Rti Surveys and forms

Appendix 2. Teacher Survey for the Evaluation of Response to Intervention Practices
for Elementary School Reading

What is the purpose of this study?

This study is part of the congressionally-mandated national evaluation of the Individuals with Disabilities Education Improvement Act (IDEA, Public Law 108-446) and will address the following questions:

• What are the effects on academic achievement of providing intensive reading interventions to elementary school children who have been identified as at risk for reading difficulties compared with children just above the cut point for providing intervention?

• How do academic outcomes, including reading achievement and special education identification, vary with elementary schools' adoption of Response to Intervention practices for early grade reading?

• How do Response to Intervention practices for early grade reading vary across schools?

How is the study team defining Response to Intervention?

Response to Intervention (RtI) is a multi-step approach to providing early and more intensive intervention and monitoring within the general education setting.

In principle, RtI begins with research-based instruction and behavioral support provided to students in the general education classroom, followed by screening of all students to identify those who may need systematic progress monitoring, intervention, or support. Students who are not responding to the general education curriculum and instruction are provided with increasingly intense interventions through a "tiered" system, and they are frequently monitored to assess their progress and inform the choice of future interventions, including possibly special education for students determined to have a disability.

IDEA permits some federal special education funds to be used for "early intervening services" such as RtI, and also permit districts to use RtI to inform decisions regarding a child's eligibility for special education.

Who is administering this study?

This study is being supported by the Institute of Education Sciences (IES) at the U. S. Department of Education as authorized by the U. S. Congress under Section 664 of IDEA. MDRC, SRI International, and RG Research Group developed plans for the study under contract ED-04-CO-0111/0003 with IES, and Survey Research Management is administering the teacher survey.

What is the purpose of this survey?

This survey seeks information to describe how classroom teachers provide core reading instruction to elementary students in grade 1, 2, or 3, including students with disabilities in these grades. Core reading instruction refers to instructional time focusing on major components of reading: phonemic awareness, phonics, fluency, reading comprehension, and vocabulary. Core reading instruction may occur in a variety of scheduling arrangements (for example, whole and small group instruction, partner and group work, independent work). In responding to questions about core reading instruction, please do NOT include instructional time devoted to spelling, grammar, or writing.

Who should complete this survey?

Any grade-level classroom teacher in your school who has responsibility for providing reading instruction to students in grades 1, 2, or 3 should complete this survey.

Will the information provided through this survey be kept confidential?

All information gathered for this study will be kept confidential and will only be used for research purposes. The information collected about schools and students for this study will be used only for statistical purposes and may not be disclosed or used, in identifiable form, for any other purpose except as required by law (Public Law 107-279, Section 183).

What are the instructions for this survey?

Please answer the questions based on your experience. There are no expected answers, so please be thoughtful and honest as you respond. Your participation is important and appreciated. The information you provide will be combined with the information provided by others in statistical reports.

The survey is broken into six short sections:

1. Professional Background and Experience

2. Characteristics of Your Students

3. Reading Instruction in Your Classroom

4. Data and Decision Making

5. Professional Development

6. Response to Intervention Module

THANK YOU IN ADVANCE FOR COMPLETING THIS SURVEY!

According to the Paperwork Reduction Act of 1995, no persons are required to respond to this voluntary collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1850-New. The time required to complete this information collection is estimated to average 45 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4537. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Jonathan Jacobson, U.S. Department of Education, Institute of Education Sciences, 555 New Jersey Avenue, NW, Suite 500J, Washington, D.C. 20208, or email jonathan.jacobson@ed.gov.

A. BACKGROUND AND EXPERIENCE

Questions A1 through A4a ask about your professional background and experience as a teacher.

A1. Including the current year, how many years have you been a teacher?

	Enter # of years below…
Total number of years as a teacher	____ # Years
Number of years teaching at this school	____ # Years
Number of years teaching reading	____ # Years

A2. What grade level do you primarily teach during reading instruction?

 Grade 1  Grade 2  Grade 3

If you primarily teach reading to students in kindergarten, grade 4, or grade 5, then you have received this survey in error and do not need to continue.

A3. What is the highest educational degree that you hold? MARK ONE.

• Bachelor’s

• Master’s

• Doctorate or Professional Degree

• Other (please specify: _____________)

A4. Which of the following describes the teaching certificate you currently hold? SELECT ONE.

