School Characteristics Survey

OMB Appendix I.
NLTS 2012 SCHOOL CHARACTERISTICS QUESTIONNAIRE

NLTS-2012
SCHOOL CHARACTERISTICS QUESTIONNAIRE
Thank you in advance for the time spent completing this questionnaire—it is vital to the success of this important
U.S. Department of Education study. Study findings will be critical as federal, state and local agencies work to improve the
quality of services and outcomes for youth with and without disabilities. Be assured that your answers will be completely
confidential; no information will be reported that identifies you or this school. For the NLTS 2012, Mathematica Research
Policy and DIR are authorized to collect data under law 20 U.S.C. 123g;34CFR Part 99. Gathering the following
information will help you complete the questionnaire more quickly:
 For the current school year:
o

Student- body demographic information, including the estimated number of students who are:



o

English language learners
In each ethnic/racial category

School personnel counts such as the number of:



Teachers and other personnel working in your school
Teachers with less than 3 years of teaching experience

 For the 2010-2011 school year:
o

The number of suspensions, expulsions, and incidents of physical violence

o

For students in grade 12, the number of students who graduated and the number who dropped out

If you prefer to complete the questionnaire on our secure website, you may do so at XXXXXX.XXX. Your log-in and
password are XXXXXXXXX XXXXXXXXX. You may also call XXX-XXX-XXXX to complete the questionnaire by
telephone, or if you have any questions about the study or the participation of your school, staff, or students.
Alternately, you may email us at XXXXXXX, or visit our web site at XXXXXXXX.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a
valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information
collection is estimated to average 30 minutes, including the time to review instructions, search existing data sources, gather the data needed and
complete and review the information collection. If you have any comments concerning the accuracy of the time estimate or suggestions for improving
this form, please write to: U.S. Department of Education, Washington, DC 20201-4651.

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A. School Characteristics
The first questions are about the characteristics of your school.
A1.

Which of the following best describes this school?

(NLTS2
Modified)

MARK ONE ONLY

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7□
8□
1

A2.

Regular school that serves a wide variety of students
School that serves only students with disabilities
Magnet school or special program-emphasis school that specializes in a particular subject area or theme
Career-technical school
Alternative school
Charter school
Hospital school
Another kind of school (Please describe)

Is this a / an…

(NLTS2A2)
Modified

MARK YES OR NO ON EACH ROW
Yes

□
1□
1□
1□

a. Public school? ..............................................................................................

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0□
0□
0□

1

b. Residential/boarding school? .......................................................................
c. Year-round school? ......................................................................................
d. School serving a single gender of students? ...............................................
e. Alternate school – such as schools specifically for students who have
been suspended, expelled or who dropped out or have been referred for
behavioral or adjustment problems? ............................................................
A3.

No

1

0

□

0

□

What grade levels are taught at this school?

(NLTS2A3, REV)

MARK ALL THAT APPLY

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6□
7□
8□
1

A4.

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10 □
11 □
12 □
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15 □
16 □

Pre-K / pre-first grade
K
1
2
3
4
5
6

9

7
8
9
10
11
12
Ungraded
Adult School

What is the average class size for the following kinds of classes? Your best guess is fine.

(NLTS2A9,
REV)

Class Size

a. General education academic classes........................................

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b. Career-technical education or applied academic classes .........

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c. Special education resource rooms ............................................

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d. Self-contained special education classes..................................

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No Classes of This Kind

□
0□
0□
0□
0

A5.
(NLTS2A10)

What proportion of buildings on the school campus are fully accessible to students with physical
disabilities (i.e., have ramps or elevators if more than one floor, accessible restrooms, Braille signage, and
visual announcement systems and fire alarms)?
MARK ONE ONLY

□
1□
2□
3□
0

A6.
(NLTS2A11,
REV)

None
Some
Most
All

During the previous school year (2010-2011), approximately how many of the following occurred at this
school?
Enter “0” if none

Number of Incidents
a. Expulsions .....................................................................................................................

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b. Out-of-school suspensions ............................................................................................

