Parent Survey

OMB APPENDIX L. PARENT-STUDENT SURVEYS

Mathematica Reference No.: 06876.341

National Longitudinal Transition
Study 2012 (NLTS2012)
Parent & Student Baseline Questionnaire: CATI Programming
Specifications
Draft Dated 02.08.12 - Final

Parent Survey Baseline: CATI Specifications 02.08.12
ADMINISTRATIVE NOTES:
•

EACH ITEM DRAWN FROM A PRE-EXISTING INSTRUMENT WILL HAVE, AT THE END OF THE QUESTION
TEXT, THE SOURCE INSTRUMENT AND ITEM REFERENCE NUMBER. IF THE ORIGINAL SOURCE HAS BEEN
MODIFIED, THE TEXT “REV” WILL FOLLOW.

•

THIS INSTRUMENT IS DESIGNED TO BE INTERVIEWER-ADMINISTERED OVER THE TELEPHONE WITH AN
ESTIMATED DURATION OF 40 MINUTES.

•

GUIDELINES FOR ADMINISTRATION ARE NOTED THROUGHOUT – ITEMS IN ALL CAPS ARE NOT READ
ALOUD, UNDERLINED VERBIAGE IS EMPHASIZED. STANDARDIZED PROBES AND DEFINITIONS ARE
PROVIDED.

•

PARENTAL CONSENT WILL BE DIGITALLY RECORDED AND STORED AT MATHEMATICA ON A SECURE
SERVER. ONCE CONSENT IS RECEIVED, THE SAMPLE MANAGEMENT (SMS) DATABASE WILL GENERATE A
MAILING TO THE PARENT DOCUMENTING THE CONSENT GRANTED.

•

PARENT INTERVIEW COMPLETED PRIOR TO LAUNCHING THE STUDENT INTERVIEW. RELEASE OF ALL
SUBSEQUENT ELEMENTS OF THE STUDY (GEN ED TEACHER, SCHOOL PROGRAM, STUDENT
ASSESSMENT, SCHOOL RECORDS, ETC) IS CONTINGENT UPON STUDENT ALSO PROVIDING CONSENT /
APPROVAL IN SECTION J OF THAT INSTRUMENT.

•

SAMPLE FILE WILL CONTAIN NAME AND CONTACT INFORMATION FOR UP TO TWO PARENTS OR
GUARDIANS FOR EACH STUDENT. ADDRESS LINKED TO THE PARTICIPATING PARENT WILL BE THE
ADDRESS POPULATED IN CATI (BASED ON RESPONDENT CONFIRMATION IN CATI FRONT END).

A. INTRODUCTION AND CONSENT
ALL

A1.

Hi, my name is {interviewer name}. The U.S. Department of Education is sponsoring
the National Longitudinal Transition Study. Through this important project, we hope
to learn more about issues youth face today as they transition from school to adult
life and how schools can better support students in reaching their goals.
CONTINUE .................................................................. 1
HUNG UP DURING INTRODUCTION ......................... 2

TERMINATE (STATUS 240)

CATI: DO NOT ALLOW A DK OPTION ON A1

ALL

A1a.

This call will be recorded for quality assurance purposes. Can we please begin by
having you say your full name?
STRING (20)

FIRST NAME

STRING (50)

LAST NAME

REFUSED ................................................................... r

GO TO A2

HUNG UP DURING INTRODUCTION ......................... 2

TERMINATE (STATUS 240)

CATI: DO NOT ALLOW A DK OPTION ON A1a
1

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

A2. {YOUTH} is one of 15,000 students across the country being asked to take part in this
voluntary study. I will briefly explain what being in the study will mean for you and
{YOUTH}. If you have any questions, please stop me, I am happy to answer them. If you
agree to take part, this interview will take 40 minutes. I’ll ask about {YOUTH}’s experiences
at school, hopes for the future, and some basic information about your household. You will
be contacted for another interview in 2014, to see what may have changed since we last
spoke. [READ IF LEA ID ≠ xxxxx. You will be paid $20 for each interview completed.]
[READ IF LEA ID = xxxxx You will be paid $10 for completing this interview in 2012 and $20
for completing the interview in 2014.]
We would also like to interview {YOUTH} over the telephone for about 30 minutes. That
interview has questions about experiences in and out of school and plans for the future.
You can help your child answer questions or answer for {him/her}, if needed. Students will
be contacted for another interview in 2014. READ IF LEA ID ≠ xxxxx{YOUTH} will get a $10
gift card for each interview completed.
All the information the researchers collect about {YOUTH} will be kept confidential and not
shared with others. All reports will be in summary form only. Your child’s name will never
be used. There are no special risks to you or {YOUTH} from taking part in this study. There
is nothing experimental about this study. If you or your child feels uncomfortable
answering any of the questions, you can stop without penalty. Do you give your
permission for these interviews?
AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2

TERMINATE. STATUS AS 211 AND

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A2
ALL

A3.

As part of the study, each student’s math or language arts teacher would be asked to
do a survey to learn more about [his / her] classroom experiences. Do we have your
permission to contact this teacher?
AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2

GO TO A4

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A3

2

Parent Survey Baseline: CATI Specifications 02.08.12
A3=1

A3a.

Can you provide the name of this [math / language arts] teacher?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME = D,R, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d

GO TO A3c

REFUSED TO PROVIDE EITHER NAME ................... r

GO TO A3c

A3a = 1

A3b.

Can you provide us with this teacher’s email address?
YES – SPECIFY: _________ (STRING 200 CHAR) .... 1
DON’T KNOW ............................................................. d
REFUSED TO PROVIDE EMAIL ADDRESS ............... r

Has IEP from sample =1

A4.

We would like to complete two surveys with a staff person from {YOUTH}’s school, to
learn about services the school provides to (him/her) in (his / her) IEP. The first would
be completed this year and the next one would be in 2014. Do we have your
permission to contact this staff member?
AGREED - CONTINUE ................................................ 1

GO TO A4a

DISAGREE / DECLINES THIS PORTION ................... 2

GO TO A5

DOES NOT HAVE AN IEP........................................... 3

GO TO A4.5

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A4
Has IEP from sample =1 AND A4 = 3

A4.5.

Maybe another name is used for the services [YOUTH] receives. The school said
he/she gets some type of accommodations or help in school. Do you give us
permission to contact the person at your school who could best complete a survey
about any services [YOUTH] may receive?
AGREED - CONTINUE ................................................ 1

GO TO A4a

DISAGREE / DECLINES THIS PORTION ................... 2

GO TO A5

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A4.5
3

Parent Survey Baseline: CATI Specifications 02.08.12
A4=1 or A4a=1

A4a.

Can you provide the name of this staff person (who is most knowledgeable about
services provided at school)?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME UNKNOWN, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d
REFUSED TO PROVIDE NAME .................................

GO TO A5
r

GO TO A5

A4a = 1

A4b.

Can you provide us with this person’s email address?
YES – SPECIFY: _________ (STRING 200 CHAR) .... 1
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

A5.

As part of the study, in 2014, researchers will look at students’ school transcripts to
see what courses they have taken. Do you grant permission for us to collect this
information?
AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2
DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A5
YEAR OF BIRTH IN SAMPLE FILE > 1996 OR YEAR OF BIRTH IN SAMPLE FILE IS MISSING (“.”)

A6.

Youth who are around 16 to 18 years old in 2014 may be asked to complete an
academic assessment. This test is only for this study and will not count towards any
of {his/her} classes in school. Do you grant permission for this assessment?

AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2
DECLINES STUDY PARTICIPATION ......................... 0
CATI: DO NOT ALLOW DK or REF OPTIONS FOR A6

4

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

A7.

To learn more about how students are doing in the future, the researchers may want
to look at databases on college enrollment, financial aid for college, vocational
rehabilitation agency services or the Social Security Administration’s records about
jobs or benefits. If the researchers decide to use data from the Social Security
Administration, we would need [NAME]’s social security number.
If we need your child’s social security number, we will ask for it during the second
interview in 2014. You can decide to give it to us then, or not. If you give us the
number, we will keep it private and will permanently erase it as soon as we link it to
the information needed. We did want to let you know now, however, that we may ask
for it. Do you have any questions about this?
NO QUESTIONS, OK TO CONTINUE ......................... 1
QUESTIONS RAISED AND ANSWERED,
CONTINUE .................................................................. 2
WILL NEVER GIVE SSN, BUT OK TO
CONTINUE INTERVIEW ............................................. 3
DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTIONS FOR A7

ALL

A8. Even if you consent for {YOUTH} to take part in this study, {he/she} must agree also. When
{he/she} turns 18 or no longer has a legal guardian, {he/she} must consent for
{him/herself}. You or {YOUTH} can ask questions or drop out of the study at any time
without penalty by calling Mathematica Policy Research. If you have any questions about
your child’s rights as a research volunteer, you can call the Institutional Review Board who
reviewed this study to make sure students’ rights are protected.
IF NEEDED: Public/Private Ventures telephone number is 800-755-4778 x4482. Ask for
Melissa Billarrial. IF NEEDED: Mathematica’s toll-free number is 866-964-7962.
I will mail you a letter describing what we just discussed, so you will have it for your
records. If you would like to see the consent form in writing before continuing with the
interview, we can email (or fax) it to you. Do you have any questions for me before we
begin the interview? [ANSWER QUESTIONS, AS NEEDED].
AGREES TO TAKE PART - CONTINUE ......................... 1
NOT AT THIS TIME – CALL LATER ................................ 2
DECLINES STUDY PARTICIPATION ......................... 0
CATI: DO NOT ALLOW DK or REF OPTIONS FOR A8

5

(SET CALLBACK WITHIN 1 WEEK)
(STATUS 800)
TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

A9.

I will begin by asking for some basic information about where you live and how we
can best reach you for the next survey in 2014. Let’s start with the address where you
get your mail. READ IF LEA ID ≠ xxxxx We will send your $20 check to this address.
READ IF LEA ID = xxxxx We will send your check to this address. READ TO ALL: The
school listed it as [ADDRESS FROM SAMPLE FILE AS ABOVE FOR PAR1, PAR 2,
NEWADD]. Is that address correct?
YES ............................................................................. 1

GO TO A10

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO A10

REFUSED ................................................................... r

GO TO A10

A9=0

A9a.

What is your mailing address?
PROBE FOR AND RECORD BOTH P.O. BOX AND STREET ADDRESS
PROBE:

Where do you stay most often?

(STRING (200)

ADDRESS 1

(STRING (200)

ADDRESS 2

(STRING (200)

CITY

(STRING (50)

STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)

|

|

ALL

A10.

What is the best telephone number at which to reach you:
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

| / Phone (STRING 30)

DOES NOT HAVE A TELEPHONE NUMBER ............. 1

GO TO A11

DON’T KNOW ............................................................. d

GO TO A11

REFUSED ................................................................... r

GO TO A11

6

Parent Survey Baseline: CATI Specifications 02.08.12
A10≠1,d,r

A10a.

Is that a landline or cell phone?
LANDLINE ................................................................... 1

GO TO A11

CELL PHONE .............................................................. 2
DON’T KNOW ............................................................. d

GO TO A11

REFUSED ................................................................... r

GO TO A11

A10a=2

A10b.

When we contact you for the next survey, may we send you a text message on that
phone?
YES ............................................................................. 1
NO ............................................................................... 0
PHONE DOES NOT USE TEXT MESSAGE................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
{YOUTH} first name from SAMPLE FILE:

A11.

I need to begin by asking a few questions about {YOUTH} to make sure I ask
questions that apply only to certain groups. Is {YOUTH} male or female? (NLTS2 A1,
rev)
MALE........................................................................... 1
FEMALE ...................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL WHERE DOB IN SAMPLE FILE IS POPULATED AND NOT “.”

A12.

I have {YOUTH}’s month and year of birth as {FILL FROM SAMPLE}? Is that correct?
(NLTS2 A2A, REV)
YES ............................................................................. 1

GO TO A13

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO A13

REFUSED ................................................................... r

GO TO A13

7

Parent Survey Baseline: CATI Specifications 02.08.12
A12=0 OR WHERE DOB IN SAMPLE FILE = “.” (BLANK)

A12a.

What is {YOUTH’S} month and year of birth? (NLTS2 A2B, REV)
PROGRAMMER: COLLECT DATE WITH SEPARATE FIELDS
|

|

|/|

|

|

|

|

MONTH YEAR
(1-12)
(1990-2000 ONLY)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL

A13.

What is your relationship to {YOUTH}? (NEW)
NOTE: CODE STEPPARENTS AS MOTHER OR FATHER.
MOTHER ..................................................................... 1
FATHER ...................................................................... 2
OTHER RELATIVE ...................................................... 3
FOSTER PARENT....................................................... 4
OTHER LEGAL GUARDIAN ....................................... 5
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 100)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

IN SAMPLE FILE IS NOT “UNKNOWN” OR “.”

A14.

Our records from the school district show the name of [STUDENT]’s school is
[SCHOOL NAME], is that correct?
YES ............................................................................ 1

GO TO A15

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO A15

REFUSED ................................................................... r

GO TO A15

A14=0

A14a.

What is the name of [STUDENT]’s school?
SPECIFY: _________ (STRING 200 CHAR)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
8

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

A15.

What city and state is this school located in?
(STRING (200)

CITY

(STRING (50)

STATE/TERRITORY

DON’T KNOW ............................................................. d
REFUSED ................................................................... r

B. STUDENT’S EXPERIENCE AT SCHOOL
B1_INTRO

The next questions are about {YOUTH}’s school experiences this school year, that
is, the 2011-2012 school year.

ALL

B1.

Has {YOUTH} been enrolled in an elementary, middle, junior or senior high school
this school year? (NLTS D1A)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO BOX B4

DON’T KNOW ............................................................. d

GO TO BOX B4

REFUSED ................................................................... r

GO TO BOX B4

9

Parent Survey Baseline: CATI Specifications 02.08.12
B1=1

B2.

What grade {is/was} {YOUTH} in this year? [PROBE FOR UNGRADED IF PARENT IS
UNSURE.] (NLTS D10)
CODE ONE ONLY
UNGRADED CLASS ................................................... 0
SIXTH GRADE ............................................................ 6
SEVENTH GRADE ...................................................... 7
EIGHTH GRADE ......................................................... 8
NINTH GRADE ............................................................ 9
TENTH GRADE ........................................................... 10
ELEVENTH GRADE .................................................... 11
TWELFTH GRADE ...................................................... 12
THIRTEENTH GRADE ................................................ 13
MULTI-GRADE ............................................................ 14
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 50)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

10

Parent Survey Baseline: CATI Specifications 02.08.12

B1=1
B3.

Which of the following best describes the school {he/she} attended this year? A
regular school that serves a wide variety of students, a school that serves only
students with disabilities, a magnet school that specializes in a particular subject
area or theme, a vocational/technical school (voc-tech), a charter school, an
alternative school, or another kind of school?
[2+ SCHOOLS IN SAME YEAR, ASK ABOUT THE MOST RECENT SCHOOL. 2+
SCHOOLS AT SAME TIME, ASK ABOUT THE SCHOOL WHERE MOST TIME SPENT.]
(NLTS D1B)
CODE ONE ONLY
A REGULAR SCHOOL THAT SERVES A WIDE
VARIETY OF STUDENTS, .......................................... 1
A SCHOOL THAT SERVES ONLY STUDENTS
WITH DISABILITIES, ................................................... 2
A MAGNET SCHOOL THAT SPECIALIZES IN A
PARTICULAR SUBJECT AREA OR THEME,.............. 3
A VOCATIONAL/TECHNICAL SCHOOL (VOCTECH), ........................................................................ 4
A CHARTER SCHOOL, ............................................... 5
AN ALTERNATIVE SCHOOL ...................................... 6
HOME INSTRUCTION BY A PROFESSIONAL ........... 7
HOME SCHOOLING BY A PARENT ........................... 8
MEDICAL FACILITY, CONVALESCENT
HOSPITAL, OR INSTITUTION FOR PEOPLE
WITH DISABILITIES .................................................... 9
MENTAL HEALTH FACILITY ...................................... 10
CORRECTIONAL OR JUVENILE JUSTICE
FACILITY..................................................................... 11
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX B4

THIS LOGIC SKIPS PARENTS OF YOUTH IN SETTINGS OTHER THAN REGULAR SCHOOLS TO QUESTION
B4c and FILLS B4-B4b WITH INFORMATION WE KNOW FROM RESPONSES TO B3.
IF B3 = 1-6, GO TO B4.
IF B3 = 7-11, 99, CODE B4 = 1 AND CODE APPROPRIATE SETTINGS IN B4b based on B3, THEN GO TO
B4c. (These should not go to box B4a along the way.)
IF B3 = D,R, GO TO B4c.
11

Parent Survey Baseline: CATI Specifications 02.08.12
IF B1 = 0, D, R, GO TO B4.

B3=1-6 OR B1 = 0,D,R
B4.

Has {he/she} received any elementary, middle, junior or senior high school level
instruction in any other setting during this school year? For example, that could
include instruction in a hospital, correctional facility, or a home school. (NLTS D2A)
YES ............................................................................. 1

GO TO BOX B4A

NO ............................................................................... 0

GO TO BOX B4A

DON’T KNOW ............................................................. d

GO TO BOX B4A

REFUSED ................................................................... r

GO TO BOX B4A

BOX B4A
IF B1 ≠ 1 (NOT ENROLLED) AND B4 = 1 (ENROLLED, NOT REGULAR SCHOOL), GO TO B4a.
IF B3 = 1-6 (ENROLLED, REGULAR SCHOOL) AND B4 = 1 (ENROLLED, NOT REGULAR SCHOOL), GO TO B4B.
IF B1 = 1 AND B3 = 1-6 AND B4 = 0,D,R, GO TO B4C.
IF B1= 0,D,R AND B4 = 0,D,R, GO TO B5
ELSE, GO TO BOX B5.

B4=1
B4a.

What grade {is/was} {YOUTH} in this year? [PROBE FOR UNGRADED IF PARENT IS
UNSURE.] (NLTS D10)
CODE ONE ONLY
UNGRADED CLASS ................................................... 0
FIRST GRADE ............................................................ 1
SECOND GRADE........................................................ 2
THIRD GRADE ............................................................ 3
FOURTH GRADE ........................................................ 4
FIFTH GRADE............................................................. 5
SIXTH GRADE ............................................................ 6
SEVENTH GRADE ...................................................... 7
EIGHTH GRADE ......................................................... 8
NINTH GRADE ............................................................ 9
TENTH GRADE ........................................................... 10
ELEVENTH GRADE .................................................... 11
TWELFTH GRADE ...................................................... 12
THIRTEENTH GRADE ................................................ 13
MULTI-GRADE ............................................................ 14
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 50)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
12

Parent Survey Baseline: CATI Specifications 02.08.12

(B4=1 AND B3 = 1-6) OR (B4 = 1 AND B1 ≠ 1)
B4b.

Which of the following best describes the setting where {YOUTH} received this
instruction? Was it… [IF MORE THAN ONE SETTING, CODE MOST RECENT SETTING]
(NLTS D2B)
CODE ONE ONLY
Home instruction by a professional, ........................ 1
Home schooling by a parent, .................................... 2
A hospital or hospital school, ................................... 3
A medical facility convalescent hospital or
institution for people with disabilities, ..................... 4
A mental health facility, ............................................. 5
A correctional or juvenile justice facility, or ............ 6
Another kind of place? (SPECIFY)............................ 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

B1 = 1 OR B4=1
B4c.

Is {he/she} receiving instruction now? (NLTS D2C)
YES ............................................................................. 1

GO TO BOX B5

NO ............................................................................... 0

GO TO BOX B5

DON’T KNOW ............................................................. d

GO TO BOX B5

REFUSED ................................................................... r

GO TO BOX B5

BOX B5
IF (B1 OR B4 = 1) AND (B2 OR B4A = 12, 13 OR ((B2 OR B4A = 0,14,99,D,R) AND AGE ≥16)), GO TO B6.
ELSE IF B1 OR B4 = 1 AND (B2= [6-11] OR B4A = [1-11]) OR ((B2=0,14,99,D,R OR B4A =
0,14,99,D,R) AND AGE < 16) , GO TO B10. ELSE IF B1 = 0,D,R AND B4 = 0,D,R, GO TO B5.
IF (B1 OR B4 = 1) AND (B2 OR B4A = 12, 13 OR ((B2 OR B4A = 0,14,99,D,R) AND AGE ≥16)), GO TO B6.
ELSE IF B1 OR B4 = 1 AND (B2= [6-11] OR B4A = [1-11]) OR ((B2=0,14,99,D,R OR B4A =
0,14,99,D,R) AND AGE < 16) , GO TO B10. ELSE IF B1 = 0,D,R AND B4 = 0,D,R, GO TO B5.

13

Parent Survey Baseline: CATI Specifications 02.08.12

B1 = 0,D,R AND B4= 0,D,R
B5.

Is {he/she} not in school now because {he/she}… (NLTS D2D)
CODE ONE ONLY
Is on school vacation, ............................................... 1

GO BACK AND FIX B1

Graduated,.................................................................. 2

GO TO B8

Took a test and received a diploma or a
certificate without taking all of {his/her} high
school classes, .......................................................... 3

GO TO B8

Dropped out or just stopped going, ......................... 4
Was suspended (temporary), .................................... 5

GO TO B6

Was expelled (permanent), ....................................... 6

GO TO B6

Was older than the school age limit, or ................... 7

GO TO B6

Some other reason? (SPECIFY)................................ 99 GO TO B6
________________________________(STRING 150)
DON’T KNOW ............................................................. d

GO TO B6

REFUSED ................................................................... r

GO TO B6

14

Parent Survey Baseline: CATI Specifications 02.08.12

B5=4
B5a.

What were {his/her} reasons for leaving? (NLTS D2F)
CODE ALL THAT APPLY
SCHOOL: ACADEMIC DIFFICULTY; POOR GRADES/NOT DOING WELL ................ 1
SCHOOL: DISLIKE OF SCHOOL EXPERIENCE .......................................................... 2
SCHOOL: SCHOOL TOO DANGEROUS ...................................................................... 3
SCHOOL: FAILED REQUIRED TEST/FAILED GRADUATION EXAM .......................... 4
SCHOOL: LACK OF APPROPRIATE CURRICULUM ................................................... 5
SCHOOL: POOR RELATIONSHIPS WITH TEACHERS AND SCHOOL STAFF .......... 6
SCHOOL: POOR RELATIONSHIP WITH FELLOW STUDENTS .................................. 7
SCHOOL: LANGUAGE DIFFICULTY ............................................................................. 8
SCHOOL: PROBLEMS WITH BEHAVIOR .................................................................... 9
FINANCIAL: ECONOMIC REASONS ............................................................................. 10
FINANCIAL: LACK OF CHILD CARE ............................................................................ 11
FINANCIAL: LACK OF TRANSPORTATION ................................................................ 12
HEALTH: SUBSTANCE ABUSE.................................................................................... 13
HEALTH: ILLNESS/DISABILITY.................................................................................... 14
HEALTH: PREGNANCY ................................................................................................ 15
PERSONAL: ENTERED THE CRIMINAL JUSTICE SYSTEM ...................................... 16
PERSONAL: NEEDED AT HOME ................................................................................. 17
PERSONAL: RELIGION ................................................................................................ 18
PERSONAL: MOVED .................................................................................................... 19
RELATIONSHIPS: PARENT/GUARDIAN INFLUENCE ................................................ 20
RELATIONSHIPS: FRIENDS WERE DROPPING OUT ............................................... 21
RELATIONSHIPS: MARRIAGE ..................................................................................... 22
WORK: MILITARY, JOINED ARMED FORCES ............................................................ 23
WORK: EMPLOYMENT, SOUGHT OR ACCEPTED JOB ............................................ 24
OTHER (SPECIFY) ......................................................................................................... 99
_________________________________________________ (STRING 150)
DON’T KNOW ................................................................................................................. d
REFUSED ....................................................................................................................... r

(GO TO BOX B7)

B5=5-7,99,D,R OR (B1 OR B4 = 1 AND (B2 OR B4A = 12,13 OR ((B2 OR B4A = 0,14,99,D,R) AND AGE ≥16)))

B6.

