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pdfAPPENDIX B
TEACHER SURVEY WITH INVITATION LETTER
AND
NONRESPONSE FOLLOW-UP MATERIALS
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Phone: (202) 484-9220
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Dear [TEACHER FIRST NAME] [TEACHER LAST NAME]:
Thank you for taking part in the Impact Study of Feedback for Teachers Based on Classroom Videos,
sponsored by the United States Department of Education and conducted by Mathematica Policy Research.
As you may know, [School District] is participating in this study. The study is focusing on ways to
improve the effectiveness of new and early career teachers. It aims to examine the impact of video-based
classroom observations and feedback on classroom practices, and will provide important information for
states and districts looking to improve support for new and early career teachers. You are one of about
[200/300] teachers in 12 districts across the country participating in this important study and we are
writing to ask you to take part in the teacher survey that, although voluntary, will contribute information
that is vital to the study.
We would like to ask you to complete a short online teacher survey as part of the study. This teacher
survey should take about 30 minutes to complete. It will ask you about the amount, quality, and
usefulness of the professional development you’ve received this school year, as well as access you have
to other teacher supports and how professional development may have contributed to how well prepared
you feel as a teacher.
All information you provide will be kept strictly confidential and will not be shared with anyone outside
the study team. No one from your school or district will see your individual responses, and neither your
name nor your school’s name will be identified in any study reports.
When you visit the website to complete the survey online, you should use the log-in ID and password
provided below. These are secure and should not be shared with anyone. Using the log-in ID and
password ensures that your responses will be protected.
We encourage you to complete the survey online at:
[SURVEY URL]
LOG-IN ID: XXXXXX
PASSWORD: XXXXXX
Mathematica staff will be happy to answer any questions about the study and to assist you with the survey
if needed. Once the survey is complete, Mathematica will send you a $30 check in appreciation for your
time completing the survey. You can contact us toll-free at [TOLL FREE NUMBER] or email us at
[STUDY EMAIL]. If you have questions about your rights as a study participant, please call the New
England Institutional Review Board toll-free at 1-800-232-9570. Thank you in advance for your help with
this important study!
Sincerely,
Sheila Heaviside, Survey Director
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 20202. If you have comments or concerns regarding the content or the status of your individual submission of this
form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.
An Affirmative Action/Equal Opportunity Employer
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Mathematica Reference No.: XXXXX
U.S. DEPARTMENT OF EDUCATION
Impact Study of Feedback for Teachers Based on
Classroom Videos
TEACHER SURVEY
SPRING [2018/2019]
This questionnaire is part of the Impact Study of Feedback for Teachers Based on Classroom Videos, a
national evaluation being conducted for the U.S. Department of Education by Mathematica Policy Research.
This questionnaire asks about your background, your teaching preparation, and your experiences with
observations of your teaching. If you prefer to complete this survey by telephone or would like a paper copy of
the questionnaire mailed to you, please call XXX-XXX-XXXX to complete the questionnaire by telephone. If
you have any questions about the study or your school’s participation, email us at XXX@MPR.
We would like you to know that:
The survey takes about 30 minutes to complete, and once you have completed it, we will send you $30
as a thank you.
Your answers will be completely confidential; no information that identifies you, your school, or
your students will be reported. Your responses are protected from disclosure per the policies and
procedures required by the Education Sciences Reform Act of 2002, Title I, Part E, Section 183.
Mathematica Policy Research will present the information collected as part of this study in an aggregate
form, and will not associate responses to any of the individuals who participate. We will not provide
information that identifies you, your school or district to anyone outside the study team, except as required
by law. Your responses will be used only for statistical purposes. The reports prepared for this study will
summarize findings across the sample and will not associate responses with a specific district, school or
individual. Any willful disclosure of such information for nonstatistical purposes, without the informed
consent of the respondent, is a class E felony.
This survey is voluntary, but your response is critical for producing valid and reliable data. You may skip
any questions you do not wish to answer; however, we hope that you answer as many questions as you
can. Your answers to questions will not affect your job or any hiring decisions now or in the future and will
only be shared with the Mathematica study team (they will not be shared with anyone from your school or
district). Participation in the teacher survey will not impose any risks to you as a respondent. If you have
any questions about your rights as a research volunteer, contact XXXXXX at New England IRB, toll free
1-800-232-9570
I have read and I understand the above statements and agree to participate in the survey.
If you would like a copy of this disclosure statement, please contact Sheila Heaviside by email at
sheaviside@mathematica-mpr.com, or by phone at 202-484-3096.
