/you) attend school in the United States or in another country? Would you say…(CIRCLE ONE)

All or most of (his/my) schooling was in the United States 1

All or most of (his/my) schooling was outside the United States 2

Attended schools both in and outside the United States 3

H22. What is the highest grade or year of school that ([CHILD]’s father/you) completed (either in the United States or in another country)? (Circle one)

NO SCHOOLING 01

GRADE 1 02

GRADE 2 03

GRADE 3 04

GRADE 4 05

GRADE 5 06

GRADE 6 07

GRADE 7 08

GRADE 8 09

GRADE 9 10

GRADE 10 11

GRADE 11 12

ATTENDED GRADE 12, BUT DID NOT COMPLETE HIGH SCHOOL OR GED 13

RECEIVED SPECIAL EDUCATION DIPLOMA (NOT A HIGH SCHOOL DIPLOMA) 14

RECEIVED HIGH SCHOOL DIPLOMA (NOT A SPECIAL EDUCATION DIPLOMA) 15

COMPLETED GED CERTIFICATE 16

ATTENDED SOME COLLEGE 17

COMPLETED COLLEGE DEGREE OR HIGHER 18

REFER TO H15: IF CHILD’S FATHER IS DECEASED,

CHECK THIS BOX

AND SKIP TO BOX H29

H23. What is ([CHILD]’s father’s/your) current marital status?

MARRIED 1

SEPARATED 2

DIVORCED 3

WIDOWED 4

NEVER MARRIED 5

REFUSED 7

DON’T KNOW 8

H24. Currently, (does he/do you) have any of the following diplomas, degrees, or job-related licenses?

		YES	NO
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H25. (Is he/are you) now working toward a certificate, diploma, or degree?

YES 1

NO 2 (GO TO H27)

H26. Which certificate, diploma, or degree (is he/are you) working toward?

		Yes	No
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H27. (Is he/Are you) currently working full-time, working part-time, looking for work, in school, in a training program, keeping house, or doing something else? (circle one)

WORKING FULL-TIME (35 HOURS OR MORE PER WEEK) 01 WORKING PART-TIME 02 LOOKING FOR WORK 03 LAID OFF FROM WORK 04 IN SCHOOL/TRAINING 05 KEEPING HOUSE 06 SOMETHING ELSE (SPECIFY) _____________________________________ 07

GO TO BOX H29

H28. How many hours per week is (his/your) main job?

|_____|_____|_____| HOURS

BOX H-29

RESPONDENT IS: (CIRCLE ONE)

CHILD’S BIO/ADOPTIVE MOTHER OR FATHER 1 (GO TO I1)

NOT CHILD’S BIO/ADOPTIVE MOTHER OR FATHER 2 (GO TO H29)

Now I’m going to ask some questions about you.

H29. What is your birth date?

_______/______ /19 _____

MONTH DAY YEAR

H30. Are you Hispanic or Latino?

YES 1

NO 2

H31. What is your race? Please select one or more. (CIRCLE ONE OR MORE)

a. American Indian or Alaska Native 1

b. Asian 2

c. Black or African American 3

c. Native Hawaiian or Other Pacific Islander 4

d. White 5

H32. Did you attend school in the United States or in another country? Would you say…(CIRCLE ONE)

All or most of my schooling was in the United States 1

All or most of my schooling was outside the United States 2

Attended schools both in and outside the United States 3

H33. What is the highest grade or year of school that you completed (either in the United States or in another country)? (Circle one)

NO SCHOOLING 01

GRADE 1 02

GRADE 2 03

GRADE 3 04

GRADE 4 05

GRADE 5 06

GRADE 6 07

GRADE 7 08

GRADE 8 09

GRADE 9 10

GRADE 10 11

GRADE 11 12

ATTENDED GRADE 12, BUT DID NOT COMPLETE HIGH SCHOOL OR GED 13

RECEIVED SPECIAL EDUCATION DIPLOMA (NOT A HIGH SCHOOL DIPLOMA) 14

RECEIVED HIGH SCHOOL DIPLOMA (NOT A SPECIAL EDUCATION DIPLOMA) 15

COMPLETED GED CERTIFICATE 16

ATTENDED SOME COLLEGE 17

COMPLETED COLLEGE DEGREE OR HIGHER 18

H34. Currently, do you have any of the following diplomas, degrees, or job-related licenses?