Do you expect that {he/she} will graduate or finish school this year? (NLTS D2G1)
YES. ............................................................................ 1

GO TO BOX B7

NO. .............................................................................. 0

GO TO BOX B7

DON’T KNOW ............................................................. d

GO TO BOX B7

REFUSED ................................................................... r

GO TO BOX B7

15

Parent Survey Baseline: CATI Specifications 02.08.12
BOX B7
IF B5 = 4-7,99,D,R, GO TO B7. ELSE GO TO B10.

B5=4-7, 99, D, R
B7.

In the past school year has {YOUTH} taken any courses or tests to earn a high school
diploma or its equivalent {since dropping out/being suspended/ being expelled}?
(NLTS D3A)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO B9

DON’T KNOW ............................................................. d

GO TO B9

REFUSED ................................................................... r

GO TO B9

B7=1 OR B5= 2,3
B8.

Has {YOUTH} earned a diploma, GED, or certificate of completion?
IF NEEDED: What was it? (NLTS D2E REV)
CODE ONE ONLY
NO DIPLOMA EARNED .............................................. 0
REGULAR DIPLOMA .................................................. 1
GED ............................................................................ 2
CERTIFICATE OF COMPLETION ............................... 3
MODIFIED DIPLOMA .................................................. 4
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d

REFUSED ................................................................... r
ASK ONLY OF STUDENTS WHO:
DID NOT ATTEND [B1=0, D, R AND B4=0, D, R) OR
WHO DROPPED OUT, WERE SUSPENDED, OR EXPELLED [B5=4, 5, 6)
B8.5.

Did {YOUTH} take any courses this year (2011-2012) at a 2-year or community college,
a career, business, or trade school, or a 4-year college? (NEW)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO B9

DON’T KNOW ............................................................. d

GO TO B9

REFUSED ................................................................... r

GO TO B9

16

Parent Survey Baseline: CATI Specifications 02.08.12

B8.5=1
B8.5a.

Which type of post-secondary program did {YOUTH} attend in 2011-2012?
CODE ONE ONLY
2-YEAR OR COMMUNITY COLLEGE ......................... 1

GO TO B12

CAREER, BUSINESS OR TRADE SCHOOL............... 2

GO TO B12

4-YEAR COLLEGE ...................................................... 3

GO TO B12

DON’T KNOW ............................................................. d

GO TO B12

REFUSED ................................................................... r

GO TO B12

B1=0,D, R AND B4=0,D,R
B9.

When did {he/she} last attend school or receive instruction in school subjects?
[RESPONSE MAY BE THE MONTH AND YEAR {YOUTH} LEFT SCHOOL OR HOW LONG
AGO {HE/SHE} LEFT SCHOOL. NOTE: THIS CAN INCLUDE HOME OR HOSPITAL
SCHOOLING] (NLTS D5A)
| | |/| | | |
MONTH
YEAR
(1-12) (2000-2012)

|

OR | | | MONTHS or YEARS AGO
NEVER ................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
B1 = 1 OR B4 = 1 OR B5 = 1-3 OR B9 year = 2012

B10.

Did {YOUTH} attend summer school in the summer of 2011? (NLTS D7A)
CODE ONE ONLY
YES ............................................................................. 1
NO ............................................................................... 0
IN YEAR ROUND SCHOOL ........................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

17

Parent Survey Baseline: CATI Specifications 02.08.12

ALL EXCEPT WHERE B5=2,3,7 OR B6=1 OR B8≠0
B11.

Do you expect that {YOUTH} will be enrolled in elementary, middle, junior, or senior
high school in the fall? [IF NEEDED: That is the 2012-2013 school year] (NLTS D5E)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

18

GO TO B13

Parent Survey Baseline: CATI Specifications 02.08.12

B11=0,D,R OR B8 = 1
B12.

What are {YOUTH’S} plans for the fall? [IF NEEDED: That is the 2012-2013 school
year] (NLTS D6A)

PROBE:
IF R SAYS “GO TO SCHOOL”: Does {YOUTH} plan to go to a 2-year, junior,
or community college; a 4-year college or university; a vocational or business school; a GED
program; or another kind of school or program?
CODE ALL THAT APPLY
HAS NO PLANS/JUST HANG OUT ............................ 1
LOOK FOR WORK/GET A JOB................................... 2
CONTINUE WORKING................................................ 3
GO TO A 2-YEAR, JUNIOR/COMMUNITY/
TECHNICAL COLLEGE............................................... 4
GO TO A 4-YEAR COLLEGE/UNIVERSITY ................ 5
GO TO A VOCATIONAL OR BUSINESS
SCHOOL OR JOB TRAINING PROGRAM .................. 6
GED PROGRAM ......................................................... 7
GO TO ANOTHER SCHOOL (UNSPECIFIED) ............ 8
GO TO AN ADULT DAY PROGRAM ........................... 9
GO TO AN ADULT RESIDENTIAL PROGRAM ........... 10
TRAVEL ...................................................................... 11
DO VOLUNTEER WORK ............................................ 12
GET MARRIED ............................................................ 13
HAVE A BABY ............................................................. 14
MOVE .......................................................................... 15
GET OWN APARTMENT/HOUSING
ARRANGEMENT ......................................................... 16
JOIN THE MILITARY ................................................... 17
INCARCERATED ........................................................ 18
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

19

Parent Survey Baseline: CATI Specifications 02.08.12

ALL
B13.

Since {he/she} entered kindergarten, has {he/she} ever been held back a grade in
school? (NLTS D7D)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO B14

DON’T KNOW ............................................................. d

GO TO B14

REFUSED ................................................................... r

GO TO B14

B13=1
B13a.

What grade or grades was {he/she} held back? (NLTS D7E)
CODE ALL THAT APPLY
KINDERGARTEN ........................................................ 0
FIRST GRADE ............................................................ 1
SECOND GRADE........................................................ 2
THIRD GRADE ............................................................ 3
FOURTH GRADE ........................................................ 4
FIFTH GRADE............................................................. 5
SIXTH GRADE ............................................................ 6
SEVENTH GRADE ...................................................... 7
EIGHTH GRADE ......................................................... 8
NINTH GRADE ............................................................ 9
TENTH GRADE ........................................................... 10
ELEVENTH GRADE .................................................... 11
TWELFTH GRADE ...................................................... 12
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

20

Parent Survey Baseline: CATI Specifications 02.08.12

B5≠6
B14.

Has {he/she} ever been expelled from school? (NLTS D7H REV)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO B15

DON’T KNOW ............................................................. d

GO TO B15

REFUSED ................................................................... r

GO TO B15

B14=1 OR B5 = 6
B14a.

From what grade or grades was {he/she} expelled? (NLTS D7I REV)
CODE ALL THAT APPLY
PRE-KINDERGARTEN ................................................ 98
KINDERGARTEN ........................................................ 0
FIRST GRADE ............................................................ 1
SECOND GRADE........................................................ 2
THIRD GRADE ............................................................ 3
FOURTH GRADE ........................................................ 4
FIFTH GRADE............................................................. 5
SIXTH GRADE ............................................................ 6
SEVENTH GRADE ...................................................... 7
EIGHTH GRADE ......................................................... 8
NINTH GRADE ............................................................ 9
TENTH GRADE ........................................................... 10
ELEVENTH GRADE .................................................... 11
TWELFTH GRADE ...................................................... 12
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
B15.

Did {he/she} ever have an out-of-school suspension? (NLTS D7H REV)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO B16

DON’T KNOW ............................................................. d

GO TO B16

REFUSED ................................................................... r

GO TO B16

21

Parent Survey Baseline: CATI Specifications 02.08.12

B15=1
B15a.

From what grade or grades was {he/she} suspended out of school? (NLTS D7I REV)
CODE ALL THAT APPLY
PRE-KINDERGARTEN ................................................ 98
KINDERGARTEN ........................................................ 0
FIRST GRADE ............................................................ 1
SECOND GRADE........................................................ 2
THIRD GRADE ............................................................ 3
FOURTH GRADE ........................................................ 4
FIFTH GRADE............................................................. 5
SIXTH GRADE ............................................................ 6
SEVENTH GRADE ...................................................... 7
EIGHTH GRADE ......................................................... 8
NINTH GRADE ............................................................ 9
TENTH GRADE ........................................................... 10
ELEVENTH GRADE .................................................... 11
TWELFTH GRADE ...................................................... 12
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
B16.

Has {YOUTH} been arrested in the past two years? (NLTS, U8a)
IF NEEDED: This excludes traffic citations, other citations (such as littering or loitering),
testifying, or being questioned by the police. An arrest includes being arrested with charges,
being arrested without charges, or being arrested with charges dropped. An arrest is any
time someone is taken into custody by police or legal authority.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

22

Parent Survey Baseline: CATI Specifications 02.08.12

C. PARENT INVOLVEMENT AT SCHOOL
C_INTRO

The next set of questions is about your involvement in {YOUTH}’s experience at
school. There are no right or wrong answers to these questions – only your
experiences.

ALL

C1.

Since the beginning of this school year, have you or another adult in the household
done any of the following at {YOUTH’S} school? (NLTS2, E1 - REV)
NOTE: FOR HOMESCHOOLERS, ACTIVITIES WITH OTHER HOMESCHOOLERS OR
EDUCATION GROUPS MAY BE INCLUDED HERE.

C2.

[IF C1=YES, ASK:] About how many times has that happened? Would you say 1-2
times, 3-4 times, 5-6 times, or more than that?
C1

C2

YES

NO

DK

REF

1-2
TIMES

3-4
TIMES

5-6
TIMES

MORE
THAN
5-6
TIMES

a. Attended a general school meeting, for
example, back to school night, or a
meeting of a parent-teacher
organization? ...........................................

1

0

d

r

1

2

3

4

d

r

b. Attended a school or class event, such
as a play, sports event, or science fair?
This can include visits to the school for
other children in the family who are at
this school. ..............................................

1

0

d

r

1

2

3

4

d

r

Volunteered at the school, for example,
chaperoning a class field trip, or serving
on a committee? ......................................

1

0

d

r

1

2

3

4

d

r

d. Gone to a parent/teacher conference
with {YOUTH}’s teacher? ........................

1

0

d

r

1

2

3

4

d

r

c.

DK

REF

ALL

C3.

Adults differ in how much they talk to children about school. During this school year,
did you or another adult in the household talk with {YOUTH} about {his/her}
experiences in school? Would you say… (NLTS2, E7)
Not at all, .................................................................... 0
Rarely, ........................................................................ 1
Occasionally or .......................................................... 2
Regularly? .................................................................. 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

23

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

C4.

During this school year, how often did you or another adult in the household help
{YOUTH} with {his/her} homework? Would you say… (NLTS2, E8)
Never, ......................................................................... 0
Less than once a week, ............................................. 1
1-2 times a week, ....................................................... 2
3-4 times a week, or .................................................. 3
5 or more times a week? .......................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D. ABILITIES, DISABILITIES, AND SERVICES
D_INTRO The next set of questions are about {YOUTH’S} abilities and disabilities.

ALL
D1.

Has a professional ever identified {YOUTH} as having a physical, sensory, learning, or
other disability or problem? (NLTS B1A REV)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO BOX D2 IF IEP IN SAMPLE
FILE=Y. ELSE GO TO D3

DON’T KNOW ............................................................. d

GO TO BOX D2 IF IEP IN SAMPLE
FILE=Y. ELSE GO TO D3

REFUSED ................................................................... r

GO TO BOX D2 IF IEP IN SAMPLE
FILE=Y. ELSE GO TO D3

24

Parent Survey Baseline: CATI Specifications 02.08.12

D1=1
D1a.

With what physical, sensory, learning, or other disabilities or problems has {YOUTH}
ever been identified by a professional as having? (NLTS B1A REV)
PROBE:

Any other disabilities or learning problems? That could include a speech
problem.

IF DISABILITY SPECIFIED IS NOT LISTED BELOW, PROBE: What condition was
[YOUTH] diagnosed by a professional as having?
IF NEVER HAD A DISABILITY, CODE AS “0”.
CODE ALL THAT APPLY
NEVER HAD A PROBLEM/DISABILITY .................................... 0

GO BACK - CORRECT D1

ASTHMA ...................................................................................................................................... 1
ATTENTION DEFICIT DISORDER (ADD or ADHD) ................................................................... 2
AUTISM SPECTRUM DISORDERS (AUTISTIC DISORDER,
ASPERGER’S SYNDROME, RETT’S DISORDER, PERVASIVE
DEVELOPMENTAL DISORDER, PERVASIVE DEVELOPMENTAL
DISORDER NOT OTHERWISE SPECIFIED) ............................................................................. 3
BLINDNESS (COMPLETE BLINDNESS) .................................................................................... 4
CEREBRAL PALSY ..................................................................................................................... 5
DEAFNESS ................................................................................................................................. 6
DEAFNESS AND BLINDNESS ................................................................................................... 7
DOWN SYNDROME .................................................................................................................... 8
DYSLEXIA ................................................................................................................................... 9
EMOTIONAL DISTURBANCE/BEHAVIOR
DISORDER (ED, BD, SED) ......................................................................................................... 10
HARD OF HEARING/HEARING IMPAIRMENT .......................................................................... 11
HEALTH IMPAIRMENT (SPECIFY DISEASE) ............................................................................ 12
________________________________(STRING 150)
LEARNING DISABILITY (LD) ...................................................................................................... 13
INTELLECTUAL DISABILITY ...................................................................................................... 14
PHYSICAL OR ORTHOPEDIC IMPAIRMENT ............................................................................ 15
SPEECH IMPAIRMENT/COMMUNICATION
IMPAIRMENT .............................................................................................................................. 16
SPINA BIFIDA ............................................................................................................................. 17
TRAUMATIC BRAIN INJURY (TBI) ............................................................................................. 18
VISUAL IMPAIRMENT/PARTIAL SIGHT .................................................................................... 19
DEVELOPMENTAL DELAY ........................................................................................................ 20
OTHER (SPECIFY) ..................................................................................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................................. d

GO TO BOX D2

REFUSED................................................................................... r

GO TO BOX D2

25

Parent Survey Baseline: CATI Specifications 02.08.12

D1a=1-3, 9-16, 18-20, OR 99
D1b.

Does a professional identify {YOUTH} as having any of the following disabilities now?
(NEW)

CATI: ONLY SPECIFIC DISABILITY CATEGORIES WILL BE POPULATED FOR THIS ITEM
(CATEGORIES WHICH MAY CHANGE OVER AN INDIVIDUAL’S LIFETIME). SEE SPECIFICATIONS
ABOVE SO AS TO ONLY ASK THIS QUESTION IF THE RESPONSE OPTIONS HIGHLIGHTED
BELOW WERE SELECTED IN D1a. USE THESE CATEGORIES TO POPULATE THE LIST OF
APPLICABLE RESPONSE OPTIONS FOR THIS QUESTION. THE ITEMS SHOULD NOT BE
PRESENTED IN ALL CAPS, SO AS TO ENABLE THEM TO EACH BE READ ALOUD.
CODE ALL THAT APPLY
{response category 01 FROM D1a} ................................ 1
{response category 02 FROM D1a } ............................... 2
{response category 03 FROM D1a } ............................... 3
{response category 09 FROM D1a } ............................... 4
{response category 10 FROM D1a } ............................... 5
{response category 11 FROM D1a } ............................... 6
{response category 12 FROM D1a } ................................ 7
{response category 13 FROM D1a } ................................ 8
{response category 14 FROM D1a}.................................. 9
{response category 15FROM D1a }.................................. 10
{response category 16 FROM D1a } ................................ 11
{response category 18 FROM D1a } ............................... 12
{response category 19 FROM D1a } ................................ 13
{response category 20 FROM D1a } ................................ 14
{response category 99 FROM D1a } ................................ 15
NONE OF THESE IDENTIFIED NOW ............................. 16
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

26

Parent Survey Baseline: CATI Specifications 02.08.12

D1a=1-20, 99 AND HAS >1 RESPONSE SELECTED
D1c.

Which of those disabilities or problems that you told me about is {YOUTH}’s main
problem or disability? (NLTS B1B)

CATI: POPULATE THESE RESPONSE OPTIONS ONLY WITH RESPONSE OPTIONS USING ALL CAPS (SO AS NOT READ
ALOUD) AS FOLLOWS: INCLUDE: ITEMS SELECTED IN D1A IF ANY OF THE FOLLOWING IN D1a=1 (responses: 4, 5, 6, 7,
8, 17, 99) AND FROM D1b WHERE ANY OF THE RESPONSE OPTION (1-15) = 1.

CODE ONE ONLY
ASTHMA ................................................................................. 1
ATTENTION DEFICIT DISORDER (ADD or ADHD).............. 2
AUTISM SPECTRUM DISORDERS (AUTISTIC DISORDER,
ASPERGER’S SYNDROME, RETT’S DISORDER, PERVASIVE
DEVELOPMENTAL DISORDER, PERVASIVE
DEVELOPMENTAL DISORDER NOT OTHERWISE
SPECIFIED)............................................................................ 3
BLINDNESS (COMPLETE BLINDNESS) .............................. 4
CEREBRAL PALSY ................................................................ 5
DEAFNESS ............................................................................ 6
DEAFNESS AND BLINDNESS .............................................. 7
DOWN SYNDROME .............................................................. 8
DYSLEXIA .............................................................................. 9
EMOTIONAL DISTURBANCE/BEHAVIOR
DISORDER (ED, BD, SED) .................................................... 10
HARD OF HEARING/HEARING IMPAIRMENT ..................... 11
HEALTH IMPAIRMENT (SPECIFY DISEASE) ...................... 12
________________________________(STRING 150)
LEARNING DISABILITY (LD) ................................................. 13
INTELLECTUAL DISABILITY ................................................. 14
PHYSICAL OR ORTHOPEDIC IMPAIRMENT....................... 15
SPEECH IMPAIRMENT/COMMUNICATION
IMPAIRMENT ......................................................................... 16
SPINA BIFIDA ........................................................................ 17
TRAUMATIC BRAIN INJURY (TBI)........................................ 18
VISUAL IMPAIRMENT/PARTIAL SIGHT ............................... 19
DEVELOPMENTAL DELAY ................................................... 20
OTHER (SPECIFY) ................................................................ 99
________________________________(STRING 150)

EQUALLY SEVERE..................................................... 21
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
27

Parent Survey Baseline: CATI Specifications 02.08.12
BOX D2
IF IEP FROM SAMPLE = Y AND D1=0, D, R GO TO D2_INTRO1
ELSE CONTINUE TO D2

IEP IN SAMPLE FILE (=Y) AND D1=0, D, R
D2_Intro1

Records from the school or school district indicate that at the beginning of the
school year (2011-2012), {YOUTH} received special education services. Is that
correct? (NLTSBCINTRO, REV)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO D3

DON’T KNOW ............................................................. d

GO TO D3

REFUSED ................................................................... r

GO TO D3

D2_INTRO1=1 AND ((A4=2 OR A4=3) AND A4.5≠ 1)

D2_Intro2

We’d like to complete two surveys with a staff person from {YOUTH}’s school, to
learn about special education services the school provides. The first would be
completed this year and the next one would be in 2014. Do we have your
permission to contact this staff member?
AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2

GO TO D2_INTRO3

CATI: DO NOT ALLOW DK, REF FOR THIS ITEM (D2_Intro2)

D2_intro2=1

D2_cons1.
Can you provide the name of this staff person (who is most knowledgeable about
services provided at school)?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME UNKNOWN, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d
REFUSED TO PROVIDE NAME
r

28

GO TO D2_INTRO3
GO TO D2_INTRO3

Parent Survey Baseline: CATI Specifications 02.08.12
D2_intro2=1

D2_cons2.

Can you provide us with this person’s email address?
YES – SPECIFY: _________ (STRING 200 CHAR) .... 1
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D2_INTRO1=1
D2_Intro3

What did {YOUTH} receive special education services for?
ASTHMA ................................................................................. 1
ATTENTION DEFICIT DISORDER (ADD or ADHD).............. 2
AUTISM SPECTRUM DISORDERS (AUTISTIC DISORDER,
ASPERGER’S SYNDROME, RETT’S DISORDER, PERVASIVE
DEVELOPMENTAL DISORDER, PERVASIVE
DEVELOPMENTAL DISORDER NOT OTHERWISE
SPECIFIED)............................................................................ 3
BLINDNESS (COMPLETE BLINDNESS) .............................. 4
CEREBRAL PALSY ................................................................ 5
DEAFNESS ............................................................................ 6
DEAFNESS AND BLINDNESS .............................................. 7
DOWN SYNDROME .............................................................. 8
DYSLEXIA .............................................................................. 9
EMOTIONAL DISTURBANCE/BEHAVIOR
DISORDER (ED, BD, SED) .................................................... 10
HARD OF HEARING/HEARING IMPAIRMENT ..................... 11
HEALTH IMPAIRMENT (SPECIFY DISEASE) ...................... 12
________________________________(STRING 150)
LEARNING DISABILITY (LD) ................................................. 13
INTELLECTUAL DISABILITY ................................................. 14
PHYSICAL OR ORTHOPEDIC IMPAIRMENT....................... 15
SPEECH IMPAIRMENT/COMMUNICATION
IMPAIRMENT ......................................................................... 16
SPINA BIFIDA ........................................................................ 17
TRAUMATIC BRAIN INJURY (TBI)........................................ 18
VISUAL IMPAIRMENT/PARTIAL SIGHT ............................... 19
DEVELOPMENTAL DELAY ................................................... 20
OTHER (SPECIFY) ................................................................ 99
________________________________(STRING 150)
DON’T KNOW......................................................................... d
REFUSED............................................................................... r
29

Parent Survey Baseline: CATI Specifications 02.08.12

D1=1
D2.

As of the beginning of the 2011-12 school year, did {YOUTH} receive special
education services for… (NLTS B1C, rev)
YES

NO

NEVER
DID

DK

REF

a.

{response category 01 FROM D1c}

1

0

99

d

r

b.

{ response category 02 FROM D1c}

1

0

99

d

r

c.

{ response category 03 FROM D1c}

1

0

99

d

r

d.

{ response category 04 FROM D1c}

1

0

99

d

r

e.

{ response category 05 FROM D1c}

1

0

99

d

r

f.

{ response category 06 FROM D1c}

1

0

99

d

r

g.

{ response category 07 FROM D1c}

1

0

99

d

r

h.

{ response category 08 FROM D1c}

1

0

99

d

r

i.

{ response category 09 FROM D1c}

1

0

99

d

r

j.

{ response category 10 FROM D1c}

1

0

99

d

r

k.

{ response category 11 FROM D1c}

1

0

99

d

r

l.

{ response category 12 FROM D1c}

1

0

99

d

r

m.

{ response category 13 FROM D1c}

1

0

99

d

r

n.

{ response category 14 FROM D1c}

1

0

99

d

r

o.

{ response category 15 FROM D1c}

1

0

99

d

r

p.

{ response category 16 FROM D1c}

1

0

99

d

r

q.

{ response category 17 FROM D1c}

1

0

99

d

r

r.

{ response category 18 FROM D1c}

1

0

99

d

r

s.

{ response category 19 FROM D1c}

1

0

99

d

r

t.

{ response category 20 FROM D1c}

1

0

99

d

r

u.

{ response category 99 FROM D1c}

1

0

99

d

r

D2 ANY PART A-U = 1 AND IN SAMPLE FILE= N

D2.5

We’d like to complete two surveys with a staff person from {YOUTH}’s school, to
learn about special education services the school provides. The first would be
completed this year and the next one would be in 2014. Do we have your
permission to contact this staff member?
AGREED - CONTINUE ................................................ 1
DISAGREE / DECLINES THIS PORTION ................... 2

CATI: DO NOT ALLOW DK, REF FOR THIS ITEM (D2.5)

30

GO TO D4

Parent Survey Baseline: CATI Specifications 02.08.12
D2.5=1

D2.5_cons1. Can you provide the name of this staff person (who is most knowledgeable about
services provided at school)?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME UNKNOWN, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d

REFUSED TO PROVIDE NAME

r

GO TO D4

GO TO D4

D2.5=1

D2_cons2.