Thank you very much for your help with this survey!
This evaluation is authorized by Title II sections 2001-2002 and Title VIII section 8042 of the
Elementary and Secondary Education Act of 1965 (20 U.S.C. 6301 et. seq.) as amended by the Every
Student Succeeds Act (ESSA).
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 20202. If you have comments or concerns regarding the content or the status of your individual submission of this
form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW, Washington, DC 20202.
A. TEACHING EXPERIENCE AND PREPARATION
A1.
Including the [2017-2018/2018-2019] school year, how many years have you worked as a classroom
teacher? Please do not count time working as a teaching assistant, substitute teacher, student
teacher, or paraprofessional, or working in classrooms in any position other than classroom
teacher.
If this is your first year teaching, enter “01”.
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A2.
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TOTAL YEARS AS A TEACHER
Please tell us about the school and district where you currently teach.
a.
Name of school: __________________________________________________________________
b.
Years as a teacher at this school
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If this is your first year teaching at this school, enter “01”.
c.
Date you were hired by your district for your current teaching position
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MONTH
A3.
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YEAR
How would you classify your current teaching position at this school?
MARK ONE ONLY
A4.
1
Regular full-time teacher
2
Regular part-time teacher
3
Substitute teacher
4
Itinerant teacher (assigned to multiple schools)
5
Other (Specify): _________________________________________________________________
Please indicate the grade(s) of the students you currently teach at this school.
SELECT ALL THAT APPLY
1
Pre-kindergarten or Kindergarten
2
1st grade
3
2nd grade
4
3rd grade
5
4th grade
6
5th grade
7
6th grade
8
7th grade
9
8th grade
10
9th – 12th grade
11
Ungraded
1
A5.
Do you currently teach one self-contained class (where you teach the same group of students most
or all of the day in multiple subjects) or do you teach several classes of different students in one or
more academic subjects?
MARK ONE ONLY
A6.
1
I teach one self-contained class
2
I teach several classes of different students
During the [2017-2018/2018-2019] school year, did you teach any of the following types of classes?
SELECT ALL THAT APPLY
A7.
A8.
A9.
1
Special instruction for English Language Learners (ELL) or Limited English Proficient
(LEP) students
2
English as a Second Language (ESL)
3
Bilingual classes (taught partly in English and partly in Spanish or
some other language)
4
Special education
5
General education
During the [2017-2018/2018-2019] school year, did you have responsibility for teaching math to your
class(es)?
1
Yes
0
No
During the [2017-2018/2018-2019] school year, did you have responsibility for teaching English
Language Arts / reading to your class(es)?
1
Yes
0
No
Prior to the [2017-2018/2018-2019] school year, did you ever work as:
IN YOUR
CURRENT
DISTRICT?
LENGTH OF TIME
YES
NO
a. A substitute teacher? ....................................
1
0
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b. A teaching assistant or teacher’s aide? ........
1
0
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1
0
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c.
A teacher with a temporary certificate
(such as a probationary or emergency
certificate)? ...................................................
2
YEARS
MONTHS
YES
NO
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1
0
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1
0
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1
0
B. CLASSROOM OBSERVATIONS AND FEEDBACK
B1.
How many times during the [2017-2018/2018-2019] school year did someone observe your teaching
for the purpose of providing feedback on your teaching?
COMPLETE ALL THAT APPLY. IF YOU WERE NOT OBSERVED USING EITHER APPROACH, ENTER “0”.
B2.
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IN-PERSON OBSERVATION(S)
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VIDEO-RECORDED OBSERVATION(S)
During the [2017-2018/2018-2019] school year, did you receive any feedback based on in-person
observations or feedback based on video recordings of your classroom teaching?
Please consider any feedback, including oral or written feedback or rating(s) from a classroom observation
instrument. Please include feedback from any source (for example, from colleagues, your principal, a
mentor, or coach).
SELECT ALL THAT APPLY
B3a.
1
Yes, I received feedback based on in-person observations
2
Yes, I received feedback based on video-recorded observations
0
No
GO TO QUESTION B9
Based on these observation(s) of your teaching during the [2017-2018/2018-2019] school year, how
many times did you receive the following types of oral feedback during a meeting or discussion
after the observation?
If you did not receive oral feedback, enter “0” and skip to B4a.
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B3b.
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TOTAL NUMBER OF ORAL FEEDBACK SESSIONS
Based on these observation(s) of your teaching during the [2017-2018/2018-2019] school year, what
is your best estimate of the duration (in minutes) of …
If you did not receive oral feedback, skip to B4a.
