Expiration
Date: XX/XX/20XX
Head Start Family and Child Experiences Survey
Center Director Survey
Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 0970-0151 which expires XXXX. The time required to complete this collection of information is estimated to average 25 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the collection of information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Mathematica Policy Research, 1100 1st Street, NE, 12th Floor, Washington, DC 20002, Attention: Jerry West. |
Thank you for agreeing to participate in FACES 2014. We appreciate your time and effort in completing this survey.
Your participation in the study is voluntary and you may refuse to answer any questions you are not comfortable answering. Your answers will be completely private and will not be shared with parents or other staff in your center, or anybody else not working on this study. The survey will take about 25 minutes of your time to complete.
B. STAFF EDUCATION AND TRAINING 5
E. CURRICULUM, CLASSROOM ACTIVITIES, AND ASSESSMENT 12
H. OVERVIEW OF PROGRAM MANAGEMENT 16
N. USE OF PROGRAM DATA AND INFORMATION 18
I. EMPLOYMENT AND EDUCATIONAL BACKGROUND 19
A. STAFFING AND RECRUITMENT |
First, we have some questions about staffing and recruitment.
A1. How many lead teachers are currently employed in this center?
LEAD TEACHERS
NO RESPONSE M
A2. How many of these lead teachers were new to the center this year? Would you say it is…
Select one only
None, 1
One, 2
Two, or 3
Three or more? 4
NO RESPONSE M
A3. NO A3 IN THIS VERSION
A4. During the past program year, how many lead teachers left and had to be replaced?
Select one only
None, 1
One, 2
Two, or 3
Three or more? 4
NO RESPONSE M
A5-A12G. NO A5-A12G IN THIS VERSION
A12h. Does your center serve any children or families who speak a language other than English at home?
Yes 1
No 0 GO TO SECTION B
NO RESPONSE M GO TO SECTION B
[IF A12h=1]
A12i. Other than English, what languages are spoken by the children and families who are part of your center?
Select all that apply
French 11
Spanish 12
Cambodian (Khmer) 13
Chinese 14
Haitian Creole 15
Hmong 16
Japanese 17
Korean 18
Vietnamese 19
Arabic 20
Other (specify) 99
Specify
NO RESPONSE M
[IF A12h=1]
A12j. Do you have any teachers or assistant teachers who are bilingual?
Yes 1
No 0 GO TO A12_C3j
NO RESPONSE M GO TO A12_C3j
[IF A12j=1]
A12k. Other than English, which of the languages that are spoken by the children and families in your center are also spoken by any teachers or assistant teachers in your center?
Select all that apply
French 11
Spanish 12
Cambodian (Khmer) 13
Chinese 14
Haitian Creole 15
Hmong 16
Japanese 17
Korean 18
Vietnamese 19
Arabic 20
Other (specify) 99
Specify
NO RESPONSE M
[IF A12j=1]
A12l. How do you determine the language proficiency of bilingual teachers and assistant teachers in the language(s) other than English that they speak?
Do you . . .
Select one per row
|
YES |
NO |
NO RESPONSE |
a. Give language proficiency tests? |
1 |
0 |
M |
b. Have other staff interview them in their language? |
1 |
0 |
M |
c. Request documentation for language courses they may have taken? |
1 |
0 |
M |
d. Do anything else? (SPECIFY) |
1 |
0 |
M |
|
|
|
|
A12m-A12n. NO A12m-A12n IN THIS VERSION
[IF A12h=1]
A_C3j. Are you unable to provide interpreters or translate written materials in any of the languages spoken by children and families that are part of your center because you do not have staff members that speak those languages?
Yes 1
No 0
NO RESPONSE M
A13-A14. NO A13-A14 IN THIS VERSION
B. STAFF EDUCATION AND TRAINING |
The next questions are about efforts to promote staff education and training.
B0. Who generally participates in creating the training and technical assistance plan for your center?
Select all that apply
Head Start program director/program management team 1
Individual center directors 2
Education managers/coordinators 3
Specialists/other coordinators 4
Individual teachers 5
Someone else (Specify) 99
Specify
NO RESPONSE M
B1-B1a. NO B1-B1a IN THIS VERSION
B2. NO B2 IN THIS VERSION
B3a-f. NO B3a-f IN THIS VERSION
B3g. Programs can support teachers’ professional development in a lot of different ways. Does your program offer the following to teachers?