Can you provide us with this person’s email address?
YES – SPECIFY: _________ (STRING 200 CHAR) .... 1

GO TO D4

DON’T KNOW ............................................................. d

GO TO D4

REFUSED ................................................................... r

GO TO D4

(D2= 0, 99, d, r for all items populated a-u) OR (D2_INTRO1 = 0, D, R) OR (IEP=N AND D1=0,D,R
D3.

Did {YOUTH} ever receive special education services or have an IEP (Individualized
Education Program)? (NEW)
IF NEEDED: “IEP” stands for an Individualized Education Program. An IEP is a written
statement for each student with a disability that sets goals for the student in
school, says how progress will be measured, describes the special education
and related services the school will provide, how much the student will be in
the regular class with nondisabled students, and lists accommodations or
modifications needed to measure what the student knows through tests. After
a student turns 16, the IEP must also include goals for what the student will
do after high school and services needed to help the student reach those
goals.
YES ............................................................................. 1
NO ............................................................................... 0

GO TO D6

DON’T KNOW ............................................................. d

GO TO D6

REFUSED ................................................................... r

GO TO D6

31

Parent Survey Baseline: CATI Specifications 02.08.12

(D1 = 1) OR (D2_INTRO1=1) OR (D2 = 1 FOR ANY CATEGORY) OR (D3=1)
D4.

At what point in {YOUTH}’s life did it become apparent that {he/she} had a disability,
problem, or condition?
IF NEEDED: About how old was {YOUTH} when {he/she} started having this difficulty
or condition? (NLTS B2A, REV)
IF NEEDED: If it’s easier to remember {YOUTH’s} grade level at that time, please give
me that information. IF RESPONDENT SAYS, LESS THAN 1 YEAR OLD,
THEN SELECT AGE AND THEN ENTER “0”. SELECT GRADE LEVEL AND
USE 0 FOR KINDERGARTEN AND 98 FOR PRE-KINDERGARTEN
|

|

| AGE (0-21)

|

|

| GRADE LEVEL (0-13, 98)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D2_INTRO1=1 OR D2 = 1 FOR ANY CATEGORY OR D3 =1
D4a.

About how old was {YOUTH} when {he/she} started receiving special education
services from a professional? (NEW)
[IF NEEDED: If it’s easier to remember {HIS/HER} grade level at that time, please give
me that information. IF RESPONDENT SAYS, LESS THAN 1 YEAR OLD,
THEN SELECT AGE AND THEN ENTER “0”. SELECT GRADE LEVEL AND
USE 0 FOR KINDERGARTEN AND 98 FOR PRE-KINDERGARTEN
|

|

| AGE (0-21)

|

|

| GRADE LEVEL (0-13, 98)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D3=1

D5.

As of the beginning of the 2011-12 school year, did {YOUTH} still receive special
education services and have an IEP? (NEW)
YES ............................................................................. 1

GO TO D6

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO D6

REFUSED ................................................................... r

GO TO D6

32

Parent Survey Baseline: CATI Specifications 02.08.12

(D5=0)
D5a.

About how old was {YOUTH} when the IEP and special education services ended?
(NEW)
[IF NEEDED: If it’s easier to remember the YOUTH’s grade level at that time, please
give me that information. IF RESPONDENT SAYS, LESS THAN 1 YEAR
OLD, THEN SELECT AGE AND THEN ENTER “0”. SELECT GRADE LEVEL
AND USE 0 FOR KINDERGARTEN AND 98 FOR PRE-KINDERGARTEN
|

|

| AGE (0-21)

|

|

| GRADE LEVEL (0-13, 98)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
(D5=0) OR (D2a-u (any item) = 0 FOR ALL)
D5b.

Why is {he/she} no longer receiving special education services? (NLTS D8B REV)
CODE ALL THAT APPLY
NO LONGER NEEDS SPECIAL SERVICES ............... 1
MET IEP GOALS ......................................................... 2
YOUTH WAS DECLASSIFIED, SCHOOL SAYS
NO LONGER NEEDS SERVICES ............................... 3
NO LONGER ELIGIBLE, DOESN’T QUALIFY ............. 4
SCHOOL DOESN’T HAVE THE PROGRAMS
{YOUTH} NEEDS ........................................................ 5
PARENT DOESN’T WANT YOUTH IN SPECIAL
EDUCATION ............................................................... 6
YOUTH DID NOT WANT TO BE IN SPECIAL
EDUCATION ............................................................... 7
YOUTH NOW HAS A 504 PLAN.................................. 8 GO TO D6a
DOESN’T THINK YOUTH EVER WAS IN
SPECIAL EDUCATION ............................................... 9
YOUTH HOME SCHOOLED BY PARENT................... 10
YOUTH NO LONGER IN SCHOOL ............................. 11
OTHER (SPECIFY) ..................................................... 99
________________________________ (STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

33

Parent Survey Baseline: CATI Specifications 02.08.12

ALL - EXCEPT D5b=8
D6.
Has {he/she} ever had a Section 504 plan? (NEW)
PROBE:

A Section 504 plan, which falls under civil-rights law, removes barriers so
students with disabilities can participate in school as freely as possible. This may
include students who do not need an IEP but may need extra help or assistance
to participate fully in school. Such help may include more time on tests, or sitting
in the front of the classroom. An IEP is more concerned with providing
educational services.

YES ............................................................................. 1
NO ............................................................................... 0

GO TO D7_INTRO

DON’T KNOW ............................................................. d

GO TO D7_INTRO

REFUSED ................................................................... r

GO TO D7_INTRO

D6=1 or D5b=8
D6a.

About how old was {YOUTH} when the Section 504 plan began? (NEW)
[IF NEEDED: If it’s easier to remember {YOUTH}’s grade level at that time, please give
me that information. IF RESPONDENT SAYS, LESS THAN 1 YEAR OLD,
THEN SELECT AGE AND THEN ENTER “0”. SELECT GRADE LEVEL AND
USE 0 FOR KINDERGARTEN AND 98 FOR PRE-KINDERGARTEN
|

|

| AGE (0-21)

|

|

| GRADE LEVEL (0-13, 98)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D6=1 or D5b=8
D6b.

As of the beginning of the 2011-12 school year, did {he/she} still have a Section 504
plan? (NEW)
YES ............................................................................. 1

GO TO D7_INTRO

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO D7_INTRO

REFUSED ................................................................... r

GO TO D7_INTRO

34

Parent Survey Baseline: CATI Specifications 02.08.12

D6b=0
D6c.

About how old was {YOUTH} when the Section 504 plan ended? (NEW)
[IF NEEDED: If it’s easier to remember {YOUTH}’s grade level at that time, please give
me that information. IF RESPONDENT SAYS, LESS THAN 1 YEAR OLD,
THEN SELECT AGE AND THEN ENTER “0”. SELECT GRADE LEVEL AND
USE 0 FOR KINDERGARTEN AND 98 FOR PRE-KINDERGARTEN
|

|

| AGE (0-21)

|

|

| GRADE LEVEL (0-98)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D6b=0
D6d.

Why does {he/she} no longer have a Section 504 plan? (NLTS D8B REV)
CODE ALL THAT APPLY
NO LONGER NEEDS ACCOMMODATIONS .............. 1
SCHOOL SAYS NO LONGER NEEDS
ACCOMMODATIONS.................................................. 2
NO LONGER ELIGIBLE, DOESN’T QUALIFY ............. 3
PARENT DOESN’T WANT YOUTH TO RECEIVE
ACCOMMODATIONS.................................................. 4
YOUTH DOES NOT WANT TO RECEIVE
ACCOMMODATIONS.................................................. 5
YOUTH CHANGED SCHOOLS (DID NOT
REQUEST SPECIAL SERVICES OR NEW
SCHOOL DID NOT IDENTIFY [YOUTH] AS
NEEDING SPECIAL SERVICES) ................................ 6
DOESN’T THINK YOUTH EVER HAD A 504
PLAN ........................................................................... 7
YOUTH HOME SCHOOLED BY PARENT................... 8
YOUTH NO LONGER IN SCHOOL ............................. 9
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

35

Parent Survey Baseline: CATI Specifications 02.08.12

ALL
D7_INTRO.
D7.

Now I want to ask you about how well {YOUTH} does some things.

First, I’ll ask about {YOUTH’s} vision. Wearing glasses or contacts if {he/she} uses
them, how well does {YOUTH } see? (NLTS B3C rev)
CODE ONE ONLY
Sees normally, ........................................................... 1 GO TO D9_INTRO
has a little trouble seeing, ......................................... 2 GO TO D9_INTRO
has a lot of trouble seeing, or ................................... 3
doesn’t see at all?...................................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D7=3,4,D,R
D8.

Does {YOUTH} use… (NLTS B3D)
YES

NO

DK

REF

a. Braille? ..........................................................................................................

1

0

d

r

b. IF D8 PART = 1, ASK: A portable Braille note taker or writer? ....................

1

0

d

r

c.

Large print type? ...........................................................................................

1

0

d

r

d. Optical devices, such as near vision magnification, telescopic devices, or
bioptic lenses? ..............................................................................................

1

0

d

r

e. Mobility devices, such as a cane, or electronic travel aids? .........................

1

0

d

r

Assistive technology, such as voice synthesizers or software to enlarge the
size of the print on the computer screen? .....................................................

1

0

d

r

g. Any other devices to help {him/her} see or read? SPECIFY ........................

1

0

d

r

f.

_________________________(CATI: STRING 150 CHAR)

ALL
D9.

Would you say {YOUTH}…
[IF NEEDED:

This assessment should be made of {YOUTH’s} hearing without any
hearing devices like a hearing aid.] (NLTS B4A)
CODE ONE ONLY

Hears normally, or ..................................................... 1

GO TO D17

Has a hearing problem? ............................................ 0
DON’T KNOW ............................................................. d

GO TO D17

REFUSED ................................................................... r

GO TO D17

36

Parent Survey Baseline: CATI Specifications 02.08.12

D9=0
D10.

Is {YOUTH}’s hearing loss… (NLTS B4B)

CODE ONE ONLY

Mild, ............................................................................ 1
Moderate, or ............................................................... 2
Severe to profound?.................................................. 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D9=0
D11.

Has a hearing aid or other kind of hearing device been prescribed for {him/her}?
(NLTS B4C)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO D12

DON’T KNOW ............................................................. d

GO TO D12

REFUSED ................................................................... r

GO TO D12

D11=1
D11a.

How well does {YOUTH} hear with the hearing device? Would you say {he/she}…
(NLTS B4D)
CODE ONE ONLY
Hears normally, .......................................................... 1
Has a little trouble hearing, ....................................... 2
Has a lot of trouble hearing, or ................................. 3
Doesn’t hear at all?.................................................... 4
DOES NOT HAVE ONE............................................... 5
WILL NOT WEAR IT .................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D9 = 0
D12.

Does {YOUTH} have a cochlear implant?
IF NEEDED: A cochlear implant is a surgically implanted electronic device that can
restore partial hearing to people with some hearing impairments. (NLTS B4E)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
37

Parent Survey Baseline: CATI Specifications 02.08.12

D9 = 0
{YOUTH} first name from SAMPLE FILE:

D13.

How well does {YOUTH} communicate by any means? Would you say {he/she}…
(NLTS B4F)
CODE ONE ONLY
Has no trouble communicating, ............................... 1
Has a little trouble communicating,.......................... 2
Has a lot of trouble communicating, or .................... 3
Doesn’t communicate at all? .................................... 4

GO TO D16

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D13 ≠ 4
D13a.

Now I’d like to ask about ways that {he/she} may communicate. Does {YOUTH} use…
(NLTS B4G)
YES

NO

DK

REF

a. Sign language or manual communication? ..........................................

1

0

d

r

b. Lip reading? .........................................................................................

1

0

d

r

c.

Cued speech? ......................................................................................

1

0

d

r

d. Oral speech [TALKING]? .....................................................................

1

0

d

r

e. A communication board or book? .......................................................

1

0

d

r

f.

1

0

d

r

Anything else to help {him/her} communicate? SPECIFY ...................
______________________________________________________
BOX D14

IF D13A PART D= 1 GO TO D14. ELSE GO TO D16.

D13A PART D= 1

D14.

How clearly does {YOUTH} speak? Would you say {he/she}… (NLTS B4H)
CODE ONE ONLY
Has no trouble speaking clearly, .............................. 1
Has a little trouble speaking, .................................... 2
Has a lot of trouble speaking, or .............................. 3
Does not speak at all? ............................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

38

Parent Survey Baseline: CATI Specifications 02.08.12
D14

≠4

D15.

How well does {he/she} carry on an oral conversation? Would you say {he/she}…
(NLTS B4I, rev)
CODE ONE ONLY
Has no trouble carrying on an oral conversation, ................ 1
Has a little trouble carrying on an oral conversation, .......... 2
Has a lot of trouble carrying on an oral conversation,
or.............................................................................................. 3
Doesn’t carry on an oral conversation at all?....................... 4
DON’T KNOW .......................................................................... d
REFUSED ................................................................................ r

D9=0

D16.

How well does {YOUTH} understand what people say to {him/her}? Would you say
{he/she}… (NLTS B4J)
CODE ONE ONLY
Has no trouble understanding what others say, ..... 1
Has a little trouble understanding, ........................... 2
Has a lot of trouble understanding, or ..................... 3
Doesn’t understand at all? ........................................ 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX D17

THIS LOGIC SEPARATES THOSE WHO HAVE HEARING IMPAIRMENTS FROM THOSE WHO DO NOT. THOSE WITH HEARING
IMPAIRMENTS CONTINUE WITH D19, PHYSICAL ABILITIES. IF D9 = 0, GO TO D19. ELSE GO TO D17.

D9=1,D,R
D17.

My next questions are about {YOUTH’s} ability to use language. How clearly does
{he/she} speak? Would you say {he/she}… (NLTS B5A)
CODE ONE ONLY
Has no trouble speaking clearly, .............................. 1

GO TO D18

Has a little trouble speaking, .................................... 2

GO TO D18

Has a lot of trouble speaking, or .............................. 3
Does not speak at all? ............................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

39

Parent Survey Baseline: CATI Specifications 02.08.12

D17=3,4,D,R
D17a.

How well does {YOUTH} communicate by any means? Would you say {he/she}…
(NLTS B5B)
CODE ONE ONLY
Has no trouble communicating, ............................... 1
Has a little trouble communicating,.......................... 2
Has a lot of trouble communicating, or .................... 3
Doesn’t communicate at all? .................................... 4

GO TO D18a

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
D17=3,4,D,R AND D17A ≠ 4
D17b.

Now I’d like to ask about ways that {he/she} may communicate with you. Does
{YOUTH} use… (NLTS B5C)
YES

NO

DK

REF

a. Words? .....................................................................................................

1

0

d

r

b. Sounds that are not words? .....................................................................

1

0

d

r

c.

Gestures, including pointing? ...................................................................

1

0

d

r

d. Sign language? ........................................................................................

1

0

d

r

e. A communication board or book? ............................................................

1

0

d

r

f.

A computer to communicate with you? ....................................................

1

0

d

r

g. Anything else to help {him/her} communicate? SPECIFY .......................

1

0

d

r

________________________(CATI: STRING 150 CHAR)

D17A ≠ 4
D18.

How well does {he/she} carry on a conversation? Would you say {he/she}… (NLTS
B4I)
CODE ONE ONLY
Has no trouble carrying on a conversation, ............ 1
Has a little trouble carrying on a conversation,....... 2
Has a lot of trouble carrying on a conversation, or . 3
Doesn’t carry on a conversation at all? ................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

40

Parent Survey Baseline: CATI Specifications 02.08.12

D9=1,D,R
D18a.

How well does {YOUTH} understand what people say to {him/her}? Would you say
{he/she}… (NLTS B4J)
CODE ONE ONLY
Has no trouble understanding what others say, ..... 1
Has a little trouble understanding, ........................... 2
Has a lot of trouble understanding, or ..................... 3
Doesn’t understand at all? ........................................ 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
D19.

How well does {YOUTH} use both of {his/her} arms and hands? Would you say {he/she}
uses both arms and hands normally?
IF NEEDED: If there is a difference for either arm or hand, refer to the side on which
(YOUTH) is experiencing the most difficulty. Do not include temporary difficulties, such as
a broken arm. (NLTS B6C, REV)
IF YOUTH IS MISSING A HAND OR ARM CODE AS 2
YES ............................................................................. 1

GO TO D20

NO ............................................................................... 0
HAS NO USE OF ONE OR BOTH HANDS OR
ARMS .......................................................................... 2

GO TO D20

DON’T KNOW ............................................................. d

GO TO D20

REFUSED ................................................................... r

GO TO D20

D19=0
D19a.

Can {YOUTH} use {his/her} arms and hands normally for things like using a spoon or
holding a pencil? (NLTS B6A, REV)
IF NEEDED: If there is a difference for either arm or hand, refer to the side on which
[YOUTH] is experiencing the most difficulty. Do not include temporary difficulties,
such as a broken arm.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

41

Parent Survey Baseline: CATI Specifications 02.08.12

D19=0
D19b.

Can {he/she} use {his/her} arms and hands normally for things like throwing, lifting,
or carrying? IF NEEDED: If there is a difference for either arm or hand, refer to the
side on which (YOUTH) is experiencing the most difficulty. Do not include temporary
difficulties, such as a broken arm. (NLTS B6B, REV)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
D20.

How well does {YOUTH} use both of {his/her} legs and feet? Would you say {he/she} uses
both legs and feet normally? IF NEEDED: If there is a difference for either leg or foot, refer
to the side on which (YOUTH) is experiencing the most difficulty. Do not include
temporary difficulties, such as a broken leg. (NLTS B6C)
YES ............................................................................. 1

GO TO D21

NO ............................................................................... 0
HAS NO USE OF ONE OR BOTH LEGS OR
FEET ........................................................................... 2
DON’T KNOW ............................................................. d

GO TO D21

REFUSED ................................................................... r

GO TO D21

D20=0, 2
D20a.

Does {he/she} use any equipment to help {him/her} get around, such as crutches, a
wheelchair, or prosthetics? (NLTS B6D, rev)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO D21

DON’T KNOW ............................................................. d

GO TO D21

REFUSED ................................................................... r

GO TO D21

42

Parent Survey Baseline: CATI Specifications 02.08.12

D20a=1
D20b.

What is the equipment {he/she} uses to get around? (NLTS B6E)
CODE ALL THAT APPLY
CRUTCHES................................................................. 1
WALKER ..................................................................... 2
LEG BRACES.............................................................. 3
WHEELCHAIR............................................................. 4
CANE .......................................................................... 5
PROSTHETICS ........................................................... 6
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
D21.

Now I have some questions about {YOUTH}’s health. Would you say {his/her} general
health is… (NLTS B7A)
CODE ONE ONLY
Excellent, .................................................................... 1
Very good, .................................................................. 2
Good, .......................................................................... 3
Fair, or ........................................................................ 4
Poor? .......................................................................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
D22.

Does {YOUTH} have a chronic physical or mental health condition that requires
regular treatment or medical care? (NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

43

Parent Survey Baseline: CATI Specifications 02.08.12

ALL
D22a.

Is most of {his/her} health care currently provided by a pediatrician or an adult care
physician or specialist? (CSHCN)

IF NEEDED: A pediatrician is a doctor who generally treats children under the age of 18.
PEDIATRICIAN OR PEDIATRIC SPECIALIST ............ 1
ADULT CARE PHYSICIAN OR SPECIALIST .............. 2

GO TO D23

DON’T KNOW ............................................................. d

GO TO D23

REFUSED ................................................................... r

GO TO D23

D22a = 1
D22b.

(Has/Have) [YOUTH]’s doctor(s) or other health care provider(s) talked with you or
[YOUTH] about how {his/her} health care needs might change when {he/she}
becomes an adult? (CSHCN)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
D23.

Is {he/she} taking any prescription medicine that controls {his/her} attention, behavior, or
activity level, or changes {his/her} mood, such as Ritalin or an antidepressant? (NLTS
B7C)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX D24
IF D21=1 (DESCRIBE YOUTH’S HEALTH AS EXCELLENT), GO TO BOX D25. ELSE GO TO D24.

D21 ≠ 1
D24.

Does {YOUTH} use any kind of medical equipment or device, like an oxygen tank or a
catheter? This does not include mobility devices, like a wheelchair, walker, or cane.
(NLTS B7F)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

44

Parent Survey Baseline: CATI Specifications 02.08.12
BOX D25
IF (D1A = 3,4,5,7,8,12,14,15,17-20,99) OR (D2_INTRO3 = 3,4,5,7,8,12,14,15,17-20,99 (AUTISM, BLINDNESS OR VISUAL
IMPAIRMENT, CP, DEVELOPMENTAL DELAY, DOWN SYNDROME, HEALTH IMPAIRMENT, INTELLECTUAL DISABILITY,
PHYSICAL OR ORTHOPEDIC IMPAIRMENT, SPINA BIFIDA, TBI, OR MULTIPLE) GO TO D25.
ELSE, GO TO D26.
(D1A = 3,4,5,7,8,12,14,15,17-20,99) OR D2_INTRO3 = 3,4,5,7,8,12,14,15,17-20,99 (AUTISM, BLINDNESS OR VISUAL
IMPAIRMENT, CP, DEVELOPMENTAL DELAY, DOWN SYNDROME, HEALTH IMPAIRMENT, INTELLECTUAL
DISABILITY, PHYSICAL OR ORTHOPEDIC IMPAIRMENT, SPINA BIFIDA, TBI, OR MULTIPLE)

D25.

How well does {YOUTH}…READ EACH ITEM …on {his/her} own, without help? Would
you say {he/she} does it very well, pretty well, not very well, or not at all well? (NLTS
G3, REV)
IF NEEDED: Reminders, prompts, and supervision are considered “help.”
VER
Y
WEL
L

PRETT
Y
WELL

NOT
VERY
WELL

NOT
AT
ALL
WELL

NOT
ALLOWE
D

DK

REF

a. Dress {himself/herself} completely ................

1

2

3

4

5

d

r

b. Feed {himself/herself} completely .................

1

2

3

4

5

d

r

Read and understand common signs, like
Stop, Men, Women, or Danger .....................

1

2

3

4

5

d

r

d. Count change or ensure {he/she} is given
proper change when making a purchase ......

1

2

3

4

5

d

r

e. Look up telephone numbers and use the
telephone.......................................................

1

2

3

4

5

d

r

c.

ALL
D26.

How well does{YOUTH} do each of the following items on {his/her} own, without
help? READ STATEMENTS. CODE ONE RESPONSE FOR EACH.
Would you say {he/she} does it very well, pretty well, not very well, or not at all well?
(NLTS G4, rev)
IF NEEDED: Reminders, prompts, and supervision are considered “help.”

VERY
WELL

PRETTY
WELL

NOT
VER
Y
WEL
L

a. Use an ATM or cash machine ..................

1

2

3

4

5

d

r

b. Make appointments, such as with a
doctor, dentist, or potential employer .......

1

2

3

4

5

d

r

1

2

3

4

5

d

r

c.

Get to places outside the home, like to
school, to a nearby store or park, or to a
neighbor’s house ......................................

45

NOT
AT
ALL
WELL

NOT
ALL
OW
ED

DK

REF

Parent Survey Baseline: CATI Specifications 02.08.12

ALL
D27.

When the following chores need doing, about how often, on {his/her} own, does
{he/she}… READ STATEMENTS. CODE ONE RESPONSE FOR EACH. Would you say
always, usually, sometimes, or never? (NLTS G5)
IF NEEDED: Reminders, prompts, and supervision are considered “help.”
ALWAYS

USUALLY

SOMETIM
ES

NEVER

DK

REF

a. Fix {his/her} own breakfast or lunch? ...

1

2

3

4

d

r

b. Do laundry? ..........................................

1

2

3

4

d

r

Straighten up {his/her} own room or
living area? ...........................................

1

2

3

4

d

r

d. Buy a few things at the store {he/she}
needs?..................................................

1

2

3

4

d

r

c.

BOX D28

IF D5 = 1 OR D6B = 1 OR D2INTRO_1 = 1 OR D2 ANY PART A-U = 1, GO TO D28.
ELSE IF D1=1 OR D2_INTRO1=1 OR D3=1 OR D6 = 1, GO TO D31.
ELSE, GO TO D32.