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c. In-school suspensions (during the school day, after school, Saturday) ........................

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d. Incidents of physical violence ........................................................................................

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B. Student Characteristics
Next, we would like to know about the students that attended your school around October of this year. Your best
estimate of numbers or percentages is fine.
B1.

Around October 1 of this school year, how many students were enrolled at this school?

(NLTS2A4)

|
B2.

|,|

□
0□
B3.

(NLTS2B3)

| NUMBER OF STUDENTS ENROLLED

Yes

GO TO B4

No

Around October 1 of this school year (2011-2012), about how many students with disabilities who did not
have IEPs had a written accommodation plan as required by Section 504 of the Vocational Rehabilitation
Act?
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B4.

|

Is this a special education only school?
1

(NLTS2B2)

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| NUMBER OF STUDENTS WITH A SECTION 504 PLAN
Enter “0” if none

Around October 1 of this school year (2011-2012), about how many students were identified as English
language learners (ELL), that is, limited-English-proficient (LEP) or English-as-a-second-language (ESL)
students?
Percentage of Students
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NUMBER OF ELL, LEP OR ESL STUDENTS ............................

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OR

Number of Students
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|%

|,|

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Enter “0” if none
B5.

Around October 1 of this school year (2011-2012), about how many students in the school belonged to
each of the following ethnic groups?

(NLTS2B4)

Please indicate percentage or number on each row, whichever is easiest.
Number of Students

Percentage of Students
a. Hispanic or Latino ..........................................................

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|%

b. Not Hispanic or Latino ...................................................

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|%

B6.

OR

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Around October 1, about how many students in the school belonged to each of the following groups?

Please indicate percentage or number on each row, whichever is easiest.
Percentage of Students
a. American Indian or Alaska Native .................................

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|%

b. Asian ..............................................................................

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|%

c.

Number of Students

OR

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Black or African American .............................................

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|%

d. Native Hawaiian or Other Pacific Islander .....................

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|%

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e. White ..............................................................................

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|%

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f.

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|%

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Two or more races .........................................................

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B7.

About how many of the students enrolled in your school last year (2010-2011) moved away from your
school during that school year (student mobility rate)?
Percentage of
Students

(NLTS2B6)
Modified)

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B8.

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|%

Number of
Students

OR
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|,|

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What is the last day of your school year for academic year 2011-2012?

(NEW)

Month:________ Day: ______, 2012

B9.
(NEW)

Did your school make Adequate Yearly Progress (AYP) Requirements during the 2010-2011 school year?

□
0□
1

B9a.

Yes

GO TO B10

No

Please specify the Program Improvement (PI) year status of your school during the 2010-2011 school year.

(NEW)

MARK ONE ONLY

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6□
1

B10.
(NEW)

School was not in PI in 2010-2011
PI Year 1
PI Year 2
PI Year 3
PI Year 4
PI Year 5 or longer

Please indicate the school’s participation status in the Title I, Part A, program for the 2011-2012 school
year from the following:
MARK ONE ONLY

□
2□
3□
4□
1

School receives funding as a Targeted Assistance School
School receives funding to operate a School-wide Program
School is not eligible for funding under Title I, Part A
School district does not accept funding from Title I, Part A

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C. Staffing

The next questions are about the staff at your school and their caseloads in the 2010-2011 school year.
C1.

In 2010-2011, what was the total number of FTE teachers (including general and special education)?

(NLTS2C1a
and C1c)



Report staff in full-time equivalent units (FTEs) and feel free to estimate percentages or numbers (e.g., a
person who worked one full day each week is considered .20 FTE).



Enter the number of FTEs on each row. Enter “0” if none.
MARK THE NUMBER OF
FTEs ON EACH ROW

Approximate Total Teacher FTEs
a. General education classroom teachers (includes all specialties such as art, music,
languages, and physical education) ....................................................................................

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b. Special education teachers (self-contained or single subject) ............................................

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c.

Special education resource room or consulting teachers..................................................

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d. Bilingual or ESL teachers ..................................................................................................

