Student background survey

The valid OMB control number for this information collection is ________.

APPENDIX A

Student Language Background Survey: English Version

[This form will be available both in English and Spanish]

Your answers to these questions about your language background will be used as part of a research study about testing accommodations sponsored by the U.S. Department of Education and carried out by WestEd’s Regional Educational Laboratory. If you have questions about the study or this survey, please contact Carole Gallagher at (415)-615-3211 or at cgallag@wested.org.

We estimate that it will take you about 5 minutes to complete this survey. Remember, there are no right or wrong answers, and you will not be graded on this task. Your participation is voluntary and you may refuse to answer any question.

For each question below, please fill in the blank with the information that best describes you.

1. My current grade is _______.

2. I am Male ______ Female _____ (check one).

3. I was born in _______________________ (name of country).

4. I lived there for ______ years.

5. I also lived in _______________(name of country) for ______ years.

6. I have lived in the United States for ______ years.

7. I have attended these grades in the U.S.: _____________________________.

8) We speak these languages in my home: _____________________________.

(SURVEY CONTINUED ON NEXT PAGE)

For each question below, please circle the response that best describes you.

well.

not very well.

not at all.

very well.

9) I think I understand Spanish……………

well.

very well.

not very well.

not at all.

10) I think I read text written in Spanish…..

very well.

well.

not very well.

not at all.

11) I think I read text written in English…..

Yes

No

Not Sure

12) I am learning a lot about math this year.

Thank you for your time!