D5 = 1 OR D6B = 1 OR D2INTRO_1 = 1 OR D2 ANY PART A-U =1
D28.

The next questions are about assistive technology. Assistive technology is any object,
piece of equipment, or product that is used to increase, maintain, or improve functional
capabilities of individuals with disabilities. Does {YOUTH} use any assistive technology
at school? (NEW)
PROBE:

Assistive technology is not only computers. The equipment can be shared
with others. Usually the need for assistive technology is written in an IEP.

YES ............................................................................. 1
NO ............................................................................... 0

GO TO D31

DON’T KNOW ............................................................. d

GO TO D31

REFUSED ................................................................... r

GO TO D31

D28 = 1
D29.

What technology does {YOUTH} use? What is the device called? If {YOUTH} uses
more than one device, please tell us about the one specified in {his/her} IEP or that is
most important for {YOUTH}’s education. (NEW)
________________________________(STRING 150)
USE AS REFERENCE IN QUESTIONS THAT FOLLOW
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
46

Parent Survey Baseline: CATI Specifications 02.08.12

D28 = 1
D30.

Does {YOUTH} bring the [FILL DEVICE FROM D29] home?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO D31

DON’T KNOW ............................................................. d

GO TO D31

REFUSED ................................................................... r

GO TO D31

D30=1
D30a.

Was someone in the household trained on using, or helping {YOUTH} use, the [FILL
DEVICE FROM D29]?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D1=1 OR D2INTRO1 =1 OR D3=1 OR D6 = 1
D31.

During the past 12 months, has {YOUTH} received any of the following
accommodations or services through school? (NLTS H1A REV and teacher B8 REV)
YES

NO

DK

REF

a. More time in taking tests ........................................................................................

1

0

d

r

b. Modified tests or alternate tests or assessments ...................................................

1

0

d

r

c.

Additional time to complete assignments...............................................................

1

0

d

r

d. Shorter or different assignments ............................................................................

1

0

d

r

e. Teacher’s aide, instructional assistant, or other personal aide or assistant ..........

1

0

d

r

f.

Books on tape, CD, in Braille, large print, or in another alternate format ..............

1

0

d

r

g. Use of a computer or calculator for activities not allowed other students ..............

1

0

d

r

h. Reader or interpreter, including sign language ......................................................

1

0

d

r

i.

Tutor .......................................................................................................................

1

0

d

r

j.

Psychological or mental health services or counseling .........................................

1

0

d

r

k.

Speech or language therapy, or communication services .....................................

1

0

d

r

l.

Audiology services for hearing problems ...............................................................

1

0

d

r

m. Vision services, such as Braille instruction ............................................................

1

0

d

r

n. Physical or occupational therapy ...........................................................................

1

0

d

r

o. Orientation and mobility services (to help individuals navigate their environment)

1

0

d

r

p. Nursing care ...........................................................................................................

1

0

d

r

q. Special transportation because of disability ...........................................................

1

0

d

r

r.

1

0

d

r

Other accommodations or services through school SPECIFY_____ (STRING 100)

47

Parent Survey Baseline: CATI Specifications 02.08.12

(B2 OR B4A = 9-13) OR ((AGE IN A12 OR A12A >= 14) AND (B2 OR B4A = 0,14,99))
D32.

I am going to read a list of programs and services schools may offer to help students
prepare for life after high school. For each, please tell me whether or not [YOUTH] has
taken part during this school year (2011-2012).
Has {he/she} taken part in a program or service that provides … (NEW)
YES

NO

DK

REF

a. Catch-up courses or double-dosing of classes during the regular school day?

1

0

d

r

b. Supplemental instruction or tutoring in academic subjects before or after school? .....

1

0

d

r

c.

Supplemental instruction or tutoring in academic subjects on weekends? ..................

1

0

d

r

d. ASK IF (B2 OR B4A = 10-13) OR ((AGE IN A12 OR A12A >= 15) AND (B2 OR B4A =
0,14,99)): Help with signing up for standardized college entrance tests—reminders,
aid with test taking fees, prep courses? ........................................................................

1

0

d

r

e. ASK IF (B2 OR B4A = 11-13) OR ((AGE IN A12 OR A12A >= 16) AND (B2 OR B4A =
0,14,99)): Help with financial aid forms, comparing financial aid packages? .................

1

0

d

r

1

0

d

r

1

0

d

r

1

0

d

r

f.

ASK IF D5 = 1 OR

D2INTRO_1 = 1 OR D2 ANY PART A-U =1: Help

connecting students to outside transition services, supports, or activities (e.g.,
tutoring, mentoring, transportation, assistive technology, networking)?

g. ASK IF (D5 = 1 OR

D2INTRO_1 = 1 OR D2 ANY PART A-U =1) AND ((B2
OR B4A = 11-13) OR ((AGE IN A12 OR A12A >= 17) AND (B2 OR B4A = 0,14,99))): Help

with connecting to adult residential providers and day services? .................................
h. ASK IF D5 = 1 OR D2INTRO_1 = 1 OR D2 ANY PART A-U =1: Help
developing capability to dress, clean, care for self .......................................................

D5=1 OR D6B=1 OR ANY ITEM D2A-U=1 OR D2_INTRO1 = 1

D33.

As {YOUTH}’s parent or guardian, during this school year, have you received any
classes or counseling on [YOUTH]’s rights and responsibilities under disabilityrelated laws? (NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

48

Parent Survey Baseline: CATI Specifications 02.08.12

E. EXPERIENCE WITH THE IEP, 504 PLAN, AND SCHOOL SUPPORTS

BOX E1
IF D5 = 1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1 , GO TO E1. ELSE, GO TO F_INTRO.

D5=1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1
E1.

During this or last school year, did you or another adult in the household go to a
meeting about an Individualized Education Plan, or IEP, for {YOUTH’S} special
education program or services? (NLTS E2A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D5=1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1
E1a.

During this or last school year, did {YOUTH} go to {that same / a} meeting about an
Individualized Education Program, or IEP, for {his/her} special education program or
services? (NLTS E2B REV)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX E1B
IF E1 ≠ 1 AND E1A ≠ 1, GO TO E1B. ELSE GO TO E2.

E1=0,D,R AND E1a=0,D,R
E1b.

Has there been an IEP meeting about {YOUTH’S} special education program or
services this or last year? (NLTS E4A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

49

Parent Survey Baseline: CATI Specifications 02.08.12

(D5=1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1) AND (AGE FROM A12 OR A12A >= 16)
E2.

Have you or another adult in the household met with teachers to set goals for what
{YOUTH} will do after high school and make a plan for how {he/she} will achieve
them? Sometimes this is called a transition plan or a transition focused IEP. (NLTS
E2C, REV)
YES ............................................................................. 1

GO TO E4

NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
E2 = 0,D,R
E3.

To the best of your knowledge, did [YOUTH]’s high school have a “transition
planning” meeting to help [YOUTH] plan what {he/she} might do after high school?
(NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

(D5=1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1) AND (AGE FROM A12 or A12a >= 16)
E4.

Did the school mostly come up with the goals on {his/her} IEP {and transition plan} or
was it mostly you or {YOUTH} who came up with the goals? CAN READ CATEGORIES.
(NLTS E3A)
CODE ONE ONLY
MOSTLY SCHOOL ...................................................... 1
MOSTLY RESPONDENT OR OTHER ADULT ............ 2
MOSTLY YOUTH ........................................................ 3
SCHOOL AND YOUTH EQUALLY .............................. 4
SCHOOL AND RESPONDENT OR OTHER ADULT
EQUALLY .................................................................... 5
YOUTH AND RESPONDENT OR OTHER ADULT
EQUALLY .................................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

50

Parent Survey Baseline: CATI Specifications 02.08.12

(D5=1 OR D2_INTRO1 =1 OR ANY ITEM D2A-U=1) and age from A12 or A12a >= 16
E5.

Which of the following best describes {YOUTH’S} role in {his/her} {IEP and transition
planning /IEP planning}? (NLTS E3B)
CODE ONE ONLY
{He/She} did not participate ...................................... 1
{He/She} was present in discussions but
participated very little or not at all ............................ 2
{He/She} provided some input .................................. 3
{He/She} took a leadership role (helping set the
direction of the discussions, goals and plans)........ 4
DOESN’T KNOW ABOUT ANY GOALS ...................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

E2 = 1 OR E3=1 and

E6.

age from A12 or A12a >= 16

The next set of questions are about the transition planning meeting:
YES

NO

DK

REF

a.

Were you invited to that meeting? ........................................................

1

0

d

r

b.

Was [YOUTH] invited to that meeting? .................................................

1

0

d

r

c.

Were [YOUTH]’s interests, strengths, and preferences discussed at
that meeting? ........................................................................................

1

0

d

r

d.

Did staff from any community service agency, such as vocational
rehabilitation services, take part in that meeting? ................................

1

0

d

r

e.

Was [YOUTH] given information on education, careers, or community
living options for when {he/she} leaves high school? ...........................

1

0

d

r

51

Parent Survey Baseline: CATI Specifications 02.08.12

F. PLANS FOR THE FUTURE
F_INTRO My next questions are about your expectations for the future.
B1 OR B4 = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4A = 0, 14, 99 AND AGE FROM A12 OR A12A >= 14))

F1.

{Has/Did} {YOUTH} {taken/take} any courses at (his / her) high school for which
{he/she} earned college credit at either a two or four year college?
PROBE:

By credit we mean it will count towards the requirements for a two or fouryear degree.

YES ............................................................................. 1
NO ............................................................................... 0

GO TO F2

DON’T KNOW ............................................................. d

GO TO F2

REFUSED ................................................................... r

GO TO F2

F1=1
F1a.

What course(s) {is/has} {YOUTH} {taking/taken} at (his /her) high school to earn
college credit?
AP COURSE (ANY SUBJECT) .................................... 1
IB COURSE (INTERNATIONAL BACCALAUREATE) . 2
OTHER COURSE(S): SPECIFY: ___STRING 500 CHAR)___ 99
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

B1 OR B4 = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4A = 0, 14, 99 AND AGE FROM A12 OR A12A >= 14))

F2.

This school year, is {YOUTH} taking courses in high school designed to expose
{him/her} to or prepare {him/her} for a career (or careers) of interest? This could be
one or more courses. For example, a student interested in going to medical school
may take more science classes. (NEW)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO F4

DON’T KNOW ............................................................. d

GO TO F4

REFUSED ................................................................... r

GO TO F4

52

Parent Survey Baseline: CATI Specifications 02.08.12

F2=1
F3.

Will {YOUTH} receive college credit for this course?
IF NEEDED: At either 2 or 4 year college?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

B1 OR B4 = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4A = 0, 14, 99 AND AGE FROM A12 OR A12A >= 15))

F4.

Have you talked with a school counselor or someone else at school about what
{YOUTH} might do after high school, including education or career options? (NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
F5.

As things stand now, how far do you think {YOUTH} will get in school? IF NEEDED:
What is the highest level of schooling you think {he/she} will complete?
NOTE: CODE A CERTIFICATE OF COMPLETION OR ATTENDANCE AS 2.
CODE ONE ONLY
LESS THAN HIGH SCHOOL (WILL NOT GRADUATE
OR GET GED) ............................................................. 1
HIGH SCHOOL DIPLOMA OR GED ............................ 2
TECHNICAL OR TRADE SCHOOL ............................. 3
2 YEAR COLLEGE ...................................................... 4
4-YEAR COLLEGE ...................................................... 5
MASTER’S, PHD, OR OTHER ADVANCED
DEGREE ..................................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

53

Parent Survey Baseline: CATI Specifications 02.08.12

AGE FROM A12 OR A12A >= 15
F6.

Next I’d like to ask about issues youth sometimes face in furthering their education
and training after high school. For each statement I read, please tell me whether you
think that this will be an issue {YOUTH} is likely to face. (NEW)
YES

NO

DK

REF

a.

We do not have enough information about education or training
options for {YOUTH} after high school ..........................................

1

0

d

r

b.

{YOUTH} needs to work.................................................................

1

0

d

r

c.

We do not know how to get financial aid or help paying for school

1

0

d

r

d.

{YOUTH} Is not ready – either academically or socially ................

1

0

d

r

e.

IF D21 ≠1 AND D2 all items a-u ≠ 1 AND D5 ≠ 1 AND D6B ≠ 1:
{YOUTH} has physical or mental health issues that would make it
difficult ............................................................................................

1

0

d

r

f.

IF D1=1 OR D2INTRO1 = 1 OR D3 = 1 OR D6 = 1: We don’t
think schools could accommodate {YOUTH}’s disability ...............

1

0

d

r

g.

Are there any other difficulties or issues that would make it
difficult for {YOUTH} to further (his /her) education after high
school? SPECIFY: ........................................................................

1

0

d

r

___________________________________________________

ALL
F7.

When {YOUTH} is 30 years old, do you think {he/she} will be living: (NEW)
CODE ONE ONLY
On (his/ her) own - without friends or family, .......... 1
At home with parents, ............................................... 2
With a relative, ........................................................... 3
With friends, ............................................................... 4
With a spouse or partner,.......................................... 5
In military housing, .................................................... 6
In a group home, ........................................................ 7
In an institution, or .................................................... 8
Some other place? (SPECIFY) .................................. 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

54

Parent Survey Baseline: CATI Specifications 02.08.12

D1=1 OR D2INTRO1=1 OR D3=1 OR D6=1
F8.

By the time {YOUTH} is 30 years old, how likely do you think it is that {YOUTH} will
earn enough to support {himself/herself} without financial help from {his/her} family
or government benefit programs? Do you think {he/she}… (NLTS J10)
CODE ONE ONLY
Definitely will,............................................................. 1
Probably will, ............................................................. 2
Probably won’t, or ..................................................... 3
Definitely won’t? ........................................................ 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

AGE FROM A12 OR A12A >= 15
F9.

Next I’d like to ask about issues youth sometimes face in getting a job after high school.
For each statement I read, please tell me whether you think that this will be an issue
{YOUTH} is likely to face. (NEW)
YES

NO

DK

REF

a. ASK IF: D2 all items a-u ≠ 1 AND D5 ≠ 1 and D2_Intro1 = 1 and D6b ≠ 1
and D21 ≠ 1: Physical or mental health issues could prevent [YOUTH] from
working

1

0

d

r

b. ASK IF D5 = 1 OR D2 any item a-u = 1 or D2_Intro1 = 1 : [YOUTH] might
lose SSI or other benefits ...............................................................................

1

0

d

r

c. Staff at the high school has not provided enough information about career
planning or job opportunities ..........................................................................

1

0

d

r

d. Are there any other challenges [YOUTH] might face in getting a job after
high school? SPECIFY: ..................................................................................

1

0

d

r

________ (500 char)

G. DEMOGRAPHICS FOR YOUTH
Now I would like to ask some questions about [YOUTH]’s characteristics and
living arrangements.

55

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

G1.

Is any language other than English regularly used in {YOUTH’s} home? (NLTS2 A4A)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO G2

DON’T KNOW ............................................................. d

GO TO G2

REFUSED ................................................................... r

GO TO G2

56

Parent Survey Baseline: CATI Specifications 02.08.12
G1=1

G1a.

What is the main language {YOUTH} usually uses at home? (NLTS2 A4B)
CODE ONE ONLY

ENGLISH ......................................................................................... 1
SPANISH ......................................................................................... 2
ALBANIAN ....................................................................................... 3
ARABIC ........................................................................................... 4
BULGARIAN .................................................................................... 5
CAMBODIAN ................................................................................... 6
CHINESE ......................................................................................... 7
CREOLE .......................................................................................... 8
CROATIAN ...................................................................................... 9
CZECHOSLOVAKIAN ..................................................................... 10
DUTCH ............................................................................................ 11
FARSI .............................................................................................. 12
FINNISH .......................................................................................... 13
FRENCH .......................................................................................... 14
GERMAN ......................................................................................... 15
GREEK ............................................................................................ 16
HEBREW ......................................................................................... 17
HMONG ........................................................................................... 18
HUNGARIAN ................................................................................... 19
ITALIAN ........................................................................................... 20
JAPANESE ...................................................................................... 21
KOREAN.......................................................................................... 22
LAOTIAN ......................................................................................... 23
PERSIAN ......................................................................................... 24
POLISH............................................................................................ 25
PORTUGUESE................................................................................ 26
PUNJABI.......................................................................................... 27
ROMANIAN ..................................................................................... 28
RUSSIAN ......................................................................................... 29
SAMOAN ......................................................................................... 30
SWAHILI .......................................................................................... 31
TAGALOG (FILIPINO LANGUAGE) ................................................ 32
THAI................................................................................................. 33
TURKISH ......................................................................................... 34
URDU .............................................................................................. 35
VIETNAMESE.................................................................................. 36
SIGN LANGUAGE/MANUAL COMMUNICATION/ASL................... 37
YOUTH DOES NOT USE A LANGUAGE ....................................... 38
OTHER (SPECIFY) ......................................................................... 99
________________________________(STRING (30))
DON’T KNOW.................................................................................. d
REFUSED........................................................................................ r

57

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

G2.

Is {YOUTH} Hispanic or Latino?
YES - HISPANIC OR LATINO ..................................... 1
NO - NOT HISPANIC OR LATINO............................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

G3.

Please choose one or more categories that best describe {YOUTH}’s race. Is
{he/she}… [IF RESPONDENT SAYS MIXED RACE OR BI- OR MULTIRACIAL, ASK AS
NEEDED: “I can record more than one. Which races should I enter?
CODE ALL THAT APPLY
American Indian or Alaska Native ............................ 1
Asian........................................................................... 2
Black or African American ........................................ 3
Native Hawaiian or Other Pacific Islander, or .......... 4
White........................................................................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

G4.

In the past school year (2011-2012), has {YOUTH} lived with you… ? [EXCLUDING
CAMPS AND VACATIONS] (NLTS2 A5A, REV)
CODE ONE ONLY
All of the time, ............................................................ 1 GO TO BOX G5
Some of the time, or .................................................. 2
None of the time? ...................................................... 3
ONLY DURING SCHOOL VACATIONS ...................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

G4≠1

G4a.

Where has {he/she} lived in the past school year (2011-2012)? (NLTS2 A5C)
CODE ALL THAT APPLY
WITH [HIS/HER] OTHER PARENT ............................. 1
WITH [HIS/HER] PARENTS ....................................... 2
WITH ANOTHER RELATIVE/ADULT FAMILY
MEMBER OTHER THAN SPOUSE OR PARENT........ 3
58

Parent Survey Baseline: CATI Specifications 02.08.12

IN FOSTER CARE....................................................... 4
WITH NON-FAMILY LEGAL GUARDIAN .................... 5
IN A RESIDENTIAL OR BOARDING SCHOOL
OTHER THAN A COLLEGE ........................................ 6
IN A GROUP HOME, OTHER ASSISTED LIVING
CENTER, SUPERVISED APARTMENT ...................... 7
IN A HOSPITAL, MEDICAL FACILITY,
CONVALESCENT HOSPITAL, OR INSTITUTION
FOR PERSONS WITH DISABILITIES ......................... 8
IN A MENTAL HEALTH FACILITY............................... 9
IN A CORRECTIONAL FACILITY/YOUTH
DETENTION CENTER ................................................ 10
ON [HIS/HER] OWN .................................................... 11
WITH A SPOUSE OR ROOMMATE ............................ 12
IN A COLLEGE DORMITORY OR OTHER
COLLEGE HOUSING .................................................. 13
IN MILITARY HOUSING .............................................. 14
TRANSIENT, HOMELESS, ON THE STREET, IN
THEIR CAR ................................................................. 15
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX G5
IF YOUTH LIVES WITH SOMEONE OTHER THAN PARENT OR FOSTER PARENT AT LEAST SOME OF THE
TIME, GO TO G5. ELSE GO TO G6.

(G4a=3,5 and A13≠4) OR (G4a= D,R,99 AND A13 ≠ 4)

G5.

Is {YOUTH} living in a foster care arrangement? (NLTS2 A5E)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

59

Parent Survey Baseline: CATI Specifications 02.08.12
ALL YOUTH AGE >= 16 [Calculated from YEAR OF BIRTH A12 OR A12a]

G6.

Has {YOUTH} ever {had/fathered} any children? (NLTS K3A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX G7

THIS LOGIC SEPARATES PARENTS OF YOUTH AGE 16 AND OVER WHO HAVE HAD CHILDREN AND TAKES THEM TO
G7. THOSE WHO HAVE NOT HAD CHILDREN OR WHO HAVE BUT ARE UNDER AGE 16 GO TO G8.
IF G6 = 1 (HAS CHILDREN) AND AGE ≥16 YEARS OF AGE, GO TO G7. ELSE, GO TO G8.

G6 = 1 AND YOUTH’S AGE >=16 [Calculated from YEAR OF BIRTH A12 OR A12a]

G7.

Is {YOUTH} … (NLTS K3B)
CODE ONE ONLY
Engaged, .................................................................... 1
Single, never married, ............................................... 2
Married, or .................................................................. 3
In a marriage-like relationship, ................................. 4
Divorced or separated, or ......................................... 5
Widowed?................................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

G8.

My next questions are about {YOUTH}’s health insurance. Is {YOUTH} now covered by
private health insurance from an employer or union, or that your family buys directly?
(NLTS C1)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

60

GO TO G10

Parent Survey Baseline: CATI Specifications 02.08.12
G8 = 0

G9.

Is {he/she} covered by any other health insurance program, including a governmentassisted or public health insurance plan such as {Medicare or Medicaid/ Medicare,
Medicaid [, or [state program name}]? (NLTS C2 REV)
YES ............................................................................. 1
NO ............................................................................... 0

GO TO G11

DON’T KNOW ............................................................. d

GO TO G11

REFUSED ................................................................... r

GO TO G11

G8=1 OR G9=1

G10.

Does {his/her} insurance cover any of the cost of … (NLTS C5)
[IF ASKED, INCLUDES PARTIAL COVERAGE]
YES

NO

DK

REF

a. Dental care?...................................................

1

0

d

r

b. Vision care? ...................................................

1

0

d

r

c.

Medicines or prescriptions? ...........................

1

0

d

r

d. Mental health care? .......................................

1

0

d

r

ALL

G11.

Does {YOUTH} have access to a computer with a high-speed internet connection at
home? (NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

H. DEMOGRAPHICS FOR PARENT & HOUSEHOLD
BOX H1
IF G4=1,2,4, GO TO H1. ELSE GO TO BOX H4. IF CHILD LIVES WITH RESPONDENT AT LEAST SOME OF
THE TIME (G4=1,2,4) GO TO H1. ELSE GO TO BOX H4.

My next set of questions will be about you and your household as a whole. These
questions will help us better understand the experiences of different groups of people
who take part in the study.

61

Parent Survey Baseline: CATI Specifications 02.08.12
G4 = 1,2,4

H1.

Are you…
CODE ONE ONLY
Married ....................................................................... 1
In a marriage-like relationship, ................................. 2
Divorced, .................................................................... 3
Separated, .................................................................. 4
Widowed, or ............................................................... 5
Single, never married? .............................................. 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

G4 = 1,2,4

H2.

How many people age 18 and over are there in the household, including you?
IF NEEDED: Include {NAME} if {he/she} is age 18 or over. Household members include
those that are there at least four nights a week, most weeks, for the past 6 months.
(NLTS K4A, rev)
|

|

| NUMBER (0-20)

[S: >5]

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
G4 = 1,2,4

H3.

How many people under age 18 are now living in the household? [CAN INCLUDE
YOUTH’S CHILDREN.]
IF NEEDED: Include {NAME} if {he/she} is under age 18. Household members
include those that are there at least four nights a week, most weeks, for
the past 6 months. (NLTS K2A, rev)
|

|

[S: >5]

| NUMBER (0-20)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX H4
IF RESPONDENT IS YOUTH’S PARENT OR GUARDIAN (A13=1,2, 4, 5), GO TO BOX H5. ELSE GO TO H4.

62

Parent Survey Baseline: CATI Specifications 02.08.12
A13 ≠ 1,2,4,5

H4.