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e. Career and Technical Education (CTE) teachers ..............................................................

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f.

Other teachers .....................................................................................................................

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g. TOTAL .................................................................................................................................

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C2.
(NLTS2C2a-o)

In 2010-2011, how many of the following personnel (including those contracted for services) worked in this
school during a typical week (in FTE units)?
MARK THE NUMBER OF
FTEs ON EACH ROW

Approximate Total FTEs
a. Reading specialists ...............................................................................................................

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b. Speech/communication therapists or pathologists ...............................................................

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c.

Nursing/medical personnel ...................................................................................................

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d. School psychologists or other diagnostic personnel ............................................................

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e. Guidance counselors ............................................................................................................

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f.

Social workers ......................................................................................................................

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g. Paid teacher aides/instructional assistants ..........................................................................

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h. Librarians, library aides, or other library/media center staff .................................................

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i.

Transition Specialists ............................................................................................................

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j.

Administrators, including instructional coordinators and supervisors such as curriculum
specialists .............................................................................................................................

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k.

TOTAL ..................................................................................................................................

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C3.

In 2010-2011, about how many FTE teachers in this school…


Report staff in full-time equivalent units (FTEs) and feel free to estimate percentages or numbers
(e.g., a person who works one full day each week is considered .2 FTE).



Enter the number of FTEs on each row. Enter “0” if none.
FTE Teachers

a. Were fully credentialed for their primary teaching assignment?......................................

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b. Had less than 3 years teaching experience? ..................................................................

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C4.
(NLTS2C3
Modification)

How many different students do the following kinds of staff members see in an average month?


Please enter one number on each row or indicate that you have no staff of this kind.
Average Number
of Students

Have No Staff
of this Kind

Seen per month
a. Guidance counselors .....................................................................................

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0

□

b. School psychologists .....................................................................................

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0

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0

□

c.

Transition specialists /case managers who coordinate services for
students with IEPs as they set goals for transition out of secondary school .

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D. School Resources and Programs
In the next questions, please tell us more about the resources available at your school.

D1.
(NLTS2 C5,
C5A and B)

FOR EACH SETTING BELOW, PLEASE MARK WHEN THIS SCHOOL HAS COMPUTERS AVAILABLE FOR
STUDENT USE.
MARK ALL THAT APPLY FOR EACH ROW

Are computers available in…
During class
hours

During lunch

Before or after
school

Computers not
available

a. Regular academic classes? .......................

0

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1

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2

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3

□

b. Special education classes? ........................

0

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1

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2

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3

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c. Career-technical education classes? .........

0

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1

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2

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3

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d. A library, media center, or computer lab? ..

0

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1

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2

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3

□

D2.
(NEW)

Below is a list of programs and supports schools can offer to students. For each, please indicate whether
your school offers this program or support during the current school year (2011-2012).


Each applies to students with and without disabilities.



Please include programs provided by alternate service providers.

Program or support offered?

Yes

No

Programs Providing Academic Support
a. Supplemental instruction or tutoring in academic subjects before or after school

1

□

0

□

b. Supplemental instruction or tutoring in academic subjects on weekends………

1

□

0

□

c.

Saturday school for struggling learners……………………………………………

1

□

0

□

d. Drop out prevention or dropout recovery program ...................................................

1

□

0

□

e. Study-skills classes ..................................................................................................

1

□

0

□

f.

Financial literacy classes .........................................................................................

1

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0

□

g. Organized school sports ..........................................................................................

1

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0

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h. Clubs or activities (e.g., literary magazine, cultural activity groups, pep club) .......

1

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0

□

i.

Band, chorus, drama, or other performing opportunities .........................................

1

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0

□

j.

Reproductive health or /pregnancy prevention education or services .....................

1

□

0

□

k.

Substance abuse counseling or education ..............................................................

1

□

0

□

l.

Teen parenting instruction .......................................................................................

1

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0

□

m. Child care for children of teen parents .....................................................................

1

□

0

□

n. Instruction on appropriate use of social networking sites ........................................