• Regular or standard state certificate or advanced professional certificate

• Certificate issued after satisfying all requirements except the completion of a probationary period

• Certificate that requires some additional college coursework, student teaching, or passage of a test before regular certification can be obtained

• Certificate issued to persons who must complete a certification program in order to continue teaching

• I do not hold any of the above certifications

A4a. Please indicate which educational areas you hold state certification, endorsement, or licensure in, and for what grade spans (for example, K-6). MARK ALL THAT APPLY.

	Area of Certification/Endorsement	Grade Span
	I do not hold certification/endorsement
	Elementary Education	________
	Early Childhood Education	________
	Secondary Education	________
	Special Education	________
	Arts/Music	________
	English Language Arts	________
	ESOL/Bilingual/ESL Education	________
	Reading	________
	Foreign Languages	________
	Mathematics	________
	Computer Science	________
	Natural Sciences	________
	Social Sciences	________
	Other (please specify: ________________)	________

B. CHARACTERISTICS OF YOUR STUDENTS

Questions B1 through B5 ask about the characteristics of the students from your classroom.

B1. What is the total number of students in your homeroom, regardless of whether you teach them reading? ____ # Students

In answering the following questions, please include ALL of the students to whom you teach reading, whether you teach reading on your own, to a group that includes students from other classes, or to more than one group of students.

B2. Tell us about your students’ reading performance. How many of your students are…

reading at or above grade level benchmark?	____ # Students
reading somewhat below the grade level benchmark and receive a targeted intervention (sometimes called Tier 2 or Level 2 )?	+ ____ # Students
reading far below the grade level benchmark and receive a more intensive intervention (sometimes called Tier 3 or Level 3 )?	+ ____ # Students
Total number of students		= ____ # Students

B3. How many of these students are English Language Learners (ELLs), also referred to as Limited English
Proficient (LEP) or English for Speakers of Other Languages (ESOL) students (for example, Spanish, Vietnamese)? ____ # Students

B4. How many of your students have an IEP and receive special education services for reading?

____ # Students

B5. How many of your struggling readers receive a systematic reading intervention that occurs ...

only during the core reading block?	____ # Students
only at a time other than the core reading block?	____ # Students
both during the core reading block and at another time?	____ # Students

C. READING INSTRUCTION

Questions C1 through C16 ask about reading instruction in your classroom.

Core reading is instruction in reading provided to all students in the classroom that focuses on topics such as phonemic awareness, phonics, fluency, reading comprehension, and vocabulary, but does not include spelling, grammar, or writing. Please keep this definition in mind as you answer questions in the survey.

C1. In the grades you teach, does your school schedule core reading instruction to group students in different classes according to their overall reading level?

 Yes  No (skip to question C5)

C2. Are approximately the same numbers of students assigned to each class you teach for the core reading block?

 Yes  No  I do not teach more than one reading class

C3. How are students assigned to different classes for their core reading block?

• Within the same grade level (for example, only students from the grade that I teach are in my classroom for reading instruction)

• Across grade levels (for example, some students from other grades come into my classroom for core reading instruction)

• I do not know

C4. During the core reading block, which students are you primarily working with? MARK ONE.

• Students at or above the grade level benchmark in reading

• Students somewhat below the grade level benchmark in reading and receive a targeted intervention (sometimes called Tier 2 or Level 2)

• Students far below the grade level benchmark in reading and receive a more intensive intervention (sometimes called Tier 3 or Level 3)

• A mix of students above and below grade level benchmark in reading, some of whom receive an intervention

C5. During the core reading block, are other adults present in your classroom to support reading instruction on a typical day?

• No, I am the only adult in the room during the core reading block (skip to question C6)

• Yes, other adults are in the room but they don’t provide reading instruction during the core reading block

• Yes, other adults are in the room who also provide reading instruction during the core reading block

C5a. During the core reading block, please indicate below how many adults (excluding yourself) provide direct instruction in reading in your classroom on a typical day?