Does {YOUTH}’s mother or father or legal guardian live in this household?
IF NEEDED: Who lives in this household? Is that {YOUTH}’s mother, father, or legal
guardian? (NLTS K5B, REV)
CODE ONE ONLY
MOTHER ONLY .......................................................... 1
FATHER ONLY ........................................................... 2
BOTH MOTHER AND FATHER................................... 3
LEGAL GUARDIAN ..................................................... 4
NONE OF THESE ....................................................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX H5

IF CHILD LIVES WITH RESPONDENT AT LEAST SOME OF THE TIME (G4=1,2,4), GO TO H5. ELSE GO TO SECTION I.

G4 = 1,2,4

H5.

What is the highest year or grade you finished in school? (NLTS K8)
CODE ONE ONLY
8TH GRADE OR LESS ................................................ 1
9TH GRADE OR ABOVE, NOT A HIGH
SCHOOL GRADUATE................................................. 2
HIGH SCHOOL GRADUATE OR GED ........................ 3
POST HIGH SCHOOL EDUCATION, NO
COLLEGE DEGREE.................................................... 4
VOCATIONAL-TECHNICAL (VOC-TECH)
DEGREE OR CERTIFICATE ....................................... 5
2-YEAR COLLEGE DEGREE/AA DEGREE ................ 6
4-YEAR COLLEGE DEGREE/BA, BS DEGREE.......... 7
SOME POST BA, BS WORK, NO GRADUATE
DEGREE ..................................................................... 8
MASTER’S DEGREE, E.G. MSW, MA, MFA,
MPH, MBA ................................................................... 9
PHD, MD, JD, LLB, OR OTHER
PROFESSIONAL GRADUATE DEGREE .................... 10
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 100)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

63

Parent Survey Baseline: CATI Specifications 02.08.12
G4 = 1,2,4

H6.

Do you have a paid job now? (NLTS K9A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX H7
IF RESPONDENT IS MARRIED OR PARTNERED H1 = 1,2, GO TO H7_INTRO. ELSE GO TO H9_INTRO.

H1 = 1,2

H7_INTRO My next questions are about your {spouse/partner}.
H7.

What is the highest year or grade your {spouse/partner} finished in school? (NLTS K10)
CODE ONE ONLY
8TH GRADE OR LESS ................................................ 1
9TH GRADE OR ABOVE, NOT A HIGH
SCHOOL GRADUATE................................................. 2
HIGH SCHOOL GRADUATE OR GED ........................ 3
POST HIGH SCHOOL EDUCATION, NO
COLLEGE DEGREE.................................................... 4
VOCATIONAL-TECHNICAL (VOC-TECH)
DEGREE OR CERTIFICATE ....................................... 5
2-YEAR COLLEGE DEGREE/AA DEGREE ................ 6
4-YEAR COLLEGE DEGREE/BA, BS DEGREE.......... 7
SOME POST BA, BS WORK, NO GRADUATE
DEGREE ..................................................................... 8
MASTER’S DEGREE, E.G. MSW, MA, MFA,
MPH, MBA ................................................................... 9
PHD, MD, JD, LLB, OR OTHER
PROFESSIONAL GRADUATE DEGREE .................... 10
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 100)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

64

Parent Survey Baseline: CATI Specifications 02.08.12
H1 = 1,2

H8.

Does your {spouse/partner} have a paid job now? (NLTS K11A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

G4 = 1,2,4
H9_INTRO My next questions are about government benefits you or others in your household
may have received.
H9.

Did you or anyone in the household receive money from TANF (Temporary
Assistance to Needy Families) or the state welfare program anytime in the past 2
years? (NLTS K12A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

G4 = 1,2,4
FILL {SNAP/STATE NAME} FROM FILE PROVIDED

H10.

Did you, or anyone in the household, receive benefits in the past two years from SNAP
(the Supplemental Nutrition Assistance Program), which used to be called food stamps? {
PROGRAM IS ALSO KNOWN AS [SNAP/STATE NAME] IN [STATE]}. It puts money on a
card that you can use to buy food. (NLTS K13A REV)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

G4 = 1,2,4
H11.

Did you or anyone in the household get money for {YOUTH} from the Supplemental
Security Income or SSI program in the past 2 years? (NLTS K14A)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
65

Parent Survey Baseline: CATI Specifications 02.08.12

G4 = 1,2,4
H12.

Household income is an important factor that goes into many research questions including how family finances affect students’ ability to go to college or pursue other
goals after high school. This information is critically important to the success of this
study and will be kept completely confidential.
What was your total household income from all sources before taxes and deductions
in calendar year 2011? Please include all income such as income from work,
investments, money from public assistance, retirement, and alimony for all household
members, before taxes. (HSLS, REV)
SPECIFY: _____________ (STRING 6) .................... 99 GO TO I1_INTRO
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

H12 = D,R

H13.

We understand that you may not be able to provide an exact number for your family’s
income. However, it would be extremely helpful if you could tell us which of the
following ranges best describes your total household income from all sources before
taxes and deductions in calendar year 2011. Was it…
IF NEEDED: Please include all income such as income from work, investments,
money from public assistance, retirement, and alimony for all household members,
before taxes. (HSLS, REV)
CODE ONE ONLY
$60,000 or less, or...................................................... 1
more than $60,000? ................................................... 2

GO TO H13b

DON’T KNOW ............................................................. d

GO TO I1_INTRO

REFUSED ................................................................... r

GO TO I1_INTRO

H13 = 1

H13a.

Was it… (NLTS K15B, REV)
CODE ONE ONLY
$10,000 or less, or...................................................... 1
$10,001 to $20,000, .................................................... 2
$20,001 to $30,000, .................................................... 3
$30,001 to $40,000 ..................................................... 4
$40,001 to $50,000, or ................................................ 5
$50,001 to $60,000? ................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
66

Parent Survey Baseline: CATI Specifications 02.08.12
H13=2

H13b.

Was it… (NLTS K15E, REV)
CODE ONE ONLY
$60,001 to $70,000, .................................................... 1
$70,001 to $80,000, .................................................... 2
$80,001 to $90,000, .................................................... 3
$90,001 to $100,000, .................................................. 4
$100,001 to $110,000, ................................................ 5
$110,001 to $120,000, or ............................................ 6
Over $120,000? .......................................................... 7
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

I. CONTACT INFORMATION FOR FOLLOW UP
I1_INTRO

We are now at the last section of the survey. As you may remember, we will
contact you for the next survey in 2014. Your answers to these questions will help
us make sure we don’t lose touch with you.

A10 ≠ 1, D,R

I1.

Is there another telephone number where we can reach you, besides [FILL FROM
A10]?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO I2

DON’T KNOW ............................................................. d

GO TO I2

REFUSED ................................................................... r

GO TO I2

I1 = 1

I1a.

What is that number?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DON’T KNOW ............................................................. d

GO TO I2

REFUSED ................................................................... r

GO TO I2

International Phone (STRING 30)

67

Parent Survey Baseline: CATI Specifications 02.08.12
I1a ≠ d,r

I1b.

Is that number a land line or cell phone?
LANDLINE ................................................................... 1
CELL PHONE .............................................................. 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

I2.

Do you have an e-mail address where we may send you study-related information?
IF NEEDED:

This may include an email to verify your contact information, an
invitation to complete the survey, or a reminder about the survey.

YES ............................................................................. 1
DOES NOT HAVE AN EMAIL ADDRESS .................... 2

GO TO I3

NO ............................................................................... 0

GO TO I3

DON’T KNOW ............................................................. d

GO TO I3

REFUSED ................................................................... r

GO TO I3

I2 = 1

I2a.

What is the email address you check most often?
(STRING (150)

EMAIL

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL

I3.

May we send you a message through Facebook if we are unable to reach you by mail,
phone, or your regular email address?
YES ............................................................................. 1
DOES NOT HAVE A FACEBOOK ACCOUNT ............. 2
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

68

Parent Survey Baseline: CATI Specifications 02.08.12
G4A = 1, 2 OR (H1 = 1,2 AND G4 = 1) OR (H1= 3,4 AND A13= 1,2)

I4.

In case we have difficulty reaching you in the future, I would like to collect contact
information for {YOUTH’s} {other parent/parents/ your spouse or partner}.
What is this person’s full name?
_____________________________ (STRING (100)
FIRST NAME
(STRING (100)
MIDDLE INITIAL/NAME
(STRING (100)
LAST NAME
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

GO TO I9
GO TO I9

G4A = 1, 2 OR (H1 = 1,2 AND G4 = 1) OR (H1= 3,4 AND A13= 1,2) AND I4 ≠ R,DK

I5.

Is [(NAME from I4a)]’s mailing address (where mail is sent) the same as yours or is it
a different address?
[CATI FILL ADDRESS FROM A9a OR SAMPLE FILE (IF A9a=blank)]
SAME FOR SPOUSE OR PARTNER .......................... 1

GO TO I6

DIFFERENT MAILING ADDRESS ............................... 2
I5=2

I5a.

What is the address where [NAME from I4] gets mail sent?
PROBE FOR AND RECORD BOTH PO BOX AND STREET ADDRESS
PROBE: Where does {he/she} stay most often?

(STRING (200)

ADDRESS 1

(STRING (200)

ADDRESS 2

(STRING (200)

CITY
STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)

(STRING (50)
|

|

G4A = 1, 2 OR (H1 = 1,2 AND G4 = 1) OR (H1= 3,4 AND A13= 1,2) AND I4 ≠ R,DK

I6.

What is the best telephone number at which to reach {him/her}:
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DOES NOT HAVE A TELEPHONE NUMBER ............. 0

GO TO I8

DON’T KNOW ............................................................. d

GO TO I8

REFUSED ................................................................... r

GO TO I8

International Phone (STRING (NUM))
69

Parent Survey Baseline: CATI Specifications 02.08.12

I6 ≠ 1,d,r

I7.

Is there another phone number where we can reach {him/her}?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO I8

DON’T KNOW ............................................................. d

GO TO I8

REFUSED ................................................................... r

GO TO I8

I7 = 1

I7a.

What is that number?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
International Phone (STRING 30)
G4A = 1, 2 OR (H1 = 1,2 AND G4 = 1) OR (H1= 3,4 AND A13= 1,2) AND I4 ≠ R,DK

I8.

Does [SPOUSE /PARTNER FIRST NAME from I4] have an e-mail address at which we
can reach {him/her}? IF NEEDED: Our contact would include things like an email to
verify contact information, an invitation to complete the survey.
YES ............................................................................. 1
DOES NOT USE EMAIL .............................................. 2

GO TO I9

NO – NOT OK TO CONTACT THIS WAY ................... 0

GO TO I9

DON’T KNOW ............................................................. d

GO TO I9

REFUSED ................................................................... r

GO TO I9

I8 = 1

I8a.

What is the email address {he/she} checks most often?
(STRING (500)
EMAIL
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

70

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

I9.

In case we have trouble reaching {either of} you directly when we do the next survey,
we’d like to get the contact information for another person who will always be able to
reach you. Can you give me the name of a friend or relative, who does not live with
you, who would be able to reach you if you move or change your telephone number?
(STRING (100))

FIRST NAME

(STRING (100))

MIDDLE INITIAL/NAME

(STRING (100))

LAST NAME

DON’T KNOW ............................................................. d

GO TO I14

REFUSED ................................................................... r

GO TO I14

I9 ≠ d,r

I10.

What is your relationship with this person?
IF NEEDED: Is this person a relative, a friend, or some other person in your life?
NOTE: CODE STEPPARENTS AS MOTHER OR FATHER.
CODE ONE ONLY
OTHER SON OR DAUGHTER (NOT [YOUTH]) .......... 1
BROTHER / SISTER ................................................... 2
MOTHER / FATHER .................................................... 3
AUNT / UNCLE............................................................ 4
COUSIN ...................................................................... 5
OTHER RELATIVE ...................................................... 6
FRIEND ....................................................................... 7
CASE MANAGER – SPECIFY NAME OF AGENCY .... 8
(STRING (150))
OTHER NON-RELATIVE ............................................. 9
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

71

Parent Survey Baseline: CATI Specifications 02.08.12
I9 ≠ d,r

I11.

What is [NAME]’s mailing address?
PROBE FOR AND RECORD BOTH PO BOX AND STREET ADDRESS
PROBE: Where does {he/she} stay most often?

(STRING (200)

ADDRESS 1

(STRING (200)

ADDRESS 2

(STRING (200)

CITY

(STRING (50)

STATE/TERRITORY
|

|

|

|

|

|-|

|

|

ZIP CODE (+ 4 IF NEEDED)

|

|

I9 ≠ d,r

I12.

What is the best telephone number at which to reach (NAME)?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DOES NOT HAVE A TELEPHONE NUMBER ............. 0

GO TO I13

DON’T KNOW ............................................................. d

GO TO I13

REFUSED ................................................................... r

GO TO I13

International Phone (STRING 30)
I12 ≠ 1,d,r

I12b.

Is there another telephone number where we can reach (NAME)?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO I13

DON’T KNOW ............................................................. d

GO TO I13

REFUSED ................................................................... r

GO TO I13

I12b = 1

I12c.

What is that number?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
International Phone (STRING 30)
72

Parent Survey Baseline: CATI Specifications 02.08.12
I9 ≠ d,r

I13.

Does (NAME) have an e-mail address where we can reach {him/her}, should we need
help contacting you for the next part of the study?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO I14

DON’T KNOW ............................................................. d

GO TO I14

REFUSED ................................................................... r

GO TO I14

I13 = 1

I13a.

What is the email address {he/she} checks most often?
(STRING (500)
EMAIL
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

D1A = 6,7,11,16 OR D2 = 1 FOR DEAFNESS, DEAFNESS/BLINDNESS, HARD OF HEARING, SPEECH
IMPAIRMENT OR D9 = 2

I14. We’ve reached the end of your portion of the survey. When we contact {YOUTH} to
complete {his/her} portion of the survey, what assistive technologies, if any,
should we have available}?
NO ASSISTIVE TECHNOLOGY .................................. 0
VIDEO RELAY............................................................. 1
INSTANT MESSAGING (IM) eg- gchat, skype, AIM ... 2
TEXT/SMS................................................................... 3
TTY/TDD ..................................................................... 4
VOICE AMPLIFICATION ............................................. 5
TACTILE SIGN ............................................................ 6
OTHER, SPECIFY________________________ ........ 99
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

73

Parent Survey Baseline: CATI Specifications 02.08.12
ALL

Those are all the questions I have for you in this survey. READ IF LEA ID ≠ xxxxx We
will be mailing your $20 check soon. READ IF LEA ID = xxxxx We will be mailing your
check soon. If you have any questions about the study, or if your contact information
changes, please call us toll-free at: 866-964-7962. You can also visit our website at:
http://ies.ed.gov/ncee/nlts.
IF LEA ID IS NOT xxxxx, DISPLAY: If it is possible to speak with {YOUTH}, can you
pass the telephone to {him/her} or tell me the best number to reach {him/her} at right
now?
IF LEAD ID = xxxxx THEN DISPLAY: Your school district has requested us to
complete the student interview with a parent or guardian, who will respond on
[YOUTH]’s behalf. Are you able to continue with the youth portion of the interview
now?
YES, CONTINUE WITH YOUTH INTERVIEW NOW ... 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

Thanks for taking time to answer these questions today. Have a nice day!
CONTINUE WITH YOUTH INTERVIEW NOW ............ 1
CALL STUDENT AT DIFFERENT NUMBER ..............

2

CALL STUDENT DIFFERENT TIME (SET CALLBACK)

3

STUDENT REQUIRES PROXY RESPONSE .............

4

STUDENT REFUSES AT THIS TIME (SET STUDENT
STATUS AS REFUSAL ............................................... 5

74

Mathematica Reference No.: 06876.341

National Longitudinal Transition Study
Student Baseline Questionnaire: CATI Programming Specifications
Dated 02.08.12 - Final

Student Baseline Questionnaire: CATI Programming Specifications

ADMINISTRATIVE NOTES:
•

THIS INSTRUMENT IS DESIGNED TO BE INTERVIEWER-ADMINISTERED OVER THE TELEPHONE
WITH AN ESTIMATED DURATION OF 30 MINUTES.

•

AT BASELINE, THE STUDENT’S INTERVIEW WILL IMMEDIATELY FOLLOW THE PARENT’S CONSENT
AND INTERVIEW. AT BASELINE, PARENTS WILL ALWAYS BE INTERVIEWED BEFORE STUDENTS.

•

PROXIES WILL BE ALLOWED AND ASKED OBJECTIVE ITEMS ONLY (AS DESIGNATED AT EACH
ITEM). IF THE STUDENT IS UNABLE TO COMPLETE THE INTERVIEW ON HIS/HER OWN, PROXY WILL
BE PERSON MOST KNOWLEDGEABLE ABOUT THE STUDENT’S EXPERIENCES IN AND OUT OF
SCHOOL.

•

EACH ITEM DRAWN FROM A PRE-EXISTING INSTRUMENT WILL HAVE, AT THE END OF THE
QUESTION TEXT, THE SOURCE INSTRUMENT AND ITEM REFERENCE NUMBER. IF THE ORIGINAL
SOURCE HAS BEEN MODIFIED, THE TEXT, ‘REV” WILL FOLLOW.

•

GUIDELINES FOR ADMINISTRATION ARE NOTED THROUGHOUT – ITEMS IN ALL CAPS ARE NOT
READ ALOUD, VERBIAGE UNDERLINED IS EMPHASIZED. STANDARDIZED PROBES AND
DEFINITIONS ARE PROVIDED FOR APPLICABLE ITEMS, AS NEEDED.

SECTION J. INTRODUCTION AND INFORMED CONSENT
IF DISTRICT ID = 0691007, STUDENT INTERVIEW MUST BE COMPLETED BY PROXY.

A2 = 1 and A8 ≠ 3
The U.S. Department of Education is sponsoring the National Longitudinal Transition
Study. Through this important project, we hope to learn more about issues youth face
today as they transition from school to adult life and how schools can better support
students in reaching their goals. We are inviting you to be part of this study.
CONTINUE …………………………………………..1 GO TO J1a
HUNG UP DURING INTRODUCTION……………………2 GO TO END (STATUS 240)
CATI: DO NOT ALLOW DK or REF OPTIONS FOR J1.

76

Draft Dated 02.08.12 - final

Student Baseline Questionnaire: CATI Programming Specifications
I14 = 1-6, 99 OR D1A = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 OR D9 = 2

{Your parent or guardian suggested that we use {TECHNOLOGY FROM I14} for

conducting this interview. Would you like to use that or is there something
else you would prefer?} {What assistive technologies, if any, would you like to
use for this interview?}
NO ASSISTIVE TECHNOLOGY.................................. 0
VIDEO RELAY ............................................................ 1
INSTANT MESSAGING (IM) eg- gchat, Skype, AIM . 2
TEXT/ SMS.................................................................. 3
TTY/ TDD .................................................................... 4
VOICE AMPLIFICATION............................................. 5
TACTILE SIGN............................................................ 6
OTHER, SPECIFY________________________ ........ 99
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

INTERVIEWER RECORD REPONSES WITHOUT READING ALOUD:
IS THIS INTERVIEW BEING CONDUCTED WITH THE YOUTH HIM/HERSELF OR
WITH HIS/HER PROXY?
CONDUCTED WITH STUDENT HIM/HERSELF ......... 1 GO TO J1e
CONDUCTED WITH PROXY FOR STUDENT ............ 2 GO TO J1c

CATI: DO NOT ALLOW DK or REF OPTIONS FOR J1b.

ALL PROXIES (J1b= 2)

INTERVIEWER: WHAT IS THE NAME OF THE PROXY? IF NEEDED: What is your
name?
__________________________________(STRING(150))
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

77

Draft Dated 02.08.12 - final

Student Baseline Questionnaire: CATI Programming Specifications

ALL PROXIES (J1b= 2)

INTERVIEWER: WHAT IS THE RELATIONSHIP OF THE PROXY TO THE YOUTH?
IF NEEDED: How are you related to {NAME}?
PARENT ...................................................................... 1

GO TO J1e

SIBLING ...................................................................... 2

GO TO J1e

OTHER FAMILY MEMBER ......................................... 3

GO TO J1e

SOMEONE FROM YOUTH’S SCHOOL ...................... 4

GO TO J1e

SOMEONE FROM AN AGENCY/SERVICE
PROVIDER .................................................................. 5

GO TO J1e

OTHER (SPECIFY) ..................................................... 99
DON’T KNOW ............................................................. d

GO TO J1e

REFUSED ................................................................... r

GO TO J1e

IF OTHER SPECIFY (99): IF NEEDED: What is your relationship to {NAME}?

___________________________ (STRING (150))

ALL

J1e.

This interview will be recorded to store your consent and for quality assurance
purposes. Can we please begin by having you say your full name? Thank you.
STRING (20)
FIRST NAME
STRING (20)

LAST NAME
REFUSED

.................................................................................... GO TO J2

HUNG UP DURING INTERVIEW ....................................................... 2

TERMINATE (STATUS 240)

CATI: DO NOT ALLOW DK or REF OPTION FOR J1e.

78

Draft Dated 02.08.12 - final

Student Baseline Questionnaire: CATI Programming Specifications

ALL
Please feel free to ask me any questions as we move along. To begin, this is a
voluntary research study.
IF J1B=1 (self interview) READ: We already spoke to your parent or guardian who completed a
telephone interview and said you could take part in the study. But, you need to decide for
yourself if you want to take part. To help you decide, I will tell you some important things
about this study.
RESUME FOR ALL: The U.S. Department of Education is paying for the study and Mathematica
Policy Research is carrying it out. The purpose is to see what helps students move from school
to adulthood. {You are/{NAME} is} one of 15,000 students being asked to take part in the study
from across the United States.
{Your/{NAME}’s} parent (or legal guardian) answered questions about {your/his/her} family,
experiences, and supports {you get/ he/she gets} from school and other places. READ IF LEA ID
≠ 3600078 Parents (or legal guardians) will be interviewed again in 2014 and will be paid $20 for
each interview. READ IF LEA ID = 3600078 Parents will be paid $10 for their interview in 2012
and $20 when they are reinterviewed in 2014.
If you agree, I will complete {your/{NAME}’s} interview over the telephone. It will take about 30
minutes. The questions will be about {you, school, and your plans for the future/ him/her,
his/her school, and his/her plans for the future}.
IF SELF INTERVIEW (J1B=1) READ: Your parent (or guardian) can help you answer questions or
answer for you, if needed.
RESUME FOR ALL: An interviewer will talk to you again in 2014. READ IF LEA ID ≠ 1201560You
will get a $10 gift card for each interview completed. RESUME READING FOR ALL Do you agree
to take part in this interview?
AGREED – CONTINUE………………………1 GO TO J3
DISAGREE/DECLINES THIS PORTION…...2 GO TO END (STATUS 211)
MODULE.

DECLINES STUDY PARTICIPATION………0

TERMINATE. STATUS AS 211 - ROUTE TO REFUSAL

CATI: DO NOT ALLOW DK or REF OPTION FOR J2.

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A3 = 1
The researchers will ask {your/{NAME}’s} math or language arts teacher to do a survey to
learn more about {your/{his/her}} class, if you agree to let them do so. Do we have your
permission to contact {your/{NAME}’s} math or language arts teacher for that survey?
CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.

AGREED - CONTINUE ............................................................ 1
DISAGREE/DECLINES THIS PORTION .................................. 2
DECLINES STUDY PARTICIPATION ...................................... 0

ROUTE TO REFUSAL MODULE.

GO TO J4
TERMINATE. STATUS AS 211 -

CATI: DO NOT ALLOW DK or REF OPTION FOR J3.

A3a = d,r

J3a.

Can you provide the name of this [math / language arts] teacher?
STRING (20) (IF FIRST NAME = D,R, GO TO LAST NAME)

FIRST NAME

STRING (50)

LAST NAME

DON’T KNOW EITHER NAME .................................... d

GO TO J4

REFUSED TO PROVIDE EITHER NAME ................... r

GO TO J4

A3b = d,r

J3b.