Select one per row
|
YES |
NO |
NO RESPONSE |
a. Regular meetings with teachers to talk with them about their work and progress |
1 |
0 |
M |
b. Support/funding to attend regional, state, or national early childhood conferences |
1 |
0 |
M |
c. Paid preparation/planning time |
1 |
0 |
M |
d. Mentoring or coaching |
1 |
0 |
M |
e. Workshops/trainings sponsored by the program |
1 |
0 |
M |
f. Support/funding to attend workshops/trainings provided by other organizations |
1 |
0 |
M |
g. Visits to other classrooms or centers |
1 |
0 |
M |
h. A community of learners, also called a professional learning community, facilitated by an expert |
1 |
0 |
M |
i. Incentives such as gift cards to encourage teachers to participate in professional development activities. |
1 |
0 |
M |
j. Other (Specify) |
1 |
0 |
M |
|
|
|
|
B4. How often do the following staff typically participate in training and technical assistance activities? Is it every week, 2 or 3 times a month, monthly, once every few months, or once a year or less?
Select one per row
|
WEEKLY |
2 OR 3 TIMES PER MONTH |
MONTHLY |
ONCE EVERY FEW MONTHS |
ONCE A YEAR OR LESS |
NO RESPONSE |
||||
a1. Lead teachers |
1 |
2 |
3 |
4 |
5 |
M |
||||
a2. Assistant teachers |
1 |
2 |
3 |
4 |
5 |
M |
||||
b. Family service workers |
1 |
2 |
3 |
4 |
5 |
M |
B4c. NO B4c IN THIS VERSION
B5. Who conducts the training?
Select all that apply
Center or Grantee Staff 1
Other Community Resources 2
Local Consultants 3
State T/TA Provider 4
National Head Start Association 5
State, Regional, or National Conferences (for example NAEYC) 6
Private Companies or Organizations (for example, High Scope, Teaching Strategies, Teachstone) 7
Other (Specify) 99
Specify
Do Not Have Trainings 0
NO RESPONSE M
B5c. NO B5c IN THIS VERSION
B6. Has your center consulted with state T/TA specialists, either early childhood education (ECE) specialists or grantee specialists?
Yes 1
No 0
NO RESPONSE M
B7-B10. NO B7-B10 IN THIS VERSION
B10a. Six National Centers provide Head Start grantees with information and resources from OHS across multiple service areas. Many of these resources are available through the online Early Childhood Learning and Knowledge Center. How often have you or other staff in your center used resources provided by the…
Select one per row
|
NEVER |
RARELY |
SOMETIMES |
OFTEN |
NO RESPONSE |
a. The National Center on Program Management and Fiscal Operations? |
1 |
2 |
3 |
4 |
M |
b. The Early Head Start National Resource Center? |
1 |
2 |
3 |
4 |
M |
c. The National Center on Quality Teaching and Learning? |
1 |
2 |
3 |
4 |
M |
d. The National Center on Parent, Family, and Community Engagement? |
1 |
2 |
3 |
4 |
M |
e. The National Center on Cultural and Linguistic Responsiveness? |
1 |
2 |
3 |
4 |
M |
f. The National Center on Health? |
1 |
2 |
3 |
4 |
M |
B11-B12. NO B11-B12 IN THIS VERSION
B12c. NO B12c IN THIS VERSION
We now want to learn about opportunities for mentoring and coaching in your center.
B13. Do you have mentor teachers or coaches to work with teachers in classrooms?
Yes 1
No 0 GO TO B20
NO RESPONSE M GO TO B20
[IF B13=1]
B14. Are your mentors and coaches . . .
Select one per row
|
YES |
NO |
NO RESPONSE |
a. More experienced teachers in your program? |
1 |
0 |
M |
b. Education coordinators? |
1 |
0 |
M |
c. Consultants hired by your program? |
1 |
0 |
M |
d. Someone else (Specify) |
1 |
0 |
M |
|
|
|
|
[IF B13=1]
B14e. How many classrooms does one mentor or coach or usually work with at any given time?
Number of classrooms
NO RESPONSE M
[IF B13=1]
B14f. How many mentors or coaches support teachers at your center?
Number of coaches
NO RESPONSE M
[IF B13=1]
B15. How often do they come to the classroom? Would you say . . .
Select one only
Once a week or less, 1
Once every two weeks, 2
Once a month, or 3
Less than once a month? 4
NO RESPONSE M
[IF B13=1]
B16. How do mentors and coaches assess teachers’ needs?