		Yes	No
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H35. Are you now working toward a certificate, diploma, or degree?

YES 1

NO 2 (GO TO H37)

H36. Which certificate, diploma, or degree are you working toward?

		Yes	No
a.	Trade license or certificate ………..	1	2
b.	GED certificate (or equivalent) ……	1	2
c.	High school diploma ……………….	1	2
d.	Associate’s degree ………………...	1	2
e.	Bachelor’s degree ………………….	1	2
f.	Graduate degree …………………...	1	2

H37. Are you currently working full-time, working part-time, looking for work, in school, in a training program, keeping house, or doing something else? (circle one)

WORKING FULL-TIME (35 HOURS OR MORE PER WEEK) 01 WORKING PART-TIME 02 LOOKING FOR WORK 03 LAID OFF FROM WORK 04 IN SCHOOL/TRAINING 05 KEEPING HOUSE 06 SOMETHING ELSE (SPECIFY) _____________________________________ 07

GO TO I1

H38. How many hours per week is your main job?

|_____|_____|_____| HOURS

PARENT LANGUAGE/LITERACY

I1. What language do you usually speak at home? (CIRCLE ONE)

ENGLISH 1

SPANISH 2

BOTH ENGLISH AND SPANISH 3

OTHER (SPECIFY) 4

I2. Is English your second language?

YES 1

NO 2 (GO TO I4)

I3. How well do you speak, read, and write your native language? For each one, tell me if it is not at all, not well, well, or very well. (USE RESPONSE CARD)

Not at all Not Well Well Very Well

a. Speak your native language 1 2 3 4

b. Read your native language 1 2 3 4

c. Write your native language 1 2 3 4

I4. How well do you understand, speak, and read English? For each one, tell me if it is not at all, not well, well, or very well. (USE RESPONSE CARD)

Not at all Not Well Well Very Well

a. Understand English 1 2 3 4

b. Speak English 1 2 3 4

c. Read English 1 2 3 4

I5. If you read to your children, what language do you usually use now? (CIRCLE ONE)

ENGLISH 1

SPANISH 2

BOTH ENGLISH AND SPANISH 3

UNABLE TO/DO NOT READ TO CHILDREN 4

OTHER (SPECIFY) 5

HOUSEHOLD DEMOGRAPHICS

Now we want to ask you about the ages of people who are currently living in your household.

J1. How many are younger than 8 years old?

|____|____| PEOPLE

J2. How many are ages 8 through 17?

|____|____| PEOPLE

J3. How many are ages 18 or older?

|____|____| PEOPLE

J4. Which of the following best describes the structure of your household? (CIRCLE ONE)

Single parent with child(ren) and no other adult relatives 1

Couple with child(ren) and no other adult relatives 2

Single parent or couple living with child(ren)

and with other adult relatives 3

OTHER (SPECIFY) 4

J5. Do you currently own your home or apartment, pay rent, or live in public or subsidized housing?

OWNS OR IS BUYING HOME OR APARTMENT 1

RENTS (WITHOUT PUBLIC ASSISTANCE) 2

PUBLIC OR SUBSIDIZED HOUSING 3

SOME OTHER ARRANGEMENT 4

J6. How many times has [CHILD] moved in the last twelve months?

|____|____| TIMES

INCOME

K1. Currently, where does most of the money your household lives on come from? Please think about the income of everyone in your household. (CIRCLE ONE)

Wages from a job 1

Alimony or child support 2

Government assistance (e.g., TANF, public

assistance, Supplemental Security Income) 3

OTHER (SPECIFY) 4

K2. Now, including everyone in your household, what was the total income for your household in the past month before taxes and other deductions? Would you say it was… (USE RESPONSE CARD)

$250 or less 01

Between $251 and $500, 02

Between $501 and $1,000, 03

Between $1,001 and $1,500, 04

Between $1,501 and $2,000, 05

Between $2,001 and $2,500, or 06

Over $2,500? 07

REFUSED 97

DON’T KNOW 98

K3. In the past year, have you or anyone in your household received any of the following?