Can you provide us with this {teacher’s} email address?
YES – SPECIFY: _______________________ ........... 1
DON’T KNOW ............................................................. d
REFUSED TO PROVIDE EMAIL ................................. r

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Student Baseline Questionnaire: CATI Programming Specifications
A4 = 1 or A4.5 = 1 OR D2_INTRO2 = 1 OR D2.5 = 1

The researchers will ask a staff member at {your/{NAME}’s} school to do two surveys
to learn about {your/his/her} IEP. These would be completed by the person who knows
most about {your/his/her} IEP. One will be completed now and another will be two
years from now. Do we have your permission to contact this staff person for that
survey? (IF NEEDED: An IEP is an Individualized Education Plan that describes how a
student learns best and what teachers should do to help the student learn most
effectively.

CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.

AGREED – CONTINUE………………………..1

GO TO J4a

DISAGREE/DECLINES THIS PORTION…….2
DOES NOT HAVE AN IEP…………………….3

GO TO J5
GO TO J4.5

DECLINES STUDY PARTICIPATION………..0

REFUSAL MODULE.

TERMINATE. STATUS AS 211 - ROUTE TO

CATI: DO NOT ALLOW DK or REF OPTION FOR J4.

(A4 = 1 or A4.5 = 1) AND J4 =2

J4.5.

Maybe another name is used for the services you receive. The school said you get
some type of accommodations or help in school. Do you give us permission to
contact the person at your school who could best complete a survey about any
services you may receive?
AGREED - CONTINUE................................................ 1

GO TO J4a

DISAGREE / DECLINES THIS PORTION ................... 2

GO TO J5

DECLINES STUDY PARTICIPATION ........................ 0

TERMINATE. STATUS AS 211 -

ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTION FOR J4.5.

J4=1 or J4a=1

J4a.

Can you provide the name of this staff person (who is most knowledgeable about
services provided at school)?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME UNKNOWN, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d

GO TO J5

REFUSED TO PROVIDE EITHER NAME ................... r

GO TO J5

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J4a = 1

J4b.

Can you provide us with this person’s email address?
YES – SPECIFY: _________ (STRING 200 CHAR).... 1
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

A5 = 1

The researchers would like to collect {your/{NAME}’s} school transcripts to see what
courses {you have/she/he has} taken. They will do this in 2014, with your permission.
Do you give permission for them to access {your/his/her} school records at that time?
AGREED - CONTINUE................................................ 1

GO TO J6

DISAGREE/DECLINES THIS PORTION ..................... 2

GO TO J6

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 -

ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTION FOR J5.

A6 = 1
If {you are/{NAME} is} around 16 to 18 years old in 2014, we may ask {you/him/her} to
take a special test called an academic assessment. This test is only for this study and
will not count towards any of {your/his/her} classes in school. The test will take between
15 and 45 minutes. Do we have your permission to complete that assessment?
CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED. DO NOT ALLOW DK or REF
OPTION FOR J6.

AGREED - CONTINUE................................................ 1

GO TO J7

DISAGREE/DECLINES THIS PORTION ..................... 2

GO TO J7

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 -

ROUTE TO REFUSAL MODULE.

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A7 =1, 2, or 3

To learn more about how students are doing in the future, the researchers may want to
look at databases on college enrollment, financial aid for college, vocational
rehabilitation agency services or the Social Security Administration’s records about jobs
or benefits. If the researchers decide to use data from the Social Security Administration,
we would need {your/{NAME}’s} social security number.
If we need {your/his/her} social security number, we will ask for it during the second
interview in 2014. You can decide to give it to us then, or not. If you give us the number,
we will keep it private and will permanently erase it as soon as we link it to the
information needed. We did want to let you know now, however, that we may ask for it.
Do you have any questions about this?
NO, CONTINUE .......................................................... 1

GO TO J8

YES, QUESTION ......................................................... 2

GO TO J8

I WILL NEVER GIVE YOU A SSN ............................... 3

GO TO J8

DECLINES STUDY PARTICIPATION ......................... 0

TERMINATE. STATUS AS 211 -

ROUTE TO REFUSAL MODULE.

CATI: DO NOT ALLOW DK or REF OPTION FOR J7.

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ALL
ALL: The information you provide will be kept confidential. It will not be shared. All
reports will be in summary form only. {Your/{NAME}’s} name will never be used. There
are no special risks to you if you take part in this study. There is nothing experimental
about this study. If you feel uncomfortable answering any of the questions you can stop
and nothing bad will happen to you.
IF AGE < 18 AND J1B = 1: If you are not 18 years old yet, or have a legal guardian, your
parent or legal guardian agreed for you to be in this study. Even if your parent or legal
guardian agreed, you must agree also. When you turn 18 or no longer have a legal
guardian, you must agree again, for yourself.
ALL: If you have any questions about your rights as a research volunteer, you can call
the Institutional Review Board. They looked at this study to make sure your rights are
protected. You can ask questions or drop out of the study at any time by calling
Mathematica Policy Research.
IF NEEDED: Public/Private Ventures telephone number is 800-755-4778 x4482 . Ask for
Melissia Billarrial. Mathematica’s toll-free number is 866-964-7962.
ALL: I will mail you a letter describing what we just discussed, so you will have it for your
records. If you would like to see the consent form in writing before we continue with the
interview, we can email (or fax) it to you. Do you have any questions for me before we
begin the interview? [ANSWER QUESTIONS].
NO QUESTIONS OR QUESTIONS ANSWERED
CONTINUE .................................................................. 1 GO TO J9
NOT AT THIS TIME – CALL LATER.......................... 2 SCHEDULE CALLBACK WITHIN
1 WEEK
DECLINED TO TAKE PART IN STUDY ...................... 3

TERMINATE. STATUS AS 211 - ROUTE TO
REFUSAL MODULE.

LOAD FOR ALL, BUT NOT POPULATED FOR INTERVIEWER – CATI VARIABLE ONLY IN BLAISE
IF J8 = 1, RECORD INTERVIEWER ID (A WINDOWS ENVIRONMENT VARIABLE) OF THE
INTERVIEWER WHO GOT THE CONSENT AND THE DATE SO IT MAY BE FILLED ON THE CONSENT FORM
THAT IS MAILED TO THE RESPONDENT.

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Student Baseline Questionnaire: CATI Programming Specifications
ALL YOUTH OR THEIR PROXIES. ASSUMES PROXY WILL BE SENT YOUTH’S GIFT CARD / THANK YOU
MAILING

J9. I’d like to begin by asking for some basic information about where you live and how we can
best reach you in the future. Let’s start with the address where you get your mail.
READ IF LEA ID ≠ 1201560We will send the $10 gift card to this address.
RESUME FOR ALL: The school listed it as [ADDRESS]. Is that address correct?
YES ............................................................................. 1

GO TO J11

NO ............................................................................... 0

GO TO J10

DON’T KNOW ............................................................. d

GO TO J11

REFUSED ................................................................... r

GO TO J11

J9= 0
J10.

What is your mailing address?
PROBE FOR AND RECORD BOTH P.O. BOX AND STREET ADDRESS
PROBE: Where do you stay most often?
ADDRESS 1

(STRING (150))

ADDRESS 2

(STRING (150))

CITY

(STRING (30))

STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)

(STRING (150))

|

|

DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL
J11.

What is the best telephone number at which to reach you?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DOES NOT HAVE A TELEPHONE NUMBER ............ 0

GO TO

DON’T KNOW ............................................................. d

GO TO

REFUSED ................................................................... r

GO TO

International Phone (STRING 30)
NOTE: ENTER “0” IF THE PERSON DOES NOT HAVE A TELEPHONE.

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Student Baseline Questionnaire: CATI Programming Specifications

Jll ≠ 1,d,r
J11a.

Is that number a land line or cell phone?
LANDLINE .................................................................. 1

GO TO

CELL PHONE ............................................................. 0

GO TO J11b

DON’T KNOW ............................................................. d

GO TO

REFUSED ................................................................... r

GO TO

J11a = 0
J11b.

Would it be ok for us to send you a text message when we try to contact you for the
next survey?
YES ............................................................................. 1

GO TO

NO - DOES NOT USE TEXT MESSAGING................. 2

GO TO

NO ............................................................................... 0

GO TO

DON’T KNOW ............................................................. d

GO TO

REFUSED ................................................................... r

GO TO

K. STUDENT ENROLLMENT & EXPERIENCES AT SCHOOL

ALL

The next questions are about {your/his/her} experiences in school and life outside
of school. There are no right or wrong answers, we want to better understand
{your/his/her} experiences.

IN SAMPLE FILE IS NOT “UNKNOWN” OR “.” AND (A14=d, r OR A14a= d, r)

K_intro1. Our records from the school district show the name of [your / STUDENT]’s school is
[SCHOOL NAME], is that correct?
YES ............................................................................ 1

GO TO K1

NO ............................................................................... 0
DON’T KNOW ............................................................. d

GO TO K1

REFUSED ................................................................... r

GO TO K1

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Student Baseline Questionnaire: CATI Programming Specifications
ALL YOUTH AND PROXIES WHERE (A14=d, r OR A14a= d, r) AND K_INTRO1= 0

K_intro1a.What is the name of [your / STUDENT]’s school?
SPECIFY: _________ (STRING 200 CHAR)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL YOUTH AND PROXIES WHERE (A15=d, r)

K_intro1b.

What city and state is [your / STUDENT]’s school located in?
(STRING (200)

CITY

(STRING (50)

STATE/TERRITORY

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL

K1.

{Are you/Is {NAME}} attending or enrolled in middle school, junior high, or high
school at this time? (YTD, A1, REV)
PROBE:
PROBE:

{Do you/Does {NAME}} go to school?
At school they teach {you/him/her} how to do things, like how to read,
write, or do math.
PROBE IF SUMMER: {Are you/Is NAME} off school for the summer? Will
{you/he/she} be going back to school in the fall?
INTERVIEWER: CODE “YES” IF ENROLLED IN SCHOOL BUT ON BREAK/VACATION.
YES ............................................................................. 1

GO TO K2intro

NO ............................................................................... 0

GO TO K1a

DON’T KNOW ............................................................. d

GO TO K2intro

REFUSED ................................................................... r

GO TO K2intro

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IF K1=0
K1a.

Why did {you/he/she} leave school?
CODE ALL THAT APPLY
ACADEMIC DIFFICULTY, POOR GRADES, NOT DOING WELL................... 1 GO TO K2INTRO
DISLIKE OF SCHOOL EXPERIENCE ............................................................. 2

GO TO K2INTRO

SCHOOL TOO DANGEROUS ......................................................................... 3

GO TO K2INTRO

FAILED REQUIRED TEST/FAILED GRADUATION EXAM............................. 4

GO TO K2INTRO

GOT GED ........................................................................................................ 5

GO TO K2INTRO

GRADUATED .................................................................................................. 6

GO TO K2INTRO

LACK OF APPROPRIATE CURRICULUM ...................................................... 7

GO TO K2INTRO

POOR RELATIONSHIPS WITH TEACHERS AND SCHOOL STAFF ............. 8

GO TO K2INTRO

POOR RELATIONSHIPS WITH FELLOW STUDENTS .................................. 9

GO TO K2INTRO

LANGUAGE DIFFICULTY ............................................................................... 10 GO TO K2INTRO
ECONOMIC REASONS .................................................................................. 11 GO TO K2INTRO
LACK OF CHILDCARE.................................................................................... 12 GO TO K2INTRO
LACK OF TRANSPORTATION ....................................................................... 13 GO TO K2INTRO
PROBLEMS WITH BEHAVIOR ....................................................................... 14 GO TO K2INTRO
SUBSTANCE ABUSE...................................................................................... 15 GO TO K2INTRO
ILLNESS/DISABILITY...................................................................................... 16 GO TO K2INTRO
PREGNANCY .................................................................................................. 17 GO TO K2INTRO
ENTERED CRIMINAL JUSTICE SYSTEM/INCARCERATED ......................... 18 GO TO K2INTRO
NEEDED AT HOME ........................................................................................ 19 GO TO K2INTRO
RELIGION ....................................................................................................... 20 GO TO K2INTRO
MOVED ........................................................................................................... 21 GO TO K2INTRO
PARENT/GUARDIAN INFLUENCE ................................................................. 22 GO TO K2INTRO
FRIENDS WERE DROPPING OUT................................................................. 23 GO TO K2INTRO
MARRIAGE ..................................................................................................... 24 GO TO K2INTRO
MILITARY, JOINED ARMED FORCES ........................................................... 25 GO TO K2INTRO
EMPLOYMENT, SEEK OR ACCEPT JOB ...................................................... 26 GO TO K2INTRO
OTHER (SPECIFY) ......................................................................................... 99 GO TO K1a.other
DON’T KNOW.................................................................................................. d

GO TO K2INTRO

REFUSED ....................................................................................................... r

GO TO K2INTRO

K1a= 99

K1a.other

What other reasons did {you/{NAME}} have for leaving school?
GO TO K2INTRO

(STRING (500))

DON’T KNOW ............................................................. d

GO TO K2intro

REFUSED ................................................................... r

GO TO K2intro

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Student Baseline Questionnaire: CATI Programming Specifications
ALL

K2intro.

Next I will read a list of statements about how some students feel about their classes.
For each, please tell me whether you agree or disagree with the statements about
{your/{NAME}’s} classes, overall, this year (2011-2012)?

K2a.

The first statement is, “Class work was hard to learn.” Do you agree a lot, agree a
little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL
K2b.

The next statement is, “{I/{NAME}} had trouble keeping up with the homework.” Do
you agree a lot, agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL
K2c.

“{I need/{NAME} needs} more help from my teachers than I get.” Do you agree a lot,
agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

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ALL
K2d.

“Teachers encourage {me to do my/{NAME} to do his/her} best.” Do you agree a lot,
agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL

K3intro.

How strongly do you agree or disagree with the following statements about
{your/{NAME}’s} school?

K3a.

“{I feel/{NAME}feels} close to people at this school.” Do you agree a lot, agree a little,
disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL

K3b.

“{I am/{NAME} is} happy to be at this school.” Do you agree a lot, agree a little,
disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

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ALL

K3c.

“{I feel/{NAME} feels} like {I am/he/she is} part of this school.” READ IF NECESSARY:
Do you agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL

K3d.

“The teachers at this school treat students fairly.” READ IF NECESSARY: Do you
agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL

K3e.

“{I feel/{NAME} feels} safe in {my/his/her} school.” READ IF NECESSARY: Do you
agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

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ALL

K4intro

How strongly do you agree or disagree with the following statements about
{your/{NAME}’s} school?

K4a.

“At {my/his/her} school, there is a teacher or some other adult who really cares about
{me/him/her}.” Do you agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL
K4b.

“At {my/{NAME}’s} school, there is a teacher or some other adult who tells {me/him
her} when {I do/he/she does} a good job.” Do you agree a lot, agree a little, disagree a
little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL

K4c.

“At {my/his/her} school, there is a teacher or some other adult who notices when {I’m
not/he/she isn’t} there.” Do you agree a lot, agree a little, disagree a little or disagree a
lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

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ALL
K4d.

“At {my/his/her} school, there is a teacher or some other adult who always wants
{me/{NAME}} to do {my/his/her} best.” Do you agree a lot, agree a little, disagree a
little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL
K4e.

“At {my/his/her} school, there is a teacher or some other adult who listens to
{me/{NAME}} when {I have/he/she has} something to say.” Do you agree a lot, agree a
little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r

ALL
K4f.

“At {my/his/her} school, there is a teacher or some other adult who believes that
{I/he/she} will be a success.” Do you agree a lot, agree a little, disagree a little or
disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
Box K5
IF J1b =1 and K1=1,D,R, GO TO K5INTRO. IF J1b =2 and K1=1,D,R, GO TO K6a.
If K1 ≠ 1,d,r, GO TO BOX L1.

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J1b = 1 and k1 = 1, d, r

K5.intro

Have you had any of the following things happen during this school year (2011-2012)?

K5a.

Have you been teased or called names at school?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

J1b = 1 and k1 = 1, d, r

K5b.

Have students made up something about you to make other students not like you
anymore?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

J1b = 1 and k1 = 1, d, r

K5c.

Have other students said they would not be your friend unless you did what they told
you to do?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

J1b = 1 and k1 = 1, d, r

K5d.

Have you been teased or threatened through use of email, text messaging, or other
electronic methods? This is sometimes called cyber bullying.
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

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J1b = 1 and k1 = 1, d, r

K5e.

Have you had things stolen from your locker, desk, or other places at school?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

J1b = 1 and k1 = 1, d, r

K5f.

Have you been physically attacked or in fights at school or on the way to or from
school?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

J1b = 1 and k1 = 1, d, r

K5g.

Have you bullied or picked on other students?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r

ALL
K6a.

Since school started this year, how often {have you/has {NAME}} gone to a class late?
Would you say never, a few times, once a week, almost every day, or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r

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ALL
K6b.

Since school started this year, how often {have you/has {NAME}} cut or skipped class?
Would you say never, a few times, once a week, almost every day, or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r

ALL
K6c.

Since school started this year, how often {have you/has {NAME}} been late for school?
READ IF NECESSARY: Would you say never, a few times, once a week, almost every day,
or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r

ALL
K6d.

Since school started this year, how often {have you/has {NAME}} gotten in trouble for
acting out in class? READ IF NECESSARY: Would you say never, a few times, once a
week, almost every day, or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r

96

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Student Baseline Questionnaire: CATI Programming Specifications
D5 = 1 OR D2 ANY PART = 1 OR D2_INTRO1 = 1

K6e.

Since school started this year, how often {have you/has {NAME}} been held or restrained
by a teacher or classroom aide because {you were/NAME was} misbehaving in class?
READ IF NECESSARY: Would you say never, a few times, once a week, almost every day,
or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r

K1= 1, d or r and J1b= 1

K7.

Since school started this year, how often did a health or emotional problem cause
you to miss a day of school? Would you say…
CODE ONE ONLY
Never, ......................................................................... 1
1-2 times, .................................................................... 2
3-5 times, .................................................................... 3
6-10 times, or ............................................................. 4
More than 10 times? .................................................. 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

K1 = 1
K8.

In total, about how many hours per week {do you/does {NAME}} usually spend
completing homework? (NEW)
IF NEEDED: ANY LOCATION, HOME OR STUDY HALL. FOR FRACTIONS OF AN
HOUR, ROUND UP IF 30 MINUTES OR MORE. ROUND DOWN IF FEWER THAN 30
MINUTES.
| | |
(0-168)

| HOURS

DOES NOT HAVE HOMEWORK ASSIGNED ............. 998
CHOOSES NOT TO DO HOMEWORK ASSIGNED .... 996
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

97

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Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9a1.

My next questions are about school activities and services. For each, please tell me
whether you have received the following kinds of instruction or help from school staff
this year (2011-2012). Have school staff provided you with extra help before or after
school in academic subjects?
YES………………………….…..1

GO TO K9a2

NO……………………………….2

GO TO K9b1

DON’T KNOW………………….d

GO TO K9b1

REFUSED……………………….r

GO TO K9b1

K9A1 = 1

K9a2.

How useful was extra help before or after school in academic subjects either in
helping you stay in school or prepare for life after school? Was it very useful,
somewhat useful, or not useful to you?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9b1.

Have school staff provided you with academic instruction on weekends?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9b2

NO……………………………….0

GO TO K9c1

DON’T KNOW………………….d

GO TO K9c1

REFUSED……………………….r

GO TO K9c1

K9B1 = 1

K9b2.

How useful was academic instruction on weekends?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

98

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Student Baseline Questionnaire: CATI Programming Specifications

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9c1.

Have school staff provided you with help completing college applications?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9c2

NO……………………………….0

GO TO K9d1

DON’T KNOW………………….d

GO TO K9d1

REFUSED……………………….r

GO TO K9d1

K9C1 = 1

K9c2.

How useful was help completing college applications?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9d1.

Have school staff provided you with guidance about which courses to take?

PROBE: Have you received this kind of instruction or help from school staff this year (2011-2012)?
YES………………………….…..1

GO TO K9d2

NO……………………………….0

GO TO K9e1

DON’T KNOW………………….d

GO TO K9e1

REFUSED……………………….r

GO TO K9e1

K9D1 = 1

K9d2.

How useful wasthe guidance about which courses to take?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

99

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Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 15)

K9e1.

Have school staff provided you with help reviewing college entrance test results or
suggested re-testing if necessary?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9e2

NO……………………………….0

GO TO K9f1

DON’T KNOW………………….d

GO TO K9f1

REFUSED……………………….r

GO TO K9f1

K9E1 = 1

K9e2.

How useful was help reviewing college entrance test results and suggesting retesting if necessary?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 15)

K9f1.

Have school staff provided you with help arranging or taking you on visits to colleges
or college fairs?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9f2

NO……………………………….0

GO TO K9g1

DON’T KNOW………………….d

GO TO K9g1

REFUSED……………………….r

GO TO K9g1

100

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Student Baseline Questionnaire: CATI Programming Specifications
K9F1 = 1

K9f2.

How useful was the help arranging or taking you on visits to colleges or college fairs?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9g1.

Have school staff provided you with help identifying possible career options?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9g2

NO……………………………….0

GO TO K9h1

DON’T KNOW………………….d

GO TO K9h1

REFUSED……………………….r

GO TO K9h1

K9G1 = 1

K9g2.

How useful was this help identifying possible career options?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9h1.

Have school staff provided you with help learning to manage money?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9h2

NO……………………………….0

GO TO K9i1

DON’T KNOW………………….d

GO TO K9i1

REFUSED……………………….r

GO TO K9i1

101

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Student Baseline Questionnaire: CATI Programming Specifications

K9H1 = 1

K9h2.

How useful was help learning to manage money?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9i1.

Have school staff provided you with reproductive health or pregnancy prevention
education or services?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9i2

NO……………………………….0

GO TO K9j1

DON’T KNOW………………….d

GO TO K9j1

REFUSED……………………….r

GO TO K9j1

K9I1 = 1

K9i2.

How useful were the reproductive health or pregnancy prevention education or
services?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

102

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Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9j1.

Have school staff provided you with teen parenting instruction?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9j2

NO……………………………….0

GO TO K9k1

DON’T KNOW………………….d

GO TO K9k1

REFUSED……………………….r

GO TO K9k1

K9J1 = 1

K9j2.

How useful was the teen parenting instruction?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND G6 = 1

K9k1.

Have school staff provided you with child care for your child?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9k2

NO……………………………….0

GO TO K9l1

DON’T KNOW………………….d

GO TO K9l1

REFUSED……………………….r

GO TO K9l1

103

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Student Baseline Questionnaire: CATI Programming Specifications
K9K1 = 1

K9k2.

How useful was the child care?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9l1.

Have school staff provided you with substance abuse counseling or education?
PROBE: This includes both drugs and alcohol.
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
YES………………………….…..1

GO TO K9l2

NO……………………………….0

GO TO K9m1

DON’T KNOW………………….d

GO TO K9m1

REFUSED……………………….r

GO TO K9m1

K9L1 = 1

K9l2.

How useful was substance abuse counseling or education?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

104

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Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))

K9m1.

Have school staff provided you with instruction on appropriate use of social
networking sites?
PROBE: Have you received this kind of instruction or help from school staff this year (20112012)?
PROBE: Social networking sites are ones like Facebook, Yahoo groups, and MySpace.
YES………………………….…..1

GO TO K9m2

NO……………………………….0

GO TO K10

DON’T KNOW………………….d

GO TO K10

REFUSED……………………….r

GO TO K10

K9M1 = 1

K9m2.

How useful was instruction on appropriate use of social networking sites?
PROBE: How useful was this kind of instruction or help from school staff this year (20112012)?
PROBE: Social networking sites are ones like Facebook, Yahoo groups, and MySpace.
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r

K1 = 1
K10.

Has anyone provided guidance on the classes {you/{NAME}} should take to prepare
for what {you plan/he/she plans} to do after high school.
YES ............................................................................. 1

GO TO K10a

NO ............................................................................... 0

GO TO K11

DON’T KNOW ............................................................. d

GO TO K11

REFUSED ................................................................... r

GO TO K11

K10= 1
K10a.

Is there a written plan summarizing this list of high school classes?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

105

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Student Baseline Questionnaire: CATI Programming Specifications

YOUTH AGE FROM A12 OR A12A IS >16 YRS OLD

K11.