		How many during Reading Instruction	For how many minutes/day
	Another general education teacher	____#	____# Minutes
	Reading specialist /interventionist/ coach	____#	____# Minutes
	Special education teacher	____#	____# Minutes
	Bilingual or ESL teacher	____#	____# Minutes
	Speech language pathologist	____#	____# Minutes
	Student teacher or intern	____#	____# Minutes
	Paraprofessional or instructional assistant	____#	____# Minutes
	Parent or community volunteer	____#	____# Minutes
	Other adult not listed here	____#	____# Minutes

C6. During the core reading block, do students having an IEP with reading goals leave the room for core reading instruction? (Do not include students who are in the special education referral process). MARK ONE.

• All students having an IEP with reading goals leave

• Some students having an IEP with reading goals leave

• No students having an IEP with reading goals leave

• My classroom does not include students having an IEP with reading goals (skip to question C8)

C7. Do students in your classroom with an IEP leave for reading instruction at a time other than the core reading block (for example, science, social studies, math, writing instruction, etc.)?

• No (skip to question C8)

• Yes, some students with an IEP leave for a reading intervention at another time (for example, during science, social studies, math, writing instruction, etc.)

C7a. At a time other than the core reading block, do students having an IEP with reading goals leave for additional reading intervention? (Do not include students who are in the special education referral process). MARK ONE.

• All students having an IEP with reading goals leave

• Some students having an IEP with reading goals leave

• No students with having an IEP with reading goals leave (skip to question C8)

C7b. Approximately how many students from your classroom who have an IEP with reading goals leave for additional reading instruction at a time other than the core reading block (for example, during science, social studies, math, writing instruction, etc.): (Do not include students who are in the special education referral process).

____ # Students

C7c. On the previous question (C7b) you indicated the number of students having an IEP with reading goals who leave for additional reading intervention. For each of those students, please provide the following information.

If more than three students, please copy this page and complete for the additional students.

Student # 1 having an IEP with Reading Goals	____ # days/week student leaves for additional reading instruction
	____ # minutes/day student leaves for additional reading instruction
Subject(s) missed when student leaves MARK ALL THAT APPLY	 None  Writing  Social studies  Science  Math  Music	 Art  Physical education  Library  Recess  Other (please specify: ____________________)
Student # 2 having an IEP with Reading Goals	____ # days/week student leaves for additional reading instruction
	____ # minutes/day student leaves for additional reading instruction
Subject(s) missed when student leaves MARK ALL THAT APPLY	 None  Writing  Social studies  Science  Math  Music	 Art  Physical education  Library  Recess  Other (please specify: ____________________)
Student # 3 having an IEP with Reading Goals	____ # days/week student leaves for additional reading instruction
	____ # minutes/day student leaves for additional reading instruction
Subject(s) missed when student leaves MARK ALL THAT APPLY	 None  Writing  Social studies  Science  Math  Music	 Art  Physical education  Library  Recess  Other (please specify: ____________________)

C8. During core reading in your classroom, do all students generally use the same reading program or reading series?

• Yes, all students use the same reading curriculum or reading series from the same publishing companies
  (skip to question C9)

• No, some students in my classroom are taught in a different reading program or reading series

C8a. Does the student’s reading level determine the reading program or reading series used?

 Yes  No

C8b. Within the reading program or reading series, do all students work on the same lesson on a typical day? MARK ONE.

• Yes, all students work on the same lesson using the same text/reader

• Yes, students work on the same lesson, but use different leveled text/readers (for example, all students work with the same story in the anthology, then use leveled text/readers that accompany the story)

• No, students are working at different levels in the reading program or reading series (for example, one group is working on lesson 18 and another group is working on lesson 34)

C9. Please indicate the publisher and title, and add the publication year for the program used in your classroom. If your reading program is not listed, please add it.

Publisher	Title of Reading Program MARK ALL THAT APPLY
Cambium/Voyager	Read Well
	Universal Literacy
Harcourt	Trophies
	Story Town
Heinemann	Fountas & Pinnell
Houghton Mifflin Harcourt	Journeys
	Rigby: Literacy by Design
Houghton Mifflin	Leveled Readers
	Houghton Mifflin Reading
MacMillan/McGraw-Hill	MacMillan/McGraw-Hill Reading
	Treasures
McGraw-Hill	Horizons
SRA/McGraw-Hill	Journeys
	Horizons
	Reading Mastery
	Open Court Reading
	Imagine It!
Pearson	Scott Foresman Reading Street
	Words Their Way
Reading A to Z	Reading A to Z
Other (please specify publisher and title: _____________________)

Questions C10 and C11 ask about how time is spent during core reading instruction. The first question asks about how you, as the instructor, divide your time. The second question asks about how the student’s time is divided.