Select all that apply
Observe the classroom using the CLASS 1
Observe the classroom using other tools 2
Directly ask the teachers 3
Review classroom-level assessment data (such as the CLASS) 4
Review child assessment data 5
Ask teachers to complete surveys or questionnaires 6
NO RESPONSE M
[IF B13=1]
B17. Mentors and coaches have different approaches or ways of supporting teachers in improving their practice. What methods do mentors and coaches use when working with teachers in your center?
Select all that apply
Discuss with teachers what they observe 1
Provide written feedback to teachers on what they observe 2
Have teachers watch a videotape of themselves teaching 3
Have teachers observe another teacher's classroom or watch a video of another teacher 4
Model teaching practices 5
Suggest trainings for teachers to attend 6
Provide trainings for teachers 7
NO RESPONSE M
[IF B13=1]
B18. Do any of the mentors or coaches in your center also serve as teacher supervisors?
Yes 1
No 0
NO RESPONSE M
[IF B13=1]
B19. Do teachers in your center receive mentoring and coaching from the same person/people responsible for supervising them?
Yes, all teachers are mentored/coached by their own supervisor 1
Yes, some of the teachers are mentored/coaches by their own supervisor 2
No, none of the teachers are mentored/coaches by their own supervisor 0
NO RESPONSE M
B20. How often are teachers given a formal performance evaluation?
Select one only
Two or more times per year 1
Once a year 2
Once every two years 3
Once every 3 years 4
Once every 4 years or more 5
No formal evaluations are conducted 0
NO RESPONSE M
The next questions are about training specifically on your center’s curriculum and assessments.
B21. How many hours of training or support related to curriculum are offered to the following staff in a typical year? If none, please record 0.
|
NUMBER OF HOURS |
a. Lead teachers who are new to the center |
|
b. Assistant teachers who are new to the center |
|
c. Lead teachers who are NOT new |
|
d. Assistant teachers who are NOT new |
|
e. Mentors/coaches |
|
B22. How many hours of training or support related to your assessment tool(s) and ongoing child assessments are offered to the following staff in a typical year? If none, please record 0.
|
NUMBER OF HOURS |
a. Lead teachers who are new to the center |
|
b. Assistant teachers who are new to the center |
|
c. Lead teachers who are NOT new |
|
d. Assistant teachers who are NOT new |
|
e. Mentors/coaches |
|
B23. We are also interested in learning how teachers’ input about their own professional development needs and interests is gathered. Please select the statement that best describes how teacher input is gathered in your center.
Select only one
Very structured (the center or program has a protocol in place for systematically gathering teacher input on their needs and interests) 1
Somewhat structured (the center or program gathers teacher needs and interests, but supervisors, mentors, coaches, or others in charge of gathering the input follow their own procedures) 2
Naturalistic (teachers know they are able to share their needs and interests when and how they prefer to do so) 3
NO RESPONSE M
E. CURRICULUM, CLASSROOM ACTIVITIES, AND ASSESSMENT |
E1-E3. NO E1-E3 IN THIS VERSION
Please indicate whether you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree with the following items.
E3d. Teachers in my center generally follow the steps or activities suggested in the curriculum lesson plans.
Select one only
Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
NO RESPONSE M
E3e. Teachers in my center use the materials (for example, books, manipulatives) recommended in the curriculum.
Select one only
Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
NO RESPONSE M
E3f. Overall, teachers in my center use the recommended teaching strategies in the curriculum.
Select one only
Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
NO RESPONSE M
E3g. Teachers in my center would like more training on how to use the curriculum.
Select one only
Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
NO RESPONSE M
E4-E8. NO E4-E8 IN THIS VERSION
E9-E9a. NO E9-E9a IN THIS VERSION
E10. NO E10 IN THIS VERSION
E11. How often are each child’s assessment results reported to the following people? Is it once at the beginning of the program year, once at the end of the program year, both at the beginning and at the end of the program year, or more often?
Select one per row
|
ONCE AT BEGINNING OF YEAR |
ONCE AT END OF YEAR |
BEGINNING AND END OF YEAR |
MORE OFTEN |
NO RESPONSE |
a. Reported to parents |
1 |
2 |
3 |
4 |
M |
b. Reported to Program Administrators |
1 |
2 |
3 |
4 |
4 |
c. Recorded in child’s record |
1 |
2 |
3 |
4 |
4 |
[IF A12h=1]
E11d. Now I would like to ask you about strategies your program or center might use to assess the English language abilities of children who are dual language learners. How often do you use any of the following strategies to assess their English language skills?