NUMBER OF MINUTES
a. Your typical oral feedback session?
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b. Your shortest oral feedback session?
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c.
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Your longest oral feedback session?
3
B4a.
Based on these observation(s) of your teaching during the [2017-2018/2018-2019] school year, how
many times did you receive formal written feedback?
If you did not receive written feedback, enter “0” and skip to B5.
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B4b.
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| TOTAL NUMBER OF TIMES YOU RECEIVED FORMAL WRITTEN FEEDBACK
Based on these observation(s) of your teaching during the [2017-2018/2018-2019] school year, what
is your best estimate (in minutes) of …
If you did not receive written feedback, skip to B5.
NUMBER OF MINUTES
a. Your typical time spent reviewing written feedback from an
observation?
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b. Your shortest time spent reviewing written feedback from an
observation?
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c.
Your longest time spent reviewing written feedback from an
observation?
4
B5.
Which of these items are true about the feedback (either written or oral) you received based on
observations of your teaching during the [2017-2018/2018-2019] school year?
MARK ONE ONLY
The feedback I received from observations
of my teaching. . .
NEVER
RARELY
SOMETIMES
MOST OF
THE TIME
ALWAYS
a. Examined my performance on a clearly
defined set of teaching practices ................
1
2
3
4
5
b. Provided a score or rating of my
performance based on a classroom
observation rubric or instrument.................
1
2
3
4
5
Provided specific techniques or
strategies that I could implement in my
classroom ...................................................
1
2
3
4
5
d. Referred to specific moments of
teaching from my classroom
observation .................................................
1
2
3
4
5
e. Provided questions that encouraged me
to reflect on my own teaching ....................
1
2
3
4
5
Identified aspects of my teaching where
I was performing well..................................
1
2
3
4
5
g. Identified aspects of my teaching where
I needed to improve ....................................
1
2
3
4
5
h. Included a plan with next steps for me
to improve my teaching ..............................
1
2
3
4
5
Involved watching a video of my
instruction while discussing feedback ........
1
2
3
4
5
Provided or recommended videos of
expert teachers to illustrate practices
described in the feedback (i.e., a
successful veteran or exemplary
teacher) ......................................................
1
2
3
4
5
Provided opportunities for me to
observe a demonstration of specific
teaching techniques or strategies by the
person providing feedback .........................
1
2
3
4
5
Provided an opportunity for me to
demonstrate specific teaching
techniques or strategies for the person
providing feedback .....................................
1
2
3
4
5
m. Provided useful or actionable feedback…..
1
2
3
4
5
c.
f.
i.
j.
k.
l.
5
B6.
Thinking of the feedback (either written or oral) you received based on observations of your
teaching during the [2017-2018/2018-2019] school year:
a.
To what extent were each of the following topics a focus of the feedback (either written or oral)?
b.
If the topic was a focus of feedback, how useful was the feedback?
A. EXTENT OF FEEDBACK
B. USEFULNESS OF FEEDBACK
NOT AT
ALL
TO A
SMALL
EXTENT
TO A
MODERATE
EXTENT
TO A
GREAT
EXTENT
NOT AT
ALL
USEFUL
NOT VERY
USEFUL
SOMEWHAT
USEFUL
VERY
USEFUL
a. Managing student
behavior ........................
1
2
3
4
1
2
3
4
b. Managing instructional
time and routines ..........
1
2
3
4
1
2
3
4
Engaging students in
classroom instruction
through clear and
interesting lessons
and materials ................
1
2
3
4
1
2
3
4
d. Providing feedback
that extends students’
learning and
encourages their
participation ..................
1
2
3
4
1
2
3
4
e. Leading discussions
that build a deeper
understanding of the
content .........................
1
2
3
4
1
2
3
4
Supporting students’
use of higher level
thinking skills ................
1
2
3
4
1
2
3
4
g. Responding to the
academic, social, and
emotional needs of
individual students
and the entire class ......
1
2
3
4
1
2
3
4
h. Developing lesson
plans that are aligned
to learning goals and
include engaging
activities ........................
1
2
3
4
1
2
3
4
Aspects of teaching:
c.
f.
6
B7.
Please indicate your level of agreement with each of the following statements about the feedback
(either written or oral) you received based on observations of your teaching during the [20172018/2018-2019] school year.
MARK ONE BOX ON EACH LINE
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. I received feedback that was a fair
assessment of my performance ..................
1
2
3
4
b. I received feedback that was easy to
understand ..................................................
1
2
3
4
I received feedback that provided
specific ideas about how I could
improve my performance ............................