C10. During the core reading block how did you spend your instruction time on the most recent typical day? Do NOT include time spent in writing instruction (that is, instruction on spelling, grammar, or writing).

I provide:

____ # Minutes/day of whole class reading instruction

____ # Minutes/day of small group reading instruction

____ # Minutes/day of one-on-one tutoring in reading

____ # Minutes/day of assistance to students with their independent reading work

____ # Minutes/day of other core reading instruction

____ # Total minutes/day of core reading instruction time

C11. Please provide, for the most recent typical day, the number of minutes of core reading instruction that an individual student typically received in each of the following. Do NOT include time spent in writing instruction (that is, instruction on spelling, grammar, or writing).

The typical student received:

____ # Minutes/day of whole class reading instruction

____ # Minutes/day of adult-led small group instruction

____ # Minutes/day of partner/group work in reading without an adult

____ # Minutes/day of one-on-one adult tutoring in reading

____ # Minutes/day of independent reading work

____ # Minutes/day of other core reading instruction (for example, computer-based instruction)

____ # Total minutes/day of core reading instruction time

C11a. During the core reading block, do you provide teacher-directed reading instruction to small groups of students (for example, 6-8 students)?

• Yes

• No (skip to question C12)

C11b. How many reading groups are your students organized into during this adult-directed small group instruction?

 2 groups  3 groups  4 groups  5 groups  6 groups

C11c. On the previous question (C11b) you indicated the number of groups that your students are organized into for adult-directed small group instruction. For each instructional group, please provide the following information.

If more than three groups, please copy this page and complete for additional groups.

Reading Group # 1	____ # Students in this reading group
a. How many minutes of teacher directed reading instruction does the group receive?
____ # Minutes/day ____ # Days/week
b. What type of reader is in the group? MARK ALL THAT APPLY.
 At or above grade level benchmarks in reading
Somewhat below grade level benchmarks in reading and receive a targeted intervention (sometimes called Tier 2 or Level 2)
 Far below grade level benchmarks in reading and receive a more intensive intervention (sometimes called Tier 3 or Level 3)
c. What is the content focus of this instruction? MARK ALL THAT APPLY.
 Phonemic awareness  Phonics		 Fluency  Reading comprehension	 Vocabulary  Other (please specify:___________)
Reading Group # 2	____ # Students in this reading group
a. How many minutes of teacher directed reading instruction does the group receive?
____ # Minutes/day ____ # Days/week
b. What type of reader is in the group? MARK ALL THAT APPLY.
 At or above grade level benchmarks in reading
Somewhat below grade level benchmarks in reading and receive a targeted intervention (sometimes called Tier 2 or Level 2)
 Far below grade level benchmarks in reading and receive a more intensive intervention (sometimes called Tier 3 or Level 3)
c. What is the content focus of this instruction? MARK ALL THAT APPLY.
 Phonemic awareness  Phonics		 Fluency  Reading comprehension	 Vocabulary  Other (please specify:___________)
Reading Group # 3	____ # Students in this reading group
a. How many minutes of teacher directed reading instruction does the group receive?
____ # Minutes/day ____ # Days/week
b. What type of reader is in the group? MARK ALL THAT APPLY.
 At or above grade level benchmarks in reading
Somewhat below grade level benchmarks in reading and receive a targeted intervention (sometimes called Tier 2 or Level 2)
 Far below grade level benchmarks in reading and receive a more intensive intervention (sometimes called Tier 3 or Level 3)
c. What is the content focus of this instruction? MARK ALL THAT APPLY.
 Phonemic awareness  Phonics		 Fluency  Reading comprehension	 Vocabulary  Other (please specify:___________)

C11d. Does the student composition or makeup of these reading groups change?

 Yes  No (skip to question C12)

C11e. On average, how frequently do you change students’ assignment to a group?