Select one per row
|
NEVER |
ONCE AT BEGINNING OF YEAR |
ONCE AT END OF YEAR |
BEGINNING AND END OF YEAR |
MORE OFTEN |
NO RESPONSE |
|
a. Teacher ratings based on observation |
1 |
2 |
3 |
4 |
5 |
M |
|
b. Testing with standardized tests or assessments |
1 |
2 |
3 |
4 |
5 |
M |
|
c. Parent reports |
1 |
2 |
3 |
4 |
5 |
M |
|
d. Something else? (Specify) |
1 |
2 |
3 |
4 |
5 |
M |
|
|
|
|
|
|
|
|
[IF A12h=1]
E11e. Does your center you assess children’s abilities in their home language?
Yes 1
No 0
NO RESPONSE M
E3a. Does your center use a particular parent education or parent support curriculum?
Yes 1
No 0 GO TO SECTION H
NO RESPONSE M GO TO SECTION H
[IF E3a=1]
E3b. What (curriculum does/curricula do) you use?
Select all that apply
Second Step 1
Parents as Teachers (PAT) 2
Systematic Training for Effective Parenting (STEP) 3
21st Century Exploring Parenting (Exploring Parenting) 4
Home Instruction for Parents Of Preschool Youngsters (HIPPY) 5
Growing Great Kids, Inc 6
Positive Solutions for Families (Center on The Social Emotional Foundations for Early Learning) 7
Second Time Around: Grandparents Raising Grandchildren 8
Practical Parent Education 9
Improving Parent-Child Relationships 10
Parenting Now! Curriculum 11
Other (Specify) 99
Specify
NO RESPONSE M
H. OVERVIEW OF PROGRAM MANAGEMENT |
H1-H4. NO H1-H4 IN THIS VERSION
H5. You have a lot of different responsibilities as a center director, many of which you share with other program and center staff. Please indicate how much of your time is needed for each of the following responsibilities in the course of the year—a lot of your time, some of your time, only a little of your time, or none of your time. If you feel any critical responsibilities have been left out, please specify them in the space provided.
|
A LOT OF MY TIME |
A MODERATE AMOUNT OF MY TIME |
ONLY A LITTLE OF MY TIME |
NONE OF MY TIME AT ALL |
a. Monitoring progress toward school readiness goals |
1 |
2 |
3 |
4 |
b. Establishing and maintaining partnerships with other organizations in the community |
1 |
2 |
3 |
4 |
c. Completing the program self-assessment |
1 |
2 |
3 |
4 |
d. Dealing with human resources issues |
1 |
2 |
3 |
4 |
e. Ensuring compliance with federal standards for Head Start programs |
1 |
2 |
3 |
4 |
f. Designing the training and technical assistance plan for this center |
1 |
2 |
3 |
4 |
g. Evaluating teachers and other staff |
1 |
2 |
3 |
4 |
h. Providing educational leadership/establishing the curriculum |
1 |
2 |
3 |
4 |
i. Strategic planning |
1 |
2 |
3 |
4 |
j. Promoting parent and family engagement |
1 |
2 |
3 |
4 |
k. Fiscal management |
1 |
2 |
3 |
4 |
l. Addressing facilities, equipment, and transportation issues |
1 |
2 |
3 |
4 |
m. Other (specify)
|
1 |
2 |
3 |
4 |
n. Other (specify)
|
1 |
2 |
3 |
4 |
o. Other (specify)
|
1 |
2 |
3 |
4 |
H6. Were you, or are you going to be, given a formal performance evaluation this program year?
Yes 1
No 0
NO RESPONSE M
H7. In the past 12 months, have you participated in the following kinds of professional development?
Select one per row
|
YES |
NO |
a. College or university course(s) related to your role as a manager or leader |
1 |
0 |
b. Visits to other Head Start or early childhood programs to improve your own work as a program/center director |
1 |
0 |
c. Formal mentoring or coaching that is provided by your program |
1 |
0 |
d. A network or community of Head Start and other early childhood program leaders organized by someone outside of your program, for example a professional organization |
1 |
0 |
e. A leadership institute offered by Head Start |
1 |
0 |
f. A leadership institute offered by an organization other than Head Start |
1 |
0 |
H8. What are the top three areas from the following list in which you need additional support to lead your center more effectively?