{Have you / Has {NAME}} taken any of the following college placement tests… (HSLS
student, rev)
CATI: PLEASE ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.

CODE ONE PER ROW
YES

NO

DK

REF

a. The PSAT? ..........................................................................................

1

0

d

r

b. The ACT? ............................................................................................

1

0

d

r

c. The SAT?.............................................................................................

1

0

d

r

d. The placement test for a local college, such as Accuplacer or
other tests used for community colleges?......................................

1

0

d

r

INTERVIEWER CHECK POINT:
DOES THE RESPONDENT SEEM FATIGUED, CONFUSED, OR NEED REINFORCEMENT?
FATIGUE PROBE:
1. Are you feeling tired or can we continue?
2. Would you like to take a break? I can hold on.
3. Would you like to continue the interview another time?
REINFORCEMENT PROBE:
1. Your answers are very helpful for this study.
2. You are doing very well.
INTERVIEWER ACTION:
NOT FATIGUED, NO REINFORCEMENT NEEDED................ 01 (BOX L1)
FATIGUED AND WANTS TO BE CALLED BACK..................... 02 (appt tab)
FATIGUED, BUT CAN CONTINUE............................................ 03 (BOX L1)
GAVE REINFORCEMENT, CAN CONTINUE........................... 04 (BOX L1)
GAVE REINFORCEMENT, WANTS TO BE CALLED BACK.... 05 (appt tab)

L. STUDENT’S IEP EXPERIENCE

BOX L1
( D5 = 1) OR (IEP IN SAMPLE = Y) OR D2_INTRO1 = 1 -> GO TO L1.
ELSE, GO TO M1

106

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Student Baseline Questionnaire: CATI Programming Specifications
( D5 = 1) OR (IEP IN SAMPLE = Y) OR D2_INTRO1 = 1

L1.

During this school year, or last school year, did {you/he/she} go to a meeting at
school about an Individualized Education Program, or IEP, for special education
programs or services?

IF NEEDED: That would be during the 2010-2011 or 2011-2012 school years.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

YOUTH AGE IN A12 OR A12A >16 AND
(IEP IN SAMPLE = Y) OR D5 = 1 OR D2 ANY PART a-u= 1 OR D2_INTRO1 = 1)

L2.

Did {you/NAME of youth} meet with adults at school to set goals for what
{you/he/she} will do after high school and make a plan for how to achieve them?
Sometimes this is called a transition plan.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

YOUTH AGE IN A12 OR A12A >16 AND J1B= 1 AND L1 OR L2 = 1

L2a.

Which of the following best describes {your/{NAME}’s} role in your {IEP and transition
planning /IEP planning}?
CODE ONE ONLY
You did not participate .............................................. 1
You were present in discussions but participated
very little or not at all ................................................. 2
You provided some input, or .................................... 3
You took a leadership role, helping set the direction
of the discussions, goals and plans......................... 4
DOESN’T KNOW ABOUT ANY GOALS ..................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX L3
IF K1 = 1, GO TO M1. IF K1≠1, GO TO L3

107

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Student Baseline Questionnaire: CATI Programming Specifications
(D5 = 1 OR D2 ANY PART = 1 OR D2_INTRO1 = 1) AND K1≠1

L3.

Before {you/{NAME}} left school, did someone from {your/his/her} school meet with
{you/him/her} to make a short summary of {your/his/her} goals, skills, and any needs
for support? This list would be created to help {you/{NAME}} pursue {your/his/her}
goals after leaving school. (NEW)
YES ............................................................................. 1

GO TO L3a

NO ............................................................................... 0

GO TO M1

DON’T KNOW ............................................................. d

GO TO M1

REFUSED ................................................................... r

GO TO M1

L3=1

L3a.

How often would {you/he/she} say {you have/he/she has} used this summary? Would
you say {you have/he/she has} not used it, {you have/he/she has} used it a little, or
{you have/he/she has} used it a lot? (NEW)
NOT USED IT AT ALL ................................................ 1

GO TO M1

USED IT A LITTLE ...................................................... 2

GO TO L3b

USED IT A LOT ........................................................... 3

GO TO L3b

DON’T KNOW ............................................................. d

GO TO M1

REFUSED ................................................................... r

GO TO M1

L3a= 2 OR 3
L3b.

How did {you/{NAME}} use this summary since leaving school?
CODE ALL THAT APPLY
APPLY FOR JOB/TALK TO EMPLOYERS ................ 1

GO TO M2

APPLY FOR EDUCATION OR TRAINING PROGRAMS 2

GO TO M2

WORKING WITH VOC REHAB OR OTHER
EMPLOYMENT COUNSELOR .................................... 3

GO TO M2

GETTING SUPPORT SERVICES................................ 4

GO TO M2

OTHER (SPECIFY) ..................................................... 99 GO TO L3b.other
(STRING (500))
DON’T KNOW ............................................................. d

GO TO M2

REFUSED ................................................................... r

GO TO M2

IF OTHER SPECIFY (99): What other way did you use the summary since leaving school?

108

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Student Baseline Questionnaire: CATI Programming Specifications

SECTION M. ACTIVITIES AND EXPERIENCE OUT OF SCHOOL

K1 = 1

M1.

During past 12 months, that is from {date} until now, {have you/ has he/she}
participated in any of the following school activities outside of class?
CODE ALL THAT APPLY
School sports team ...................................................... 1
Music, dance, art, or theater ........................................ 2
Student government .................................................... 3
Academic subject matter club (math, science, computer)

4

Volunteer or community service group ......................... 5
Vocational or career-focused student
organization, or ............................................................ 6
Other school-sponsored clubs or activities ................... 7
NONE OF THESE ....................................................... 8
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL

M2.

During the past 12 months, {have you/ has he/she} taken part in any of the following
non-school activities?
CODE ALL THAT APPLY
Organized sports supervised by an adult ..................... 1
Music, dance, art, or theater lessons ........................... 2
A religious youth group or religious instruction ............. 3
Math, science, or computer camps or lessons ............. 4
Volunteer or community service group ......................... 5
Scouting or another group or club activity .................... 6
Another camp or type of non-school activity................. 7
NONE OF THESE ....................................................... 8
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

109

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Student Baseline Questionnaire: CATI Programming Specifications
ALL

M3.

During the past 12 months, about how many days a week did {you/he/she} usually get
together with friends outside of school and outside of organized activities or groups?
CODE ONE ONLY
Never, .......................................................................... 1
Sometimes, but not every week, .................................. 2
1 day a week, .............................................................. 3
2 or 3 days a week,...................................................... 4
4 or 5 days a week, or ................................................. 5
6 or 7 days a week?..................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b= 1
M4.

How often do you use each of the following to communicate with friends? How about
[FILL ITEM]? Do you use that several times a day, once a day, several times a week,
once a week or less, or never?
CODE ONE PER ROW
Several
times a
day

Once a
day

Several
times a
week

Once a
week, or
less

Never?

DK

REF

a. Texting...............................................

1

2

3

4

5

d

r

b. Instant messaging ............................

1

2

3

4

5

d

r

c. Email ..................................................

1

2

3

4

5

d

r

d. Talking on a telephone (either cellular,
landline, Skype, or video phone) ....

1

2

3

4

5

d

r

e. Facebook, Twitter (sending or
receiving tweets) and other social
media .................................................

1

2

3

4

5

d

r

110

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Student Baseline Questionnaire: CATI Programming Specifications

J1b= 1
M5.

How often do you use a computer for {FILL ITEM}.
Would you say, several times a day, once a day, several times a week, once a week or
less, or never?
CODE ONE PER ROW
Several
times a
day a
day

Once a
day

Several
times a
week

Once a
week, or
less

Never?

DK

REF

a. Homework and school assignments?
...........................................................

1

2

3

4

5

d

r

b. Playing games? ................................

1

2

3

4

5

d

r

c. Using the internet - to read a book,
news-related website, or search for
information? .....................................

1

2

3

4

5

d

r

SECTION N. EMPLOYMENT

ALL
N1_INTRO. Now I would like to ask a few questions about {your/his/her} work experience.
REVIEWERS GUIDE TO INCOME SERIES IS AS FOLLOWS:
Item Start
N1
N5
N7
N19
N29
N44

Asked of…
All Youth
(AND PROXIES)
Youth in school
(AND PROXIES)
Youth who left
school in the past
12 months
(AND PROXIES)

Descriptor of sequence
School sponsored work in the past 12 months
Youth doing work other than school sponsored jobs in the past 12 months
Youth with a job now other than school sponsored work
Youth who do not have a job now but had one in the past 12 months
Youth who have a job now
Youth who do not have a job now but who had a job since leaving school

111

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Student Baseline Questionnaire: CATI Programming Specifications
ALL

N1.

In the past 12 months, {have you/has {NAME}} taken part in any school-sponsored
work activities, like a work-study or co-op job, an internship, or a school-based
business?
PROBE:

This may include working in the school store, bank, or café.

YES ............................................................................. 1

GO TO N1a

NO ............................................................................... 0

GO TO BOX N5

DON’T KNOW ............................................................. d

GO TO BOX N5

REFUSED ................................................................... r

GO TO BOX N5

N1=1
N1a.

Did {you/he/she} get school credit for that work activity?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N1=1
N1b.

Did {you/he/she} get paid for that work activity?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N1=1
N2.

About how many hours a week {have you/has he/she} usually worked in this schoolsponsored job? (NLTS2, T2c, REV)
IF MORE THAN ONE JOB, COMBINE ALL JOBS.
IF WORKED LESS THAN 1 HOUR PER WEEK, CODE AS 1 HOUR.
|

|

| NUMBER (1-80)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N1=1
N3.

About how long {have you/ has he/she} worked in this school sponsored job?
IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|

|

| NUMBER (1-52)

WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N1=1
N4.

Is that work activity related to a particular job or
career {you/{NAME}} are interested in?
YES ............................................................................. 1
NO - THE WORK IS NOT IN A CAREER/JOB I’M
INTERESTED IN. ........................................................ 0
I DON’T HAVE A PARTICULAR JOB/CAREER
INTEREST ................................................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

BOX N5
IF B1 OR B4 = 1, GO TO N5. ELSE IF B9 <= 1 YEAR AGO, GO TO N29.
ELSE GO TO N55.

B1 OR B4 = 1

N5.

My next questions are about paid work other than school-sponsored jobs. At any time in
the past 12 months, did {you/NAME} do any work for pay, other than work around the
house {IF N1 = 1: or a school-sponsored job}? That could include being a babysitter or
working for a neighbor.
YES ............................................................................. 1

GO TO N6

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

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N5 = 1

N6.

Did {you/he/she} do this work only during the summer, the school year, or both?
IF ASKED, THE SCHOOL YEAR IS FROM SEPTEMBER TO MAY AND SUMMER IS FROM
JUNE TO AUGUST.
CODE ONE ONLY
ONLY DURING THE SUMMER ................................... 1

GO TO N6a

ONLY DURING THE SCHOOL YEAR ......................... 2

GO TO N6b

BOTH .......................................................................... 3

GO TO N6a

DON’T KNOW ............................................................. d

GO TO N7

REFUSED ................................................................... r

GO TO N7

N6 = 1,3

N6A.

About how many hours a week {have you/has he/she} usually worked during the
summer?
IF MORE THAN ONE JOB, COMBINE ALL JOBS. IF YOUTH IS WORKING THIS SUMMER
AND LAST SUMMER, CODE THIS SUMMER. IF WORKED LESS THAN 1 HOUR PER
WEEK, CODE AS 1 HOUR.
|

| | NUMBER
(0-80)

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF N6 = 1, GO TO N7. IF N6 = 3, GO TO N6b.
N6=2, 3

N6b.

How many hours a week {have you/has he/she} usually worked during the school
year?
IF MORE THAN ONE JOB, COMBINE ALL JOBS. IF NO LONGER IN SCHOOL AND
ASKED, WE MEAN DURING SEPTEMBER TO MAY. IF WORKED DIFFERENT HOURS IN
2 SCHOOL YEARS, CODE MOST RECENT SCHOOL YEAR. IF WORKED LESS THAN 1
HOUR PER WEEK, CODE AS 1 HOUR.
| | | HOURS
(0-60)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N5 = 1

N7.

{Do you/Does {NAME}} have a paid job now, other than work around the house {IF N1
= 1: or a school sponsored job}? That could include being a babysitter or working for
a neighbor.
YES ............................................................................. 1

GO TO N8

NO ............................................................................... 0

GO TO N19

DON’T KNOW ............................................................. d

GO TO N19

REFUSED ................................................................... r

GO TO N19

N7=1
N8.

How many different paid jobs {do you/ does he/she} have now?
|

|

| NUMBER

(0-10)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N7=1
N9.

Thinking about [IF N8=1: the job] [IF N8>1, d, r: all the jobs] {you have/he/she has}
now {IF N1 = 1: ,not counting {your/his/her} school sponsored job}, about how many
hours a week {do you/ does he/she} usually work?
|

|

| HOURS

GO TO N10

(0-80)
DON’T KNOW ............................................................. d

GO TO N9a

REFUSED ................................................................... r

GO TO N9a

N9 = d,r
N9a.

[IF N8=1: In the job {you have/he/she has} now] [IF N8>1, d, r: Taking all {your/his/her}
jobs together], {IF N1 = 1: not counting {your/his/her} school sponsored job}, {do you/
does he/she} usually work 35 hours or more per week?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N7=1
N10.

{Thinking about the job where you work the most hours} About how long {have you/
has he/she} worked there?
IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|

| | NUMBER
(0-52)

WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N7=1
N11.

What kind of job is this? Is it an informal job {you do/{NAME} does} for family or
friends (such as babysitting or yard work), or is formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY

1

FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N7=1
N12.

About how much {are you/is {NAME}} paid for this job, before taxes or deductions are
taken out?
PROBE: Is that per hour?
|

|

|,|

|

|

|.|

|

|

(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.

116

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N7=1
N13.

How {do you/does he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

IF OTHER SPECIFY (99): What form of transportation was used?

BOX N14
IF N7 = 1 AND N11 ≠ 1 AND (D5 = 1 OR D2 ANY PART = 1 OR
D2_INTRO1 = 1 OR D6B = 1), GO TO N14. ELSE, GO TO N55.

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Student Baseline Questionnaire: CATI Programming Specifications

N7= 1 (WORKING) AND N11 =2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND D2 ANY
ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N14.

Did {you/he/she} tell {your/his/her} employer that {you have/ he/she has} any kind of
learning problem, disability, or other special need…
CODE ONE ONLY
Before {you/he/she} got {your/his/her} job, ............. 1

GO TO N16

After {you/he/she} started the job, or ....................... 2

GO TO N16

{Have you/ Has he/she} not told them at all?........... 3

GO TO N15

DON’T KNOW ............................................................. d

GO TO N15

REFUSED ................................................................... r

GO TO N15

N14 = 3,d, r
N15.

Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N14=1, 2, 3, d, r
N16.

At {your/his/her} job, do most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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Student Baseline Questionnaire: CATI Programming Specifications

N14=1, 2, 3, d, r
N17.

Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} to learn {your/his/her} job?
(NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N14=1, 2, 3, d, r
N18.

{Have you/ Has/{he/she}} received any accommodations or other help from
{your/his/her} employer because {you have/he has/she has} any kind of learning
problem, disability, or other special need?
YES ............................................................................. 1

GO TO N18a

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

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N18=1
N18a.

What accommodations or other help have {you/he/she} received?
CODE ALL THAT APPLY
NONE ............................................................................................................................................................................ 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ............................................................... 1
WRITTEN MATERIALS ON TAPE................................................................................................................................. 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD, SWITCH
INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................................................. 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ...................................................... 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON THE JOB ...... 5
TTY, TTD, OR VIDEOPHONE AVAILABLE ................................................................................................................... 6
ALTERED WORK STATION .......................................................................................................................................... 7
A READER OR INTERPRETER .................................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE ......................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ..................................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ............................................................................ 11
MORE OR DIFFERENT SUPERVISION OR MENTORING .......................................................................................... 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ............................................................... 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G., PICTORIAL
INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ........................................... 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ..................................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE ........................................................................................................ 16
MORE BREAKS, LONGER BREAKS ............................................................................................................................ 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS, ETC. .......... 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY ........................................................ 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) ................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ........................... 21
PARKING ACCOMMODATIONS ................................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ...................................... 23
OTHER (SPECIFY) What

other accommodations were received? .......................................................... 99

(STRING 500)
DON’T KNOW ................................................................................................................................................................ d
REFUSED ...................................................................................................................................................................... r

CATI: ALL RESPONSES FROM N18a GO TO N55

B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
N19.

About how long {did you/he/she} work at {your/his/her} last job?
INTERVIEWER: IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|

|

| NUMBER (0-52)

WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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Student Baseline Questionnaire: CATI Programming Specifications

B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
N21.

What kind of job was this? Was it an informal job {you did/{NAME} did} for family or
friends (such as babysitting or yard work), or was it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY

1

FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
N22.

About how much {were you/was {NAME}} paid for this job, before taxes or deductions
were taken out?
PROBE:
|

|

Is that per hour?
|,|

|

|

|.|

|

|

(.01-99999.99)

PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: PLEASE ENTER A DECIMAL IF NEEDED. DO
NOT ENTER A DOLLAR SIGN.

121

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Student Baseline Questionnaire: CATI Programming Specifications

B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
N23.

How did {you/he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON MODE
OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

IF OTHER SPECIFY (99): What form of transportation was used?

BOX N24
IF B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1 AND N21 ≠ 1 AND (D5 = 1 OR D2 ANY PART = 1
OR D2_INTRO1 = 1 OR D6B = 1), GO TO N24. ELSE GO TO N55.

122

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Student Baseline Questionnaire: CATI Programming Specifications

B1 OR B4 = 1 (ENROLLED IN SCHOOL THIS YEAR) AND
N7 = 0,D,R (NOT WORKING / NOT RESPONDED TO WORKING NOW) AND N5 =1 (HAS
WORKED IN PAST 12 MO) AND N21=2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND
D2 ANY ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N24.

Did you tell your employer that you have any kind of learning problem, disability, or
other special need…
CODE ONE ONLY
Before you got your job, ........................................... 1

GO TO N26

After you started the job, or ...................................... 2

GO TO N26

Have you not told them at all? .................................. 3

GO TO N25

DON’T KNOW ............................................................. d

GO TO N25

REFUSED ................................................................... r

GO TO N25

N24 = 3,D,R
N25.

Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need? (NLTS T8j2, REV)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N24=1,2,3,d,r
N26.

At {your/his/her} job, did most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N24=1,2,3,d,r
N27.

Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

123

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N24=1,2,3,d,r
N28.

Did {you/he/she} receive any accommodations or other help from your employer
because {you have/he has/she has} any kind of learning problem, disability, or other
special need?
YES ............................................................................. 1

GO TO N28a

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

N28 = 1
N28a.

What accommodations or other help did {you/he/she} receive?
CODE ALL THAT APPLY
NONE .............................................................................................................................................................................. 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ................................................................. 1
WRITTEN MATERIALS ON TAPE................................................................................................................................... 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD, SWITCH
INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................................................... 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ........................................................ 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON THE JOB ........ 5
TTY, TTD, OR VIDEOPHONE AVAILABLE ..................................................................................................................... 6
ALTERED WORK STATION ............................................................................................................................................ 7
A READER OR INTERPRETER ...................................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE ........................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ....................................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS .............................................................................. 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ............................................................................................ 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ................................................................. 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G., PICTORIAL
INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ............................................. 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ....................................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE .......................................................................................................... 16
MORE BREAKS, LONGER BREAKS .............................................................................................................................. 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS, ETC. ............. 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY .......................................................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) ..................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ............................. 21
PARKING ACCOMMODATIONS ..................................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ........................................ 23
OTHER (SPECIFY) .......................................................................................................................................................... 99
(STRING 500
DON’T KNOW .................................................................................................................................................................. d
REFUSED ........................................................................................................................................................................ r

IF OTHER SPECIFY (99): What other accommodations were received?
CATI: ALL RESPONSES FROM N28 GO TO N55

124

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Student Baseline Questionnaire: CATI Programming Specifications

B1 AND B4 ≠ 1 AND B9 <= 1 YEAR AGO
N29.

{Do you/ Does {NAME}} have a paid job now, other than work around the house {IF
N1= 1: or a school sponsored job}? That could include being a babysitter or working
for a neighbor.
YES ............................................................................. 1

GO TO N30

NO ............................................................................... 0

GO TO N44

DON’T KNOW ............................................................. d

GO TO N44

REFUSED ................................................................... r

GO TO N44

N29 = 1
N30.

Did {you/{NAME}} have this job while in high school?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N29 = 1
N31.

How many different paid jobs {do you/does he/she} have now?
|

|

| NUMBER

(0-10)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF GT 2 I recorded {NUMBER} jobs right now. Is that correct?
N29 = 1
N32.

Thinking about [IF N31=1: the job] [IF N31>1, d, r: all the jobs] {you have/he/she has}
now {IF N1 = 1: not counting {your/his/her} school sponsored job}, about how many
hours a week {do you/ does he/she} usually work?
|

| | HOURS
(0-80)

GO TO N33

DON’T KNOW ............................................................. d

GO TO N32a

REFUSED ................................................................... r

GO TO N32a

125

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Student Baseline Questionnaire: CATI Programming Specifications
N32= D, R

N32a.

[IF N31 =1: In the job {you have/he/she has} now] [IF N31 >1, d, r: Taking all
{your/his/her} jobs together], {IF N1= 1: not counting {your/his/her} school sponsored
job}, {do you/ does he/she} usually work 35 hours or more per week?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N29 = 1
N33.

{N31 > 1, FILL: Thinking about the job where you work the most hours} About how
long {have you/ has he/she} worked there?
INTERVIEWER: IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|

|

| NUMBER (1-52)

WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N29 = 1 AND (N30 = 1 OR N31 ≠ 1)
N34.

Since leaving school, how many hours a week {have you/has he/she} usually worked
at that job?
|

|

| HOURS

(1-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N29 = 1
N35.

What kind of job is this? Is it an informal job {you do/he/she does} for family or
friends (such as babysitting or yard work), or is it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY

1

FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

126

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Student Baseline Questionnaire: CATI Programming Specifications

N29 = 1
N36.

About how much {are you/is {NAME}} paid for this job, before taxes or deductions are
taken out? PROBE:
Is that per hour?
|

|

|,|

|

|

|.|

|

|

(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: PLEASE ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.
N29 = 1
N37.

How {do you/does {NAME}] usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

IF OTHER SPECIFY (99): What form of transportation was used?

127

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Student Baseline Questionnaire: CATI Programming Specifications

BOX N38
IF N29 = 1 AND (D1 = 1 OR D3 =1 OR D6 = 1 OR D5 = 1 OR D2
ANY PART = 1 OR D2_INTRO1 = 1) AND N35 ≠ 1, GO TO N38. ELSE,
GO TO N55.

N29 = 1 (WORKING PD JOB NOW) AND N35 =2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND D2 ANY
ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N38.

Did you tell your employer that you have any kind of learning problem, disability, or
other special need
CODE ONE ONLY
Before you got your job, ........................................... 1

GO TO N40

After you started the job, or ...................................... 2

GO TO N40

Have you not told them at all? .................................. 3

GO TO N39

DON’T KNOW ............................................................. d

GO TO N39

REFUSED ................................................................... r

GO TO N39

N38 = 3,D,R
N39.

Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1

GO TO N40

NO ............................................................................... 0

GO TO N40

DON’T KNOW ............................................................. d

GO TO N40

REFUSED ................................................................... r

GO TO N40

N38=1, 2, 3, d, r
N40.

At {your/his/her} job, do most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N38=1, 2, 3, d, r
N41.

Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N38=1, 2, 3, d, r
N42.

{Have you/Has/{he/she}} received any accommodations or other help from
{your/his/her} employer because {you have/he has/she has} any kind of learning
problem, disability, or other special need?
YES ............................................................................. 1

GO TO N43

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

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N42 = 1
N43.