 More frequently than once per week

 One time per week

 Every 2 weeks

 Every 3 weeks

 Every 4 weeks

 Every 5 weeks

 Every 6 weeks

 Every 7 weeks

 Every 8 weeks

 Less frequently than every 8 weeks

C11f. What data is used to place students in each reading group or to change a student from one group to a different one? MARK ALL THAT APPLY.

 Informal observations of their reading performance

 Phonics test

 Sight words tests

 Running records

 Benchmark tests (please specify: ___________________)

 Curriculum placement tests

 End of unit tests

 Other (please specify: ____________)

C12. In addition to the core reading block, is there an additional period of time set aside when all students receive intervention, enrichment, or acceleration in reading (for example, some schools name such periods as “intervention period,” “acceleration block,” “extensions time,” etc.)?

• No (skip to question D1)

• Yes, it occurs less than once per week for my students

• Yes, it occurs about 1 time per week for my students

• Yes, it occurs about 2 times per week for my students

• Yes, it occurs about 3 times per week for my students

• Yes, it occurs about 4 times per week for my students

• Yes, it occurs daily for my students

C12a. Approximately how long is this additional time period (for example, “intervention period,” “acceleration block,” “extensions time,” etc.)?

____ # Minutes/day

C12b. During this time period (for example, “intervention period,” “acceleration block,” “extensions time,” etc.), indicate who provides instruction to the students from your classroom? MARK ALL THAT APPLY.

Students At or Above Grade Level Benchmark in Reading	Students Somewhat Below Grade Level Benchmark in Reading and receive a targeted intervention (sometimes called Tier 2 or Level 2)	Students Far Below Grade Level Benchmark in Reading and receive a more intensive intervention (sometimes called Tier 3 or Level 3)
 Myself  Reading specialist  Reading interventionist  Reading coach  Special education teacher  ELL or ESL teacher  Other general education teacher  School psychologist/ counselor  Speech language pathologist  School administrator  Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here	 Myself  Reading specialist  Reading interventionist  Reading coach  Special education teacher  ELL or ESL teacher  Other general education teacher  School psychologist/ counselor  Speech language pathologist  School administrator  Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here	 Myself  Reading specialist  Reading interventionist  Reading coach  Special education teacher  ELL or ESL teacher  Other general education teacher  School psychologist/ counselor  Speech language pathologist  School administrator  Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here

C13. Do you have students from your classroom that are classified as somewhat below the grade level benchmark in reading and who receive a targeted intervention (sometimes called Tier 2 or Level 2)?

 Yes  No (skip to question C15)

C14. Please provide the information below for those students that are somewhat below the grade level benchmark in reading and receive a targeted intervention (sometimes called Tier 2 or Level 2).

During the Core Reading Block
a. For a typical day, the average number of minutes of teacher/adult led small group reading instruction in which students are grouped by skill level or reading ability during the core reading block: ________ # Minutes/day
b. Who teaches the small group? MARK ALL THAT APPLY.
 Myself  Reading specialist  Reading interventionist  Reading coach	 Special education teacher  ELL or ESL teacher  Other general education teacher  Speech language pathologist	 Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here
Outside of the Core Reading Block
a. For a typical day, the average number of minutes of teacher/adult led small group reading instruction in which students are grouped by skill level or reading ability outside the core reading block: ________ # Minutes/day
b. Who teaches the small group (for example, myself, reading teacher, special education teacher, para-educator)? MARK ALL THAT APPLY.
 Myself  Reading specialist  Reading interventionist  Reading coach	 Special education teacher  ELL or ESL teacher  Other general education teacher  Speech language pathologist	 Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here

C15. Do you have students from your classroom that are classified as far below grade level benchmark in reading and receive an intensive intervention (sometimes called Tier 3 or Level 3)?

 Yes  No (skip to D1)

C16. Please provide the information below for those students that are far below grade level benchmark in reading and receive an intensive intervention (sometimes called Tier 3 or Level 3).