Select up to 3
Educational/curriculum leadership 1
Child assessment 2
Creating positive learning environments 3
Program improvement planning 4
Budgeting 5
Staffing (hiring) 6
Teacher evaluation 7
Evaluation of other program staff 8
Teacher professional development 9
Data-driven decision making 10
Working with parents and community 11
NO RESPONSE M
N. USE OF PROGRAM DATA AND INFORMATION |
The next questions are about data and information that may be available to you.
N1. Do supervisors, mentors or coaches, or other specialists share and review individual children’s data in one-on-one meetings with teachers or in team meetings?
Yes 1
No 0
NO RESPONSE M
N2. Please indicate how much the following areas are barriers to teachers using child-level data to guide instruction and to individualize:
NOTE: By child-level data we mean formal assessments, informal assessments and data on child or family characteristics.
|
Select one per row |
|||
Barriers to using child-level data to guide instruction |
NOT A BARRIER |
A LITTLE BARRIER |
SOMEWHAT OF A BARRIER |
A BARRIER |
a. Lack of understanding what the child-level data mean (data literacy) |
1 |
2 |
3 |
4 |
b. Not enough time to use the child-level data to guide instruction |
1 |
2 |
3 |
4 |
c. Inadequate technology resources to track and analyze child data |
1 |
2 |
3 |
4 |
d. Lack of staff buy-in to value of data |
1 |
2 |
3 |
4 |
I. EMPLOYMENT AND EDUCATIONAL BACKGROUND |
Now, we’d like to ask you some questions about your professional background and your job with Head Start.
I0. In total, how many years have you been a director in any early childhood program?
Years
NO RESPONSE M
I1. In what month and year did you start working for this Head Start program?
MONTH YEAR
NO RESPONSE M
I2. In total, how many years have you worked with any Head Start or Early Head Start Program? ROUND RESPONSE TO NEAREST NUMBER OF YEARS.
NOTE: HEAD START HAS BEEN IN EXISTENCE FOR ABOUT 50 YEARS.
Years
NO RESPONSE M
I2a. Prior to this program year, how many years did you serve as director in any Head Start program?
Years
NO RESPONSE M
I2b. Prior to this program year, how many years did you serve as director of this Head Start program/center?
Years
NO RESPONSE M
I2c. Before you became a director, how many years of experience did you have as part of any Head Start program’s management team?
Years
NO RESPONSE M
I2d. Before you became a director, how many years of experience did you have as a teacher or home visitor in any Head Start program?
Years
NO RESPONSE M
I3. How many hours per week are you paid to work for Head Start?
Hours
NO RESPONSE M
I4-I5. NO I4-I5 IN THIS VERSION
I23. What is your total annual salary (before taxes) as a center director for the current program year?
Per Year
NO RESPONSE M
I6. In your current Head Start position(s), how much do the following make it harder for you to do your job well? Do they make it a great deal harder, somewhat harder, or not at all harder for you to do your job well?
|
Select one per row |
|||
|
GREAT DEAL HARDER |
SOMEWHAT HARDER |
NOT AT ALL |
NO RESPONSE |
a. Time constraints (not enough hours in the day) |
3 |
2 |
1 |
M |
b. Too many conflicting demands |
3 |
2 |
1 |
M |
c. Not a high enough salary for the job demands |
3 |
2 |
1 |
M |
d. Lack of support staff |
3 |
2 |
1 |
M |
e. Not enough training and technical assistance for professional development |
3 |
2 |
1 |
M |
f. Not enough support and communication from administration |
3 |
2 |
1 |
M |
g. Not enough funds for supplies and activities |
3 |
2 |
1 |
M |
h. Dealing with a challenging population |
3 |
2 |
1 |
M |
i. Staff turnover |
3 |
2 |
1 |
M |
j. Lack of parent support |
3 |
2 |
1 |
M |
k. Lack of qualified teaching staff |
3 |
2 |
1 |
M |
l. Anything else? (Specify) |
3 |
2 |
1 |
M |
|
|
|
|
|
I7. Which of the following benefits are available to you through Head Start?
|
Select one per row |
||
|
YES |
NO |
NO RESPONSE |
a. Paid vacation time |
1 |
0 |
M |
b. Paid sick leave |
1 |
0 |
M |
c. Paid (maternity/paternity) leave |
1 |
0 |
M |
d. Unpaid (maternity/paternity) leave |
1 |
0 |
M |
e. Paid family leave |
1 |
0 |
M |
f. Fully or partially paid health insurance |
1 |
0 |
M |
g. Fully or partially paid dental insurance |
1 |
0 |
M |
h. Tuition reimbursement |
1 |
0 |
M |
i. Retirement plan |
1 |
0 |
M |
I8-I11. NO I8-I11 IN THIS VERSION
I12. What is the highest grade or year of school that you completed?