What accommodations or other help have {you/he/she} received?
CODE ALL THAT APPLY
NONE .............................................................................................................................................................. 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ................................................. 1
WRITTEN MATERIALS ON TAPE .................................................................................................................. 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD,
SWITCH INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................... 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ........................................ 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON
THE JOB ......................................................................................................................................................... 5
TTY, TTD, OR VIDEOPHONE AVAILABLE .................................................................................................... 6
ALTERED WORK STATION ........................................................................................................................... 7
A READER OR INTERPRETER...................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE .......... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ...................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ............................................................. 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ............................................................................ 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE................................................. 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G.,
PICTORIAL INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ........ 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ...................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE ......................................................................................... 16
MORE BREAKS, LONGER BREAKS .............................................................................................................. 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS,
ETC. ................................................................................................................................................................ 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY .......................................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) .... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ............ 21
PARKING ACCOMMODATIONS .................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ........................ 23
OTHER (SPECIFY) ......................................................................................................................................... 99
(STRIN

G 50)

DON’T KNOW ................................................................................................................................................. d
REFUSED ....................................................................................................................................................... r

IF OTHER SPECIFY (99): What other accommodations were received?
CATI: ALL RESPONSE OPTIONS FROM N43 GO TO N55

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B9 <= 1 YEAR AND N29 ≠ 1
N44.

{Have you/has he/she} had a paid job since leaving school?
YES ............................................................................. 1

GO TO N45

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

N44 = 1

N45.

About how long did {you/he/she} work there? IF UNSURE, PROBE FOR SEASONS,
HOLIDAYS, ETC.
|

|

| NUMBER

(0-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N44 = 1

N46.

How many hours a week did {you/he/she} usually work at that job since leaving
school?
|

|

| HOURS

(0-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N44 = 1

N47.

What kind of job was this? Was it an informal job {you did/he/she did} for family or
friends (such as babysitting or yard work), or was it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY

1

FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N44 = 1

N48.

About how much {were you/was {NAME}} paid for this job, before taxes or deductions
were taken out?
PROBE:
|

|

Is that per hour?
|,|

|

|

|.|

|

|

(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.

N44 = 1

N49.

How did {you/he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

IF OTHER SPECIFY (99): What form of transportation was used?

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N44 = 1 (HAD JOB SINCE LEAVING SCHOOL) AND N47 =2 (FORMAL JOB) AND

[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND D2 ANY
ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N50.

Did you tell your employer that you have any kind of learning problem, disability, or
other special need…
CODE ONE ONLY
Before you got your job, ........................................... 1

GO TO N52

After you started the job, or ...................................... 2

GO TO N52

Have you not told them at all? .................................. 3

GO TO N51

DON’T KNOW ............................................................. d

GO TO N51

REFUSED ................................................................... r

GO TO N51

J1B=1 AND N50=3,d,r

N51.

Do you think your employer was aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N50=1,2,3, d, r

N52.

At {your/his/her} job, did most of the other workers have disabilities? (NLTS2, T8I)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

N50=1,2,3, d, r

N53.

Was there someone, either from {your/{NAME}’s} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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N50=1,2,3, d, r

N54.

Did {you/he/she} receive any accommodations or other help from your employer
because {you have/he has/she has} any kind of learning problem, disability, or other
special need?
YES ............................................................................. 1

GO TO N54a

NO ............................................................................... 0

GO TO N55

DON’T KNOW ............................................................. d

GO TO N55

REFUSED ................................................................... r

GO TO N55

N54=1
N54a.

What accommodations or other help did {you/he/she} receive?
CODE ALL THAT APPLY
NONE ................................................................................................................................................... 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ...................................... 1
WRITTEN MATERIALS ON TAPE ....................................................................................................... 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE
KEYBOARD, SWITCH INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER
PERIPHERALS) ............................................................................................................................ 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ............................. 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED
ON THE JOB ................................................................................................................................. 5
TTY, TTD, OR VIDEOPHONE AVAILABLE.......................................................................................... 6
ALTERED WORK STATION ................................................................................................................. 7
A READER OR INTERPRETER ........................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE
PERFORMANCE ........................................................................................................................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB............................................................ 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ................................................... 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ................................................................. 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ...................................... 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED
(E.G., PICTORIAL INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION
TO WRITTEN) ............................................................................................................................... 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ............................................................ 15
SLOWER PACE FOR GETTING THE JOB DONE ............................................................................... 16
MORE BREAKS, LONGER BREAKS ................................................................................................... 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY
APPOINTMENTS, ETC. ................................................................................................................ 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY ............................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS
ACCESSIBLE) ............................................................................................................................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK
SITE) ............................................................................................................................................. 21
PARKING ACCOMMODATIONS .......................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ............. 23
OTHER (SPECIFY)............................................................................................................................... 99
___________________________________________________________________(STRING 50)
DON’T KNOW ....................................................................................................................................... d
REFUSED............................................................................................................................................. r

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IF OTHER SPECIFY (99): What other accommodations were received?
AGE IN A12 OR A12A >= 15
N55.

{Have you/Has he/she} had a job in the past that {you don’t/he/she doesn’t} work at
anymore?
YES ............................................................................. 1

GO TO N55a

NO ............................................................................... 0

GO TO O_Intro

DON’T KNOW ............................................................. d

GO TO O_Intro

REFUSED ................................................................... r

GO TO O_Intro

AGE IN A12 OR A12A >= 15 AND N55 = 1

N55a.

When {you/he/she} left {your/his/her} most recent former job
CODE ONE ONLY
Did {you/he/she} quit, ................................................ 1

GO TO N55b

{Were you/Was he/she} fired,.................................... 2

GO TO O _Intro

{Were you/Was he/she} laid off, or ........................... 3

GO TO O _Intro

Was it a temporary job that ended? ......................... 4

GO TO O _Intro

HAVE NOT LEFT A JOB ............................................. 5

GO TO O _Intro

DON’T KNOW ............................................................. d

GO TO O _Intro

REFUSED ................................................................... r

GO TO O _Intro

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N55a=1
N55b.

What was the main reason {you/he/she} quit?
CODE ONE ONLY
FOUND A BETTER JOB........................................................ 1

GO TO O _Intro

WANTED TO LOOK FOR A BETTER JOB ............................ 2

GO TO O _Intro

WANTED TO START OWN BUSINESS/WORK FOR SELF .. 3

GO TO O _Intro

DIDN’T LIKE THE HOURS/KIND OF WORK/ CONDITIONS . 4

GO TO O _Intro

WAGES TOO LOW ............................................................... 5

GO TO O _Intro

DIDN’T GET ALONG WITH COWORKERS OR BOSS.......... 6

GO TO O _Intro

WENT BACK TO SCHOOL.................................................... 7

GO TO O _Intro

JOB INTERFERED WITH SCHOOL ...................................... 8

GO TO O _Intro

ILLNESS OR DISABILITY INTERFERED WITH JOB ............ 9

GO TO O _Intro

EMPLOYER WOULDN’T PROVIDE ACCOMMODATION ..... 10 GO TO O _Intro
PARENTS DIDN’T WANT YOUTH TO WORK....................... 11 GO TO O _Intro
FAMILY REASONS (PREGNANCY, CARE FOR FAMILY) .... 12 GO TO O _Intro
MOVED ................................................................................. 13 GO TO O _Intro
TRANSPORTATION PROBLEMS/HARD TO GET TO JOB .. 14 GO TO O _Intro
CAN MAKE MORE MONEY ON DISABILITY ......................... 15 GO TO O _Intro

DON’T KNOW ....................................................................... d

GO TO O _Intro

REFUSED .......................................................................................... r

GO TO O _Intro

ALL YOUTH AND PROXIES
O_INTRO. The next questions ask about {your/NAME’s} life today and {your/his/her}
expectations for {your/his/her} future. Remember, there are no right or wrong
answers.

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ALL YOUTH AND PROXIES
O1.

(Do you/Does he/she) have…

PROBE: This question is about {your/NAME’s} life today and {your/his/her} expectations for
{your/his/her} future.
CODE ONE PER ROW
YES

NO

DK

REF

a. an allowance, or have other money {you/he/she} can
decide how to spend? This could include money earned
from a job. .........................................................................

1

0

d

r

b. a savings account? ...........................................................

1

0

d

r

c. a checking account where {you write/ he/she writes}
checks or use{s} a debit card? (NLTS2, P16c) ...............

1

0

d

r

BOX O2
IF O1C = 1, GO TO O2. ELSE, GO TO O3.
J1B=1 AND O1C=1
O2.

Have you ever overdrawn this checking account?
PROBE: By this we mean have you ever spent more than was available in the account
and it resulted in a balance that was less than zero.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL YOUTH AND PROXIES

O3.

{Do you/Does {NAME}} get any bills in {your/his/her} own name that {you are/he/she
is} responsible for paying?
PROBE: This could include a bill for a cell phone, electricity, internet access, credit
card, rent, or a magazine subscription.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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YOUTH AGE IN A12 OR A12A >= 15 AND D1A ≠ 4,7,19.
O4.

{Do you/Does he/she} have a driver’s license or learner’s permit?
YES ............................................................................. 1

GO TO O5

NO ............................................................................... 0

GO TO O4a

DON’T KNOW ............................................................. d

GO TO O5

REFUSED ................................................................... r

GO TO O5

YOUTH AGE IN A12 OR A12A >= 15 AND D1A ≠ 4,7,19 AND J1B = 1 AND O4 = 0
O4a.

How likely do you think it is that you will get a driver’s license? Do you think you…
CODE ONE ONLY
Definitely will, ............................................................... 1
Probably will, ............................................................... 2
Probably won’t, or ........................................................ 3
Definitely won’t? .......................................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

YOUTH AGE FROM A12 OR A12A >= 18
O5.

{Are you/Is {NAME}} registered to vote?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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J1b = 1
INTERVIEWER CHECKPOINT:

NEED REINFORCEMENT?

DOES THE RESPONDENT SEEM FATIGUED, CONFUSED, OR

FATIGUE PROBE:
1. Are you feeling tired or can we continue?
2. Would you like to take a break? I can hold on.
3. Would you like to continue the interview another time?
REINFORCEMENT PROBE:
1. Your answers are very helpful for this study.
2. You are doing very well.
INTERVIEWER ACTION:
NOT FATIGUED, NO REINFORCEMENT NEEDED................ 01 (P1_INTRO)
FATIGUED AND WANTS TO BE CALLED BACK..................... 02 (appt tab)
FATIGUED, BUT CAN CONTINUE........................................... 03 (P1_INTRO)
GAVE REINFORCEMENT, CAN CONTINUE........................... 04 (P1_INTRO)
GAVE REINFORCEMENT, WANTS TO BE CALLED BACK.... 05 (appt tab)

SECTION P. STUDENT’S SELF-ADVOCACY

J1b = 1
P1_INTRO

Now I am going read some statements. For each, please tell me the answer that
best tells how you act in that situation. There are no right or wrong answers.

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J1b = 1
P1a.

“My friends and I choose activities that we want to do.” The choices are, I do not do,
even if I have the chance; I do sometimes when I have the chance; I do most of the
time I have a chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control
over the activity – such as a personal care attendant, answer as if you performed that
activity.

I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
J1b = 1
P1b.

“I write letters, texts, or talk on the phone to friends and family.” The choices are, I do
not do, even if I have the chance; I do sometimes when I have the chance; I do most
of the time I have a chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control
over the activity – such as a personal care attendant, answer as if you performed that
activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

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J1b = 1
P1c.

“I go to restaurants that I like.” The choices are, I do not do, even if I have the chance;
I do sometimes when I have the chance; I do most of the time I have a chance; or I do
every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

J1b = 1
P1d.

“I choose gifts to give to family and friends.”
The choices are, I do not do, even
if I have the chance; I do sometimes when I have the chance; I do most of the time I
have a chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

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J1b = 1
P1e.

“I go to movies, concerts, and dances.” The choices are, I do not do, even if I have the
chance; I do sometimes when I have the chance; I do most of the time I have a
chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

J1b = 1
P1f.

“I plan weekend activities that I like to do.” The choices are, I do not do, even if I have
the chance; I do sometimes when I have the chance; I do most of the time I have a
chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

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J1b = 1
P1g.

“I volunteer in things that I am interested in.” The choices are, I do not do, even if I
have the chance; I do sometimes when I have the chance; I do most of the time I have
a chance; or I do every time I have the chance.

PROBE:

Tell me the answer that best tells how you act in this situation.

PROBE:

There are no right or wrong answers

PROBE:

If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r

J1b = 1
P2.

Next, I am going to read you two statements. I want you to tell me the one that best
describes you. Choose only one answer. There are no right or wrong answers. Which
of the following statements best describes you?
CODE ONE ONLY
Trying hard at school doesn't do me much good, or ..... 1
Trying hard at school will help me get a good job ........ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b = 1
P3.

Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
It is no use to keep trying because that won't change
things, or...................................................................... 1
I keep trying even after I get something wrong............. 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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J1b = 1
P4.

Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I don't know how to make friends, or ............................ 1
I know how to make friends ......................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b = 1
P5.

READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I do not make good choices, or .................................... 1
I can make good choices ............................................. 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b = 1
P6.

READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
My choices will not be honored, or ............................... 1
I will be able to make choices that are important to me 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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J1b = 1
P7.

READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I will have a hard time making new friends, or.............. 1
I will be able to make friends in new situations............. 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b = 1
P8.

READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I usually agree with people when they tell me I can't do
something, or ............................................................... 1
I tell people when I think I can do something that they tell
me I can’t ..................................................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1b = 1
P9.

Now I am going to read some statements. Please tell me whether you think each of
these describes how you feel about yourself or not. There are no right or wrong
answers. Choose the answer that best fits you.
PROBE: You agree or you don’t agree?
CODE ONE PER ROW
AGREE

DON’T
AGREE

DON’T
KNOW

REFUSED

a. I know what I do best ............................................

1

2

d

r

b. I like myself .............................................................

1

2

d

r

c. I am confident in my abilities ...............................

1

2

d

r

d. Other people like me . ............................................

1

2

d

r

e. It is better to be yourself than to be popular ......

1

2

d

r

f. I know how to make up for my limitations ..........

1

2

d

r

g. I am loved because I give love .............................

1

2

d

r

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SECTION Q. EXPECTATIONS FOR THE FUTURE
J1B=1

Q1.

As things stand now, how far do you think you will get in school?
CODE ONE ONLY
LESS THAN HIGH SCHOOL (WILL NOT GRADUATE
OR GET GED) ............................................................. 1
HIGH SCHOOL DIPLOMA OR GED ........................... 2
TECHNICAL OR TRADE SCHOOL ............................ 3
2 YEAR COLLEGE .................................................... 4
4-YEAR COLLEGE ..................................................... 5
MASTER’S DEGREE, PHD, OR OTHER ADVANCED
DEGREE ..................................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1B=1 AND [D1 = 1 OR D2_INTRO1 = 1 OR D3=1 OR (D5B=8 OR D6B=1)] AND [ N5=0,D,R] AND [N55= 0,D,R]

Q2

How likely do you think it is that you will get a paid job by the time you are 30 years
old? Do you think you … (NLTS2, V13, REV)
IF ASKED: MEANS ANY PAID JOB, DOES NOT NEED TO MAKE ENOUGH TO SUPPORT
SELF. (READ CATEGORIES IF NECESSARY)
CODE ONE ONLY
Definitely will, ............................................................... 1
Probably will, ............................................................... 2
Probably won’t, or ........................................................ 3

GO TO Q4

Definitely won’t? .......................................................... 4

GO TO Q4

DON’T KNOW ............................................................. d

GO TO Q4

REFUSED ................................................................... r

GO TO Q4

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J1B=1 AND STUDENT Q2=1,2 AND (PARENT D1 = 1 OR D2_INTRO1 = 1 OR D2 ANY FROM A-U = 1, OR D3
= 1 OR (D5B=8 OR D6B=1)]

Q3.

By the time you are 30 years old, how likely do you think it is that you will earn
enough to support yourself without financial help from your family or government
benefit programs? Do you think you… (NLTS2, V14)
CODE ONE ONLY
Definitely will, ............................................................... 1
Probably will, ............................................................... 2
Probably won’t, or ........................................................ 3
Definitely won’t? .......................................................... 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

J1B=1

Q4.

When you are 30 years old, do you think you will be living: (NEW)
CODE ONE ONLY
On your own - without friends or family, ....................... 1
At home with parents, .................................................. 2
With a relative, ............................................................. 3
With friends,................................................................. 4
With a spouse or partner,............................................. 5
In military housing, ....................................................... 6
In a group home or with supervision, ........................... 7
In a larger facility with paid staff (an institution), or ....... 8
Somewhere else? (SPECIFY)...................................... 99
(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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J1B=1 AND YOUTH AGE >=15

Q5.

People sometimes face challenges deciding what to do after high school. Please tell
me if you agree or disagree with each of the following. (NEW)
AGREE

DISAGREE

DK

REF

a. I know what kinds of jobs I would like or what I would
be good at doing. .........................................................

1

0

d

r

b. I am getting enough help from school staff in learning
about different careers. ................................................

1

0

d

r

I know what further education is needed for jobs I
might want. ...................................................................

1

0

d

r

d. I am getting enough help from my teachers or school
counselors about schools I might want to attend after
high school. ..................................................................

1

0

d

r

e. I know where to get help paying for college or other
types of schools. ..........................................................

1

0

d

r

1

0

d

r

c.

f.

Are there any other challenges you face in deciding
what to do after high school?

INTERVIEWER: CODE “DISAGREE” IF ANSWER IS NO
(SPECIFY) ..........................................................................
_______________________________(STRING 500)

SECTION R. CONTACT INFORMATION FOR FOLLOW UP
These are the final questions in this survey. As you may remember, we will contact
{you/him/her} for the next survey in two years. To help us make sure we don’t lose
touch with {you/him/her}, it is helpful for us to make sure we have all of
{your/his/her} contact information.
J11 ≠ 1,d,r

R1.

At the start of this interview, you mentioned the best telephone number to reach
{you/him/her} was [CATI: FILL NUMBER FROM J11]. Is there another telephone
number where we can reach {you/him/her}?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO R2

DON’T KNOW ............................................................. d

GO TO R2

REFUSED ................................................................... r

GO TO R2

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Student Baseline Questionnaire: CATI Programming Specifications
R1=1

R1a.

What is that number?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)

|

DON’T KNOW ............................................................. d

GO TO R2

REFUSED ................................................................... r

GO TO R2

International Phone (STRING (NUM))
R1A ≠ d,r

R1b.

Is that a land line or cell phone?
LANDLINE .................................................................. 1

GO TO R2

CELL PHONE ............................................................. 2
DON’T KNOW ............................................................. d

GO TO R2

REFUSED ................................................................... r

GO TO R2

R1b = 2

R1c.

Would it be ok for us to send {you/him/her} a text message when we try to contact
{you/him/her} for the next survey?
YES ............................................................................. 1
DOES NOT USE TEXT MESSAGING ON PHONE ..... 2
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

R2.

How about email – {do you/ does he/she} have an e-mail address where we can send
study related information to {you/him/her}? This may include things like an email to
verify {your/his/her} contact information, an invitation to complete the survey, or a
reminder about the survey.
YES ............................................................................. 1
NO ............................................................................... 0

GO TO R3

DON’T KNOW ............................................................. d

GO TO R3

REFUSED ................................................................... r

GO TO R3

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Student Baseline Questionnaire: CATI Programming Specifications
R2 = 1

R2a.

What is the email address {you/he/she} check{s} most often?
(STRING (500))

EMAIL

DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL

R3.

{Do you/ Does he/she} have a Facebook account?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO R4

DON’T KNOW ............................................................. d

GO TO R4

REFUSED ................................................................... r

GO TO R4

R3 = 1

R3a.

May we send {you/him/her} a message through Facebook if we are unable to reach
{you/him/her} by mail, phone, or {your/his/her} regular email address?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

ALL

R4.

In case we have trouble reaching {you/him/her} directly when we do the next survey, we
would like to get the contact information for another person who will always be able to
reach {you/him/her}. Can you give me the name of a friend or relative who does not live
with {you/him/her} and would know how to reach {you/him/her} if {you/he/she} move{s}
or change{s} {your/his/her} telephone number? What is that person’s name?
(STRING 100)

FIRST NAME

(STRING 100)

MIDDLE INITIAL/NAME

(STRING 100)

LAST NAME

DON’T KNOW ............................................................. d

GO TO R10

REFUSED ................................................................... r

GO TO R10

CATI: ALLOW DK or REF OPTIONS FOR ANY PORTION OF NAME AND ALLOW INTERVIEWER TO CAPTURE/OFFER
NEXT FIELD

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Student Baseline Questionnaire: CATI Programming Specifications
.R4 ≠ d,r

R4a.

What is {your/his/her} relationship with this person? IF NEEDED: Is this person a
relative, a friend, or some other person in {your/his/her} life?
NOTE: CODE STEPPARENTS AS MOTHER OR FATHER.
CODE ONE ONLY
MOTHER/FATHER...................................................... 1
BROTHER/SISTER ..................................................... 2
GRAND MOTHER/GRANDFATHER ........................... 3
AUNT/UNCLE ............................................................. 4
COUSIN ...................................................................... 5
OTHER RELATIVE ..................................................... 6
FRIEND ....................................................................... 7
CASE MANAGER – SPECIFY NAME OF AGENCY ... 8
(STRING 150)
OTHER NON-RELATIVE ............................................ 98
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

R4 ≠ d,r

R5.

What is {NAME FROM R4}’s mailing address?
COLLECT/CONFIRM CURRENT CONTACT INFORMATION FOR RESPONDENT
(STRING 100)

ADDRESS 1

(STRING 100)

ADDRESS 2

(STRING 200)

CITY
STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)

(STRING 30)
|

|

DON’T KNOW ............................................................. d
REFUSED ................................................................... r

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R4 ≠ d,r

R6.

What is the best telephone number at which to reach {NAME FROM R4}?
|

|

|

(RANGE)

|-|

|

|

|-|

(RANGE)

|

|

|

|

(RANGE)

DOES NOT HAVE A TELEPHONE NUMBER ............ 1

GO TO R7

DON’T KNOW ............................................................. d

GO TO R7

REFUSED ................................................................... r

GO TO R7

International Phone (STRING 30)
R6 ≠ 1,d,r

R7.

Is there another telephone number where we can reach {NAME FROM R4}?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO R8

DON’T KNOW ............................................................. d

GO TO R8

REFUSED ................................................................... r

GO TO R8

R7 = 1

R7a.

What is that number?
|

|

|

(RANGE)

|-|

|

|

|-|

(RANGE)

|

|

|

|

(RANGE)

DON’T KNOW ............................................................. d

GO TO R8

REFUSED ................................................................... r

GO TO R8

International Phone (STRING (NUM))
R4 ≠ d,r

R8.

Does {NAME FROM R4} have an email address we can use in case we need help
contacting you for the next part of the study?
YES ............................................................................. 1
NO ............................................................................... 0

GO TO R10

DON’T KNOW ............................................................. d

GO TO R10

REFUSED ................................................................... r

GO TO R10

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Student Baseline Questionnaire: CATI Programming Specifications
R8=1

R9.

What is the email address {NAME FROM R4} checks most often?
(STRING (500))
EMAIL
DON’T KNOW ............................................................. d
REFUSED ................................................................... r

LEA ID ≠ 1201560
R10.

Thank you for answering all these questions. As I said earlier, we will send a $10 gift card
as a thank you. Would {you/he/she} prefer a gift card to amazon.com (where {you/he/she}
can make a purchase or download music) , a $10 gift card to Target, or a $10 gift card to
AMC movie theaters? (NEW)
CODE ONE ONLY
A $10 CARD FOR AMAZON.COM,............................. 1
A $10 CARD FOR USE AT TARGET .......................... 2
A $10 CARD FOR AMC MOVIE THEATRES .............. 3

ALL

ALL: This is the end of our survey.
IF LEA ID ≠ 1201560 AND J1B=1: You should receive the $10 gift card in the next few weeks.
IF PROXY (J1B=2): We are sending you a $10 gift card to give to or use for [STUDENT]. You
should receive it in the next few weeks.
ALL: If (you have/ he has/ she has} any questions about the study, or if {your/his/her} contact
information changes, please call us toll-free at 866-964-7963. {You/he/she} can also visit our
website at: http://ies.ed.gov/ncee/nlts. Thanks for taking time to answer these questions today.

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