During the Core Reading Block
a. For a typical day, the average number of minutes of teacher/adult led small group reading instruction in which students are grouped by skill level or reading ability during the core reading block: ________ # Minutes/day
b. Who teaches the small group? MARK ALL THAT APPLY.
 Myself  Reading specialist  Reading interventionist  Reading coach	 Special education teacher  ELL or ESL teacher  Other general education teacher  Speech language pathologist	 Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here
Outside of the Core Reading Block
a. For a typical day, the average number of minutes of teacher/adult led small group reading instruction in which students are grouped by skill level or reading ability outside the core reading block: ________ # Minutes/day
b. Who teaches the small group? MARK ALL THAT APPLY.
 Myself  Reading specialist  Reading interventionist  Reading coach	 Special education teacher  ELL or ESL teacher  Other general education teacher  Speech language pathologist	 Student teacher or intern  Paraprofessional or instructional assistant  Parent or community volunteer  Other adult not listed here

D. DATA AND DECISION MAKING

Questions D1 through D13 ask about data and decision making in your classroom and at the school.

D1. What reading data do you have on your students? MARK ALL THAT APPLY.

	No data is available (skip to question D2)
	Annual state standards assessment (No Child Left Behind accountability data)
	Other norm referenced achievement test (not state accountability test)
	Benchmark tests
	Progress monitoring assessments
	Diagnostic assessments (for example, Informal reading inventory)
	Phonics tests
	Sight words tests
	Running records
	Curriculum placement tests
	End of unit tests
	Other (please specify: ___________________________________)

D1a. What specific reading data do you use for monitoring reading progress of individual students from your classroom? MARK ALL THAT APPLY.

Monitoring reading progress means reading assessment data that is collected more often than universal screening / benchmark tests.

		Average Frequency of Data Collection…
		Student Somewhat Below Grade Level Benchmark in Reading (sometimes called Tier 2 or Level 2 students)	Student Far Below Grade Level Benchmark in Reading (sometimes called Tier 3 or Level 3 students)
	No Data is available (skip to question D2)
	Informal observation	Every ____ # Weeks	Every ____ # Weeks
	Curriculum embedded tests (for example, weekly test, unit tests, etc.)	Every ____ # Weeks	Every ____ # Weeks
	Oral reading fluency scores (for example, DIBELS, AIMSweb, etc.)	Every ____ # Weeks	Every ____ # Weeks
	Running records	Every ____ # Weeks	Every ____ # Weeks
	Sight words test	Every ____ # Weeks	Every ____ # Weeks
	Phonics test	Every ____ # Weeks	Every ____ # Weeks
	Reading scores from computer administered tests	Every ____ # Weeks	Every ____ # Weeks
	Other data not listed here	Every ____ # Weeks	Every ____ # Weeks

D2. How often do you use an assessment in READING for the following purposes? MARK ONE RESPONSE ON EACH ROW.

	Never	Once a year	2 times a year	3 to 4 times a year	1 to 2 times a month	1 to 2 times a week
To organize instructional groups						
To evaluate how well each student is responding to the core curriculum provided in the general education classroom						
To monitor each student’s progress on specific skills over the school year						
To identify the deficits in specific skills of struggling students						
To monitor the progress of students who fall below benchmark levels						
To determine whether students need placement in a more or less intensive level of instruction						

D3. Using the district’s or school’s data system, which of the following data analysis functions do you perform? MARK ALL THAT APPLY.

• I compare graphs that show my class’ reading scores relative to other same-grade classrooms in my school

• I compare graphs that show my class’ reading scores relative to other same-grade classrooms in my district

• I compare graphs that show my school’s reading scores relative to other same-grade classrooms in my district

• I use data, but not in the ways listed above

• I do not use data

D4. Do you meet in grade level teams to review or monitor student’s progress in reading?

 Yes  No (skip to question D8)

D5. At the last grade level team meeting, in addition to you who attended this meeting? MARK ALL THAT APPLY.

• Other teachers from same grade-level

• Reading specialist

• Reading interventionist

• Reading coach

• Special education teacher

• ELL or ESL teacher

• Other general education teacher(s)

• School psychologist/counselor

• Speech language pathologist

• School administrator

• Paraprofessional or instructional assistant

• Staff from the district office

• Other adult not listed here
  (please specify: _________________)

D6. How frequently does this grade level team meet? MARK ONE.

• More often than once per week

• Once per week

• Once every 2 weeks

• Once every 3 weeks

• Once every 4 weeks

• Once every 5 weeks

• Once every 6 weeks

• Once every 7 weeks

• Once every 8 weeks

• Once every 9 weeks

• Once every 10 weeks

• Once every 11 weeks

• Once every 12 weeks

• More often than every 12 weeks

D7. How are reading data usually used during grade level team meetings? MARK ALL THAT APPLY.

