4th-5th Grade Student Survey (Baseline & First Follow Up)

OMB Control No. 2700-XXXX

Approval expires xx/xx/20xx

Appendix 2: 4^th- 5^th Grade Student Survey (Baseline & First Follow-Up)

Revised: June 8, 2011

N ational Aeronautics and Space Administration

www.nasa.gov

Welcome! Thank you for being part of NASA’s Summer of Innovation.

Students who attend this program during summer 2011 are being asked to complete this survey. There are no “right” or “wrong” answers to the questions. Your opinion is what is wanted. We estimate that it will take about 10 minutes to complete the questions. Thank you for your help!

NASA’s Office of Education, and the researchers at Abt Associates and Education Development Center, follow strict rules to make sure that only they will see your answers to this and future surveys for this program, except as required by law. No report will use your name or describe you in any way that could identify you.

If you want to participate in this special study, please turn the page to start answering questions.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget control number. We estimate that it will take about 10 minutes to read the instructions, gather the facts, and answer the questions. You can find additional information on this program at http://www.nasa.gov/offices/education/programs/national/summer/home/index.html. You may send comments on our time estimate above to: NASASummerofInnovation@abtassoc.com. Please send only comments relating to our time estimate to this address, not the completed form.

1. ______________________________________

Print Your First and Last Name

2. What is your birthday? Month: _____________ Day:________ Year:______________

3. What is today’s date? Month: _____________ Day:________ Year:______________

4. What grade level will you start in fall 2011? Please check one only.

4^th 5^th  Other:____________________

5. What is the name of the school you will be attending in fall 2011: ______________________

The next series of questions contain a number of statements about science. You will be asked what you think about these statements. There are no “right” or “wrong” answers. For this survey, the word “science” covers a broad range of topics, including space and planets, animals and plants, medicine, computer programming, and designing machines and materials.

1=Strongly Disagree, 2=Disagree, 3=Not Sure, 4=Agree, 5=Strongly Agree

For each statement, draw a circle around the specific value corresponding to how you feel about each statement. Please circle only ONE value per statement.

Statement	Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
I would like to belong to a science club.	1	2	3	4	5
I would like to be a scientist when I grow up.	1	2	3	4	5
Science is boring.	1	2	3	4	5
I get bored watching science programs on TV at home.	1	2	3	4	5
I enjoy my science class.	1	2	3	4	5
I would like to be a police officer when I grow up.	1	2	3	4	5
I have good feelings about science.	1	2	3	4	5
I would like to be given a science book or a piece of scientific equipment as a present.	1	2	3	4	5
I like science a lot.	1	2	3	4	5
I do not like reading books about science during my free time.	1	2	3	4	5
I think scientists are cool people.	1	2	3	4	5
I would enjoy visiting a science museum on the weekend.	1	2	3	4	5
I would like to be a lawyer when I grow up.	1	2	3	4	5
I would like to do science experiments at home.	1	2	3	4	5
Talking to friends about science after-school would be boring.	1	2	3	4	5
Everyone should learn about science.	1	2	3	4	5
I do not want to be a scientist when I grow up.	1	2	3	4	5
I would like to be a science teacher when I grow up.	1	2	3	4	5
I would enjoy having a job related to science during my summer vacation.	1	2	3	4	5
I do not like looking at websites about science.	1	2	3	4	5
I would enjoy being a scientist.	1	2	3	4	5
Watching movies about science would be boring.	1	2	3	4	5
I would enjoy being a business person.	1	2	3	4	5

The next series of questions contain a number of activities that you might be interested in participating during the upcoming school year or next summer.

1=Really NOT Interested, 2=NOT Interested, 3=Not Sure, 4=Interested, 5=Really Interested

For each activity, draw a circle around the specific value corresponding to how interested you are in participating. Please circle only ONE value per statement.

Activity	Really NOT Interested	NOT Interested	Not Sure	Interested	Really Interested
Doing additional hands-on science activities in my classroom	1	2	3	4	5
Talking with a scientist or engineer	1	2	3	4	5
Participating in a rocket or space shuttle launch event	1	2	3	4	5
Participating in a live video downlink event from the International Space Station or Space Shuttle	1	2	3	4	5
Visiting a science museum, science center, or planetarium	1	2	3	4	5
Participating in a science competition	1	2	3	4	5
Attending an after-school science club or activity	1	2	3	4	5

When you are done, please return this survey to your teacher.

Abt Associates Inc. Appendix 2 2-3