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PIRLS 2011
Field Test Version
Student
Questionnaire
Grade 4
National Center for Education Statistics
U.S. Department of Education
1990 K St., NW
Washington, DC 20006
NCES is authorized to collect information from
this questionnaire under the Education Sciences
Reform Act of 2002 (Public Law 107-279, Section
153). You do not have to provide the information
requested. However, the information you provide
will help the U.S. Department of Education’s
ment in the United States. There are no penalties
should you choose not to participate in this study.
Your answers may be used only for statistical
purposes and may not be disclosed, or used, in
107-279, Section 183 and Title V, subtitle A of the
E-Government Act of 2002 (P.L. 107-347)). Your
responses will be combined with those from other
participants to produce summary statistics and
reports.
This survey is estimated to take an average of
30 minutes, including time for reviewing instructions, and completing 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. Send comments regarding this burden estimate or any other
aspect of this collection of information, including
suggestions for reducing this burden, to: Stephen
Provasnik, National Center for Education Statistics,
U.S. Department of Education, 1990 K Street NW,
Room 9034, Washington, DC 20006-5650. Do not
return the completed form to this address.
D
irections
question, you should choose the answer you think is best.
Let us take a few minutes to practice the kinds of questions you will answer in this
booklet.
Example 1
Do you go to school?
Fill one circle only.
Yes --
O
No --
O
Example 2
How often do you do these things?
Fill one circle for each line.
Every day
or almost
every day
1
2
Once or
twice a
week
Once or
twice a
month
Never or
almost
never
a) I listen to music --------------------------
O
O
O
O
b) I talk with my friends ------------------
O
O
O
O
c) I play sports -------------------------------
O
O
O
O
Grade 4 4>
4 Student
Student Questionnaire
2
3
A
bout you
1
Are you a girl or a boy?
Fill one circle only.
Girl --
O
Boy --
O
2
When were you born?
Fill the circles next to the month and year you were born.
a) Month
b) Year
O
February -- O
March -- O
April -- O
May -- O
June -- O
July -- O
August -- O
September -- O
October -- O
November -- O
December -- O
1997 --
January --
3
2
Grade 4 4>
4 Student
Student Questionnaire
4
3
4
About how many books are there in your home?
(Do not count magazines, newspapers, or your school books.)
Fill one circle only.
5
4
None or very few (0-10 books) --
O
This shows 10 books
--
O
This shows 25 books
(26-100 books) --
O
This shows 100 books
(101-200 books) --
O
This shows 200 books
(more than 200) --
O
This shows more than 200 books
Grade 4 4>
4 Student Questionnaire
6
5
6
A. Do you ever use a computer?
Fill one circle only.
Yes --
O
No --
O
(If No, go to question 7)
B. How often do you use a computer in each of these places?
Fill one circle for each line.
Every day
or almost
every day
Once or
twice a
week
Once or
twice a
month
Never or
almost
never
a) At home ------------------------------------
O
O
O
O
b) At school -----------------------------------
O
O
O
O
c) Some other place -------------------------
O
O
O
O
C. How often do you use a computer to do these things?
Fill one circle for each line.
Every day
or almost
every day
Once or
twice a
month
Never or
almost
never
a) Look up information for school -----
O
O
O
O
b) Look up information on a topic
you like (e.g., your favorite athlete,
animals you like, or places
you have traveled to) -------------------
O
O
O
O
O
O
O
c) Exchange information about schoolwork
online (e.g., homework, discussion
boards, asking for help) --------------- O
7
6
Once or
twice a
week
Grade 4 4>
4 Student
Student Questionnaire
8
7
Y
our School
8
What do you think about your school? Tell how much
you agree with these statements.
Fill one circle for each line.
Agree
a lot
Agree
a little
Disagree
a little
Disagree
a lot
a) I like being in school --------------------
O
O
O
O
b) I feel safe when I am at school -------
O
O
O
O
c) I feel like I belong at this school-----
O
O
O
O
9
How often have any of the following things happened to
you at school?
Fill one circle for each line.
At least
once a
week
A few
times a
year
Never
a) I was made fun of or called names--
O
O
O
O
b) I was left out of games or activities
by other students ------------------------
O
O
O
O
c) Someone spread lies about me -------
O
O
O
O
d) Something was stolen from me ------
O
O
O
O
e) I was hit or hurt by other student(s)
(e.g., shoving, hitting, kicking) ------- O
O
O
O
O
O
O
f)
9
8
Once or
twice a
month
I was made to do things I didn’t
want to do by other students ---------
Grade 4 4>
| File Type | application/pdf |
| File Modified | 2009-09-29 |
| File Created | 2009-09-27 |