1

□

0

□

Other School Programs and Supports

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Items D3 and D4 are for principals with grades 9 or above in their school.
Principals without these grades in their school should go to question D5.

D3.
(NEW)

Below is a list of programs and supports that schools can offer to students for transitioning to
postsecondary education or employment. For each, please indicate whether your school offers this
program or support during the current school year (2011-2012).



Each applies to students with and without disabilities.



Please only count formalized, wide-spread supports provided (versus those provided an ad-hoc basis to
selected students, as needed).
Program or
support is
offered?
Yes
No

Supports for Transitioning to Postsecondary Education Programs

a. Helping students complete postsecondary school applications .................................................

1

□

0

□

b. Assuring that high school course selections match requirements for the kind of
postsecondary education program student plans to attend ........................................................

1

□

0

□

c.

Helping students sign up for standardized college entrance tests .............................................

1

□

0

□

d. Reviewing college entrance test results and suggesting re-testing if necessary........................

1

□

0

□

e. Helping families with financial aid forms, comparing financial aid packages..............................

1

□

0

□

f.

Helping students arrange campus visits, taking them to college campuses or college fairs ......

1

□

0

□

g. Help ensuring students are aware of disability support services on college campuses .............

1

□

0

□

1

□

0

□

Instruction in looking for jobs (e.g., application, interview, resume, portfolio, job readiness
training, etc.) .................................................................................................................................

1

□

0

□

j.

Internship, apprenticeship, or other short-term work experience (paid or unpaid) .......................

1

□

0

□

k.

Training for specific occupations...................................................................................................

1

□

0

□

Supports for Transitioning to Employment
h. Career counseling, including a formal assessment of skills and interests ....................................
i.

D4.
New

Does this school offer a processes for students who do not have IEPs to plan their transition from high
school to adult life? If so, is it optional or required for students to participate?
MARK ONE ONLY

□
2□
0□
1

Yes – Optional Transition Planning Process
Yes – A Required Transition Planning Process
No such planning process exists at our school for students who do not have IEPs

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D5.

To what extent do teachers and administrators use the following behavior strategies in your school?
MARK ONE FOR EACH ROW

(NEW)

Always

Sometimes

Never

a. Behavior expectations are defined and taught to students as part of the
curriculum ........................................................................................................

1

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2

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3

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b. A continuum of consequences is implemented for behavior infractions .........

1

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2

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3

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c.

Staff provide consistent reinforcement for positive behaviors .........................

1

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2

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3

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d. Information on individual student behavior is shared among teachers and
other staff and used in decision making ..........................................................

1

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2

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3

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e. A school-wide team of key stakeholders (e.g., general education and
special education teachers, school psychologist, administration, etc.) to
manage a positive behavior strategy ...............................................................

1

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2

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3

□

1

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2

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3

□

f.

Training for school staff on positive behavioral interventions and supports
during the school year .....................................................................................

D6.

What percentage of the total student body in your school are…

(HSLS:09
SAQ)

Percentage of
Students
a. Enrolled in an alternative program to meet the needs of at-risk students
who are not succeeding in a traditional setting (either at your school or
off site)? .....................................................................................................

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|%

b. Enrolled in a dropout-prevention program (either at your school or off
site)? ..........................................................................................................

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c. Enrolled in College Board Advanced Placement (AP) Courses (either at
your school or off site)? ..............................................................................

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Number of
Students
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|%

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|%

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OR

In the next questions, please tell us about the types of programs that are offered at your school either as part of
the curriculum or as after school instruction.
D7.
(Revised from

NLTS2 C8a and b to
reflect the three tiers
in the RTI model)

Is there a systematic procedure for providing interventions to students who have learning or other
problems, but no IEP or 504 plan (e.g., pre-referral interventions, response to intervention)?

□
0□
0□
1

D7a.

Yes
No

GO TO SECTION E

N/A – All students at this school have an IEP or 504 Plan

GO TO SECTION E

Which of the following are involved in this procedure?