1
2
3
4
d. The feedback made me more reflective
about my teaching.......................................
1
2
3
4
e. In the long run, students will benefit
from the feedback I received ......................
1
2
3
4
1
2
3
4
c.
f.
B8.
B9a.
I made a specific change to my
teaching as a result of the feedback ...........
During the [2017-2018/2018-2019] school year, did you watch a video recording of your own
teaching? Include short video clips and full video recordings.
1
Yes
0
No
GO TO QUESTION B12
During the [2017-2018/2018-2019] school year, how many video recordings of your teaching did
you watch?
If you watched multiple clips from the same video recording, please count that as one video recording.
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B9b.
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NUMBER OF VIDEO RECORDINGS
During the [2017-2018//2018-2019] school year, what is your best estimate (in minutes) of …
If you watched multiple clips from the same video recording, please count that as one video recording.
NUMBER OF MINUTES
a. the typical amount of time you spent watching a video
recording of your teaching?
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b. the shortest amount of time you spent watching a video
recording of your teaching?
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c.
the longest amount of time you spent watching a video
recording of your teaching?
7
B10.
B11.
During the [2017-2018//2018-2019] school year, did you ever share a video recording of your own
teaching with a teacher or colleague? Do NOT include video recordings shared with a coach
specifically for the purpose of receiving feedback.
1
Yes
0
No
Please indicate your level of agreement with each of the following statements about the video
recordings you watched of your own teaching during the [2017-2018/2018-2019] school year.
MARK ONE BOX ON EACH LINE
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. I identified aspects of my teaching that
I needed to improve as a result of
watching video recordings of my
teaching ....................................................
1
2
3
4
b. I made a specific change to my
teaching based on something I saw in
a video recording of my teaching ..............
1
2
3
4
I learned something about my own
teaching practice by watching video
recordings of my teaching ........................
1
2
3
4
d. I noticed student behaviors or
reactions that I had not noticed while
teaching after watching video
recordings of my teaching .........................
1
2
3
4
e. My students acted differently when my
classroom was being video recorded .......
1
2
3
4
c.
B12.
During the [2017-2018/2018-2019] school year, did you watch a video recording of an expert
teacher? Include short video clips and full video recordings.
An expert teacher is a successful veteran or exemplary teacher.
1
Yes
0
No
GO TO QUESTION C1
B13a. During the [2017-2018/2018-2019] school year, how many times did you watch a video recording of
an expert teacher?
If you watched multiple clips from the same video recording, please count that as one video recording.
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NUMBER OF VIDEOS YOU WATCHED
8
B13b. During the [2017-2018/2018-2019] school year, what is your best estimate (in minutes) of ,,,,
If you watched multiple clips from the same video recording, please count that as one video recording.
NUMBER OF MINUTES
a. the typical amount of time you spent watching a video
recording of an expert teacher?
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b. the shortest amount of time you spent watching a video
recording of an expert teacher?
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c.
B14.
the longest amount of time you spent watching a video
recording of an expert teacher?
Please indicate your level of agreement with each of the following statements about the video
recordings of expert teaching that you watched during the [2017-2018/2018-2019] school year.
MARK ONE BOX ON EACH LINE
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. The recordings were a useful
illustration of teaching strategies that I
could use in my own classroom ..................
1
2
3
4
b. The recordings provided sufficient
information to understand which
teaching strategies or practices were
viewed as exemplar .....................................
1
2
3
4
1
2
3
4
c.
The recordings provided sufficient
information on how to use the teaching
strategies in my classroom ..........................
9
C. SUPPORT FOR TEACHING
The following questions are about additional supports you received for teaching during the [2017-2018/20182019] school year. Do NOT include any feedback and coaching based on observations of your teaching that
you reported in the previous section.
C1.
During the [2017-2018/2018-2019] school year, how many times (per week, month, or year) did you
receive each type of support for your teaching?
If you did not receive the type of support, enter “0” in the first column.
Types of support for your teaching
(do NOT include any feedback and
coaching that you reported in the
previous section):
a.
CHECK ONE
NUMBER OF
TIMES
PER WEEK
PER MONTH
PER
YEAR
One-on-one support for your
teaching from a coach or mentor ......
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1
2
3
b. One-on-one support for your
teaching from other teachers,
your principal, and other staff
(who are not assigned as your
coach or mentor) ...............................
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1
2
3
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1
2
3
c.
C2.
NUMBER OF TIMES PER WEEK, MONTH OR YEAR
Opportunities to collaborate or
learn from other teachers (e.g.
professional learning
communities, grade-level teams) ......