		YES	NO
a.	Income assistance, including welfare, SSI, or unemployment insurance ……………………………………………………………	1	2
b.	Food and nutrition assistance, including food stamps or WIC…	1	2
c.	Help paying for utilities (water, heat, electric, telephone) ……...	1	2
d.	Foster care payments ……………………………………………...	1	2
e.	Child support or alimony payments ……………………………....	1	2

CHILD’S HEALTH/DISABILITIES

L1. Did a doctor or other health or education professional ever tell you that [CHILD] has any special needs or disabilities—for example, physical difficulties, emotional, language, hearing, or learning difficulties, or other special needs?

YES 1

NO 2 (GO TO M1a)

L2. Does [CHILD]’s disability or special need affect (his/her) ability to learn?

yes 1

no 2

L3. Does [CHILD] have an Individualized Education Program or Plan (IEP) or an Individual Family Service Plan (IFSP)?

YES 1

NO 2

TRACKING INFORMATION

Thank you for spending this time with me. I would also like to thank you for participating in this interview and will give you your gift in just a few minutes. We may need to contact you in the future, so we need to know how to get in touch with you.

M1a. Can you give me a telephone number where you can be reached?

___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M1b. What is another phone number where you can be reached?

___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M1c. Please give me your permanent address.

Address:

Street Apt.

Town/City State Zip Code

Would you please tell me the names and telephone numbers of three people who will know how to contact you a year from now?

M2a. What is the name of the first person?

M2b. How is this person related to [CHILD]? RELATIVE (SPECIFY) 1

NONRELATIVE 2

M2c. What is their phone number? ___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M2d. What is another phone number where this person can be reached?

___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M3a. What is the name of the second person?

M3b. How is this person related to [CHILD]? RELATIVE (SPECIFY) 1

NONRELATIVE 2

M3c. What is their phone number? ___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M3d. What is another phone number where this person can be reached?

___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M4a. What is the name of the third person?

M4b. How is this person related to [CHILD]? RELATIVE (SPECIFY) 1

NONRELATIVE 2

M4c. What is their phone number? ___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

M4d. What is another phone number where this person can be reached?

___ ___ ___ -- ___ ___ ___ -- ___ ___ ___ ___

(area code)

Is this a home phone, work phone, cell phone, or beeper? (CIRCLE ONE).

Home Phone 1

Work Phone 2

Cell Phone 3

Beeper 4

NO TELEPHONE 5

REFUSED 7

GET SIGNATURE BELOW.

Finally, I need you to sign this page. This indicates that you give us permission to contact these people and for them to give us the information we need to contact you. This is the only reason we will use this information.

I give permission to the contacts named above to release my current address and phone number to a representative of the Classroom Literacy Interventions and Outcomes Study, Spring 2006.

________________________________________

Respondent’s signature

________________________________________

Printed Name

__________________

Date

Thank you very much for your cooperation.

END OF INTERVIEW:

Thank you for your cooperation!

COMPLETE AFTER INTERVIEW IS CONCLUDED.

CONFIDENCE RATINGS

N1. Interview Completion Code:

Respondent terminated interview prematurely 1

Respondent refused interview .. 2

Respondent unable to respond (SPECIFY). 3

Interview completed 4

N2. Please rate the following qualities of the respondent, the interviewing situation, and the quality of the data. The Respondent (was/had):

a. Able to understand questions easily	7	6	5	4	3	2	1	Hardly able to understand
b. Truthful	7	6	5	4	3	2	1	Untruthful
c. Accurate	7	6	5	4	3	2	1	Inaccurate
d. Interested in the interview	7	6	5	4	3	2	1	Not interested in the interview
e. Cooperative	7	6	5	4	3	2	1	Uncooperative
f. No English language problem	7	6	5	4	3	2	1	Spoke English with great difficulty
g. Interviewed without interruptions	7	6	5	4	3	2	1	Interrupted often
h. Your opinion about the overall quality of the data:
High	7	6	5	4	3	2	1	Low

If found, return to:

Westat

1650 Research Boulevard

RA1221F

Rockville, MD 20850