• Determine if individual students are making satisfactory progress in reading

• To identify students that need reading intervention

• To determine if we need to make adjustments in grade- or classroom-level reading instruction/curriculum

• To determine if students should be moved to a different reading group

• To determine if students should be moved to a different classroom for reading

• To determine if any struggling readers need a change in their instruction

• To decide if any students should be referred for special education

• Other (please specify: _________________)

D8. Do you meet with a school-level team (for example, school psychologist, speech language pathologist, reading specialist, etc.) that evaluates the progress of struggling readers to make decisions about reading interventions?

 Yes  No (skip to question D12)

D9. At the last school-level team meeting you attended to make decisions about reading interventions, who else attended the meeting? MARK ALL THAT APPLY.

• Other teachers from same grade-level

• Reading specialist

• Reading interventionist

• Reading coach

• Special education teacher

• ELL or ESL teacher

• Other general education teacher(s)

• School psychologist/counselor

• Speech language pathologist

• School administrator

• Paraprofessional or instructional assistant

• Staff from the district office

• Other adult not listed here
  (please specify: _________________)

D10. How frequently does this school-level team meet? MARK ONE.

• More often than once per week

• Once per week

• Once every 2 weeks

• Once every 3 weeks

• Once every 4 weeks

• Once every 5 weeks

• Once every 6 weeks

• Once every 7 weeks

• Once every 8 weeks

• Once every 9 weeks

• Once every 10 weeks

• Once every 11 weeks

• Once every 12 weeks

• More often than every 12 weeks

D11. How are reading data usually used during school-level team meetings? MARK ALL THAT APPLY.

• Determine if individual students are making satisfactory progress in reading

• To identify students that need reading intervention

• To determine if we need to make adjustments in grade- or classroom-level reading instruction/curriculum

• To determine if students should be moved to a different reading group

• To determine if students should be moved to a different classroom for reading

• To determine if any struggling readers need a change in their instruction

• To decide if any students should be referred for special education

• Other (please specify: _________________)

D12. During this school year, how often have you used an electronic student data system (e.g. Excel spread sheet, district data system, system provided by reading program vendor) for each of the following purposes? MARK ONE RESPONSE ON EACH ROW.

	Never	Once a year	2 times a year	3 to 4 times a year	1 to 2 times a month	1 to 2 times a week
Determine whether your class is ready to move on to the next instructional unit						
Determine if we need to make adjustments in our classroom reading instruction/curriculum						
Determine if individual students are making satisfactory progress in reading						
Determine if individual students should be moved to a different reading group						
Identify individual students that need supplemental reading instruction /intervention						
Identify students who may be in need of behavioral interventions						
Decide if individual students should be referred for special education						

D13. For each of the following statements about READING, indicate how strongly you agree or disagree. MARK ONE RESPONSE ON EACH ROW.

	Strongly disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree	Don’t know
a. This school has explicit goals for what we want students to achieve (learning outcomes) in reading in the grade I teach.						
b. There is a systematic, formal process for intervening with students who are struggling or at risk of failure in reading in the grade I teach.						
c. This school has a set of clear, predetermined, grade-level benchmarks (that is, cut scores, goals/targets, or percentiles) that are used to determine which students are struggling or at risk of failure in reading in the grade I teach.						
d. This school has clear, predetermined criteria for determining the level of intervention students in the grade I teach will receive in reading.						
e. This school has clear, predetermined criteria for determining when students in the grade I teach no longer need a reading intervention.						

E. PROFESSIONAL DEVELOPMENT

Questions E1 through E4 ask about professional development in your school. Professional development may include formal education; courses, conferences, workshops, or in-service training; staff meetings that include staff development activities; and receiving coaching or mentoring.

E1. During the last 12 months, including the summer, in how many of each of the following types of professional development activities related to reading instruction have you participated? Please count each activity only once. What is the total number of hours you spent in these activities?

• First write in the number of activities of each type in which you have been engaged over the last 12 months.

• Then, write the total number of hours you spent in these activities. Write “0” if you participated in none.