Select one only
Up to 8th grade 1 GO TO I18
9th to 11th grade 2 GO TO I18
12th grade, but no diploma 3 GO TO I18
High School Diploma/ Equivalent 4 GO TO I18
Voc/ Tech Program after High School 5 GO TO I18
Some college, but no degree 6 GO TO I14
Associate’s Degree 7 GO TO I14
Bachelor’s Degree 8
Graduate or Professional School, but no degree 9
Master’s Degree (MA, MS) 10
Doctorate Degree (Ph.D., Ed.D.) 11
Professional Degree after Bachelor’s Degree (Medicine/ MD, Dentistry/ DDS, Law/ JD, etc.) 12
NO RESPONSE M GO TO I18
[IF I12=8, 9, 10, 11, OR 12]
I13. In what field did you obtain your highest degree?
Select one only
Child Development or Developmental Psychology 1
Early Childhood Education 2
Elementary Education 3
Special Education 4
Education Administration/ Management & Supervision 5
Business Administration/ Management & Supervision 6
Other Field (Specify) 99
S
pecify
NO RESPONSE M
[IF I12=6, 7, 8, 9, 10, 11, OR 12]
I14. Did your schooling include 6 or more college courses in early childhood education or child development?
Yes 1 GO TO I15a
No 0
NO RESPONSE M
[IF I14=0 AND I12=7, 8, 9, 10, 11, OR 12]
I15. Have you completed 6 or more college courses in early childhood education or child development since you finished your degree?
Yes 1
No 0
NO RESPONSE M
[IF I12=6, 7, 8, 9, 10, 11, OR 12]
I15a. Have you completed an entire course on dual language learner children?
Yes 1
No 0
NO RESPONSE M
[IF I12=6, 7, 8, 9, 10, 11, OR 12]
I15b. Do you currently hold a license, certificate, and/or credential in administration of early childhood/child development programs or schools?
Yes 1
No 0
NO RESPONSE M
I16-I17. NO I16-I17 IN THIS VERSION
I18. Do you have a Child Development Associate (CDA) credential?
Yes 1
No 0
NO RESPONSE M
I19. Do you have a state-awarded preschool certificate?
Yes 1
No 0
NO RESPONSE M
I20. Do you have a teaching certificate or license?
Yes 1
No 0
NO RESPONSE M
I21-I22. NO I21-I22 IN THIS VERSION
I24. What is your gender?
Male 1
Female
NO RESPONSE M
I25. In what year were you born?
Year
NO RESPONSE M
I26. Are you of Spanish, Hispanic, or Latino origin?
Yes 1
No 0 GO TO I28
NO RESPONSE M GO TO I28
[IF I26=1]
I27. Which one of these best describes you . . .
Select one or more
Mexican, Mexican American, Chicano, 1
Puerto Rican, 2
Cuban, or 3
Another Spanish/Hispanic/Latino group? (Specify) 99
S
pecify
NO RESPONSE M
I28. What is your race? You may name more than one if you like.
Select one or more
White 11
Black or African American 12
American Indian or Alaska Native 13
Asian Indian 14
Chinese 15
Filipino 16
Japanese 17
Korean 18
Vietnamese 19
Other Asian 20
Native Hawaiian 21
Guamanian or Chamorro 22
Samoan 23
Other Pacific Islander (Specify) 24
S
pecify
Another Race (Specify) 99
Specify
NO RESPONSE M
I29. Do you speak a language other than English?
Yes 1
No 0 GO TO END
NO RESPONSE M GO TO END
[IF I29=1]
I30. What languages?
Select all that apply
French 11
Spanish 12
Cambodian (Khmer) 13
Chinese 14
Haitian Creole 15
Hmong 16
Japanese 17
Korean 18
Vietnamese 19
Arabic 20
Other (specify) 99
Specify
NO RESPONSE M
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Subject | CLIENT WEB |
Author | MATHEMATICA STAFF |
File Modified | 0000-00-00 |
File Created | 2021-01-23 |