MARK YES OR NO
ON EACH ROW

Yes

No

a. Periodic screening to identify struggling learners ..............................................................

1

□

0

□

b. Increasingly intensive instruction for students not making adequate progress .................

1

□

0

□

c.

1

□

0

□

Individualized, intensive interventions ...............................................................................

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E. Special Education Policies And Practices
Next, please tell us about the special education policies and practices at your school.
IF A1=2 (SCHOOL SERVING ONLY STUDENTS WITH DISABILITIES) – SKIP TO E3. ELSE CONTINUE TO E1.

E1.

Which of the following placement options are available for students with IEPs at this school?

(Modified
NLTS2D1)

MARK YES OR NO ON EACH ROW

Yes

No

a. General education with services or supports .............................................

1

□

0

□

b. Classes co-taught by general and special education teachers .................

1

□

0

□

c. Part-time resource room for special education students ...........................

1

□

0

□

d. Self-contained special education classrooms ............................................

1

□

0

□

e. Individual instruction such as home school or a residential, off-site,
incarceration or hospital program ..............................................................

1

□

0

□

f. Other (Please specify) ...............................................................................

1

□

0

□

_________________________________________________________
E2.
(Modified
NLTS2D2)

Which of the following are available to general education teachers in this school when students with IEPs
are included in their classes?
MARK YES OR NO ON EACH ROW

Yes

No

a. Consultation or technical assistance by special education or other staff
with training and expertise in the child’s disability .....................................

1

□

0

□

b. Special equipment or materials..................................................................

1

□

0

□

c. In-service training .......................................................................................

1

□

0

□

d. Teacher aides, instructional assistants, or aides for individual students ...

1

□

0

□

e. Smaller student load or class size .............................................................

1

□

0

□

f. Co-teaching or team teaching with a special education teacher or related
services provider ........................................................................................

1

□

0

□

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E3.
(Modified
NLTS2D3)

Which of the following statements describe this school’s practice regarding mandated standardized tests
for students with IEPs? When standardized tests are mandated, students with IEPs are...
MARK ONE ONLY ON EACH ROW
All IEP Students

Some IEP
Students

No IEP Students

a. Required to follow the same procedures and meet the same
standards for successful completion as regular education
students.................................................................................

1

□

2

□

0

□

b. Provided special accommodations in taking the test (e.g.,
reader, dictation, more time) .................................................

1

□

2

□

0

□

c. Provided with a modified version of the test (e.g., shortened
version, different test materials) ............................................

1

□

2

□

0

□

d. Given the option to complete an alternate assessment. .......

1

□

2

□

0

□

E4.

Below is a list of programs and supports schools can offer to students with IEPs. For each, please indicate
whether your school offers this program or support during the current school year (2011-2012).


Please include programs provided by alternate service providers.

Program or support is
offered?
Yes
No

a. Job coaching (e.g., staff who directly supervise and train students in the workplace) ........

1

□

0

□

b. Referrals to Vocational Rehabilitation Services ..................................................................

1

□

0

□

c.

Help developing capability to dress, clean, care for self .....................................................

1

□

0

□

d. Learning self-determination and self-advocacy skills ..........................................................

1

□

0

□

e. Peer buddy program

1

□

0

□

f.

1

□

0

□

g. Helping students connect to outside transition services, supports, and activities (e.g.,
tutoring, mentoring, transportation, assistive technology, networking) ...............................

1

□

0

□

h. Helping students connect to adult residential providers and day services ..........................

1

□

0

□

Information bank for parents or guardians with materials and resources relating to
independent living ................................................................................................................

1

□

0

□

Instruction for parents or guardians on youth’s rights and responsibilities under
disability-related laws...........................................................................................................

1

□

0

□

i.
j.

E5.
(NLTS2D10
REV)

Alternative placements for students who are expelled and/or suspended

At what age or grade level does this school begin developing transition focused IEPs to assist students
with IEPs as they move from high school to adult life?
ENTER AGE OR GRADE LEVEL OF STUDENT OR MARK AN “X” TO INDICATE THAT YOU DO NOT DEVELOP
INDIVIDUAL TRANSITION FOCUSED IEPs.

|

□

|

| Age or |

|

| Grade Level

Do not develop Individual Transition Focused IEPs for leaving high school

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11

E6.