	Enter below the # of
	Times over the last 12 months	Total Hours over the last 12 months
a. Attended short, stand-alone training or workshop related to reading instruction (half-day or less)	# ____	# ____
b. Attended a longer institute or workshop related to reading instruction (more than half-day)	# ____	# ____
c. Attended a college course related to reading instruction (include any courses you are currently attending)	# ____	# ____
d. Attended a conference related to reading instruction (might include multiple short offerings)	# ____	# ____
e. Received coaching related to reading instruction	# ____	# ____
f. Received mentoring related to reading instruction	# ____	# ____
g. Acted as a coach related to reading instruction	# ____	# ____
h. Acted as a mentor related to reading instruction	# ____	# ____
i. Participated in a professional learning community (PLC) related to reading instruction	# ____	# ____
j. Other professional development related to reading instruction (for example, participated in a committee or task force related to reading instruction; or observed reading instruction in other schools)	# ____	# ____

E2. During the last 12 months, how much did any professional development activities in which you participated emphasize the following topics related to reading instruction? MARK ONE RESPONSE ON EACH ROW.

	Not an emphasis	Minor emphasis	Moderate emphasis	Major emphasis
How to administer benchmark test				
How to administer other assessments				
How to use reading data to adjust core instruction				
How to use reading data to evaluate school progress				
How to use graphed data to determine relative progress of students				
How to organize small group instruction				
How to analyze and interpret student achievement data				
How to interpret and use reading assessment data to guide instruction				
How to diagnose reading difficulties				
How to choose reading intervention(s)				
How to use reading intervention(s)				
Strategies for teaching reading to ELL students				

Questions E3 and E4 ask general information about professional development and support.

E3. In the last 12 months, how often did you participate in professional development activities covering the following topics? MARK ONE RESPONSE ON EACH ROW.

	Never	Once	2 times	3 to 4 times	More than 4 times
How to use assessment data to identify students who are struggling or at risk of failure in reading					
How to use and apply assessment data to guide reading instruction					
How to implement the reading curriculum					

E4. Have you received support for teaching reading from any of the following staff members during the current academic year? MARK ONE RESPONSE ON EACH ROW.

	Yes, support received	No, support not received but available	Resource not available
A school or district staff member whose role is to provide ongoing training and support to classroom teachers in the delivery of effective reading instruction			
A school or district staff member whose role is to provide ongoing training and support to classroom teachers in the delivery of effective behavioral supports			
A school or district staff member to support teachers in collecting, organizing, and managing assessment data			
A school or district staff member to support teachers in the interpretation and use of assessment data to guide instruction			

F. RESPONSE TO INTERVENTION MODULE

Questions F1 and F2 ask about professional development in your school related to Response to Intervention.

Response to Intervention (RtI) is a multi-step approach to providing early and progressively intensive intervention and monitoring within the general education setting.

In principle, RtI begins with research-based instruction and behavioral support provided to students in the general education classroom, followed by screening of all students to identify those who may need systematic progress monitoring, intervention, or support.

Students who are not responding to the general education curriculum and instruction are provided with increasingly intense interventions through a “tiered” system, and they are frequently monitored to assess their progress and inform the choice of future interventions, including possibly special education for students determined to have a disability.

F1. Is Response to Intervention (RtI), as defined above, being used in your classroom?

 Yes  No (survey complete)

F2. What level of implementation below would you say applies to your use of Response to Intervention (RtI)? MARK ONE.

• I am not learning about RtI

• I am currently learning about RtI and thinking about how it may fit into my teaching

• I am preparing for the implementation of RtI, working on a plan for implementing, and/or figuring out what I need to put in place to begin implementation

• I have a few pieces of RtI in place, and a plan for moving forward with the rest of implementation

• An RtI framework is up and running in my classroom

• I am looking for ways to improve RtI in my class, all the pieces are in place and being used, but I think I can make it even better by tweaking some aspects to be more relevant to my classroom

• RtI is operational, innovations are applied in my classroom, and systems are in place to ensure that what we are doing is sustainable and continues to work well

• I don’t know

• Currently, RtI is not being implemented at the school

Questions from this survey were adapted from the following sources:

ECLS-K 2011 Teacher and School Surveys

National Education Technology Trends Survey

Reading First Implementation Evaluation Grade 1 Teacher Survey

Washington RTI Evaluation Survey

April 3, 2012 Revised Teacher Survey Page 33