During the [2017-2018/2018-2019] school year, including the preceding summer, approximately how
many hours did you spend participating in professional development activities?
Include university courses, degree programs, workshops, conferences, seminars, or in-service training that
are designed specifically for the purpose of teacher professional development. Do not include any feedback
or coaching you received based on observations of your teaching or individual support already covered
above. If you did not participate in any of these types of professional development activities, enter “0”.
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TOTAL HOUR(S)
10
C3.
Thinking about the supports for your teaching and professional development you received in the
[2017-2018/2018-2019] school year to what extent did they focus on the following aspects of
teaching?
Do NOT include feedback and coaching based on observations of your teaching,
MARK ONE BOX ON EACH LINE
NOT AT ALL
TO A SMALL
EXTENT
TO A
MODERATE
EXTENT
TO A GREAT
EXTENT
a. Managing student behavior ..................................
1
2
3
4
b. Managing instructional time and routines .............
1
2
3
4
Engaging students in classroom instruction
through clear and interesting lessons and
materials ...............................................................
1
2
3
4
d. Providing feedback that extends students’
learning and encourages their participation .........
1
2
3
4
e. Leading discussions that build a deeper
understanding of the content ...............................
1
2
3
4
Supporting students’ use of higher level
thinking skills ........................................................
1
2
3
4
g. Responding to the academic, social, and
emotional needs of individual students and
the entire class .....................................................
1
2
3
4
h. Developing lesson plans that are aligned to
learning goals and include engaging activities .....
1
2
3
4
Aspects of teaching
c.
f.
C4.
Thinking about the supports for your teaching and professional development you received in the
[2017-2018/2018-2019] school year indicate whether they involved any of the following activities and
the extent to which they have been useful for improving your teaching.
Do NOT include feedback and coaching based on observations of your teaching,
MARK ONE BOX ON
EACH LINE
MARK ONE BOX ON EACH LINE
SUPPORTS
INCLUDED
ACTIVITY
USEFUL FOR IMPROVING TEACHING
Support activity
YES
NO
NOT AT ALL
USEFUL
NOT VERY
USEFUL
SOMEWHAT
USEFUL
VERY
USEFUL
a. Observing another teacher .........
1
0
1
2
3
4
b. Jointly planning lessons with
another teacher ...........................
1
0
1
2
3
4
Sharing materials with other
teachers ......................................
1
0
1
2
3
4
d. Getting feedback or input on
instructional plans .......................
1
0
1
2
3
4
e. Having regular supportive
communication with your
principal, other administrators,
or department head .....................
1
0
1
2
3
4
c.
11
C5.
Please indicate to what extent you agree or disagree with each of the following statements
regarding the principal at your school:
MARK ONE BOX ON EACH LINE
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. Supports me on student disciplinary
issues ........................................................
1
2
3
4
b. Actively monitors the quality of
teaching in this school. ..............................
1
2
3
4
Actively creates opportunities for
teachers to collaborate with other
teachers .....................................................
1
2
3
4
d. Actively creates opportunities for
teachers to observe other teachers’
instruction ..................................................
1
2
3
4
e. Takes a personal interest in the
professional development of teachers ......
1
2
3
4
1
2
3
4
The principal at my school. . .
c.
f.
C6.
Is aware of areas in which I would like
to improve ..................................................
At this point in the [2017-2018/2018-2019] school year, how well prepared do you feel you are to
handle a range of classroom behavior or discipline situations?
1
Not at all prepared
2
Somewhat prepared
3
Well prepared
4
Very well prepared
12
D. FEEDBACK FROM [PROGRAM NAME] FOR DEPARTMENT OF EDUCATION STUDY
(TREATMENT TEACHERS ONLY)
D1.
D2.
Apart from the feedback received from [program name], did you receive feedback based on
observations of your teaching conducted by others in your school or district?
1
Yes
0
No
GO TO QUESTION D3
Please compare the feedback you received from [program name] to feedback (oral or written) you
received from observations of your teaching conducted by others in your school or district.
Iindicate your level of agreement with each of the following statements.
MARK ONE BOX ON EACH LINE
The feedback I received from the [program
name] observations:
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. Was more objective than feedback I
received from other school or district staff .....
1
2
3
4
b. Was more focused on specific things I did
during the observation than feedback I
received from other school or district staff .....
1
2
3
4
Provided me with clearer ideas about
how my teaching could improve than
feedback I received from other school or
district staff .....................................................
1
2
3
4
d. Was more useful than feedback I
received from other