For students with IEPs, does this school offer instruction that specifically focuses on transition planning
(e.g., a specialized curriculum designed to help students assess options and develop strategies for
leaving secondary school and transitioning to adult life)?

(NLTS2 D11
REV)

MARK ONE ONLY

□
0□
n□
1

E7.
(NLTS2 D12)

Yes
No
Not applicable

Does this school or district receive any Medicaid funds for providing services (such as speech therapy or
occupational therapy) to students with IEPs at this school?

□
0□
n□
1

Yes
No
Don’t Know

F. School Services for 12th Graders
Finally, we would like to learn more about the services offered to 12th grade students, your school/school
district’s graduation requirements, the average age of your 12th graders and how many have taken college
entrance examinations.
F1.

Does your school have 12th graders or those of equivalent age?

□
0□
1

F2.
(NLTS2F2—
modified to
include high
school exit
exam)

Yes
No

GO TO “THANK YOU” ON PAGE 15

For how many semesters or quarters must students in this school take each of the following subjects to
graduate with a regular diploma?
ENTER THE NUMBER OF SEMESTERS OR QUARTERS
FOR EACH SUBJECT

a. English or language arts ..............................................

|

|

| Semesters OR |

|

| Quarters

b. Mathematics ................................................................

|

|

| Semesters OR |

|

| Quarters

c.

Science ........................................................................

|

|

| Semesters OR |

|

| Quarters

d. Social studies ...............................................................

|

|

| Semesters OR |

|

| Quarters

e. Foreign language .........................................................

|

|

| Semesters OR |

|

| Quarters

Prepared by Mathematica Policy Research

12

F3.

During the previous school year (2010-2011), about how many 12th grade students or those of equivalent
age…
ANSWER TOTAL 12th GRADERS AND
12th GRADERS WITH IEPs ON EACH ROW
A.
B.
Total Number 12th
Number of 12th Grade
Grade Students
Students with IEPs

(NLTS2F3)

a. Were enrolled at this school?...............................................................

|

|,|

|

|

|

|

|,|

|

|

|

b. Graduated with a regular diploma from this school? ...........................

|

|,|

|

|

|

|

|,|

|

|

|

c. Graduated with a special diploma or certificate of completion from
this school? ..........................................................................................

|

|,|

|

|

|

|

|,|

|

|

|

F4.

(NLTS2F4)

About how many students who had been enrolled in this school last year (2010-2011) in any grade, 9th
through 12th, were considered to be dropouts by the end of the year?
|

F5.
(NLTS2F5, REV)

|,|

|

|

| DROPOUTS

About what percentage of this school’s students take college entrance examinations (i.e., SAT, ACT)
before leaving high school?
1

□

Less than 50 percent

2

□

50 to 75 percent

3

□

76 to 90 percent

4

□

More than 90 percent

THANK YOU AGAIN FOR COMPLETING THIS QUESTIONNAIRE.
AS SOON AS WE RECEIVE THIS QUESTIONNAIRE, WE WILL SEND YOUR $25 THANK YOU.
PLEASE ENTER THE NAME AND ADDRESS TO WHICH WE SHOULD SEND THE CHECK:
Name:
Address:
City:
State:

ZIP Code:

May we also have your email and telephone number in case we have any questions about your responses?
Email:
Phone: (_______) Area Code

@
Number

PLEASE RETURN THE QUESTIONNAIRE IN THE POSTAGE-PAID ENVELOPE. IF YOU DO NOT HAVE THE
ENVELOPE, YOU MAY FAX THE QUESTIONNAIRE TO: xxxxxxx OR MAIL IT TO: NLTS-2012 SCHOOL
CHARACTERISTICS STUDY, xxxxxxxxxxxxxxxx

Prepared by Mathematica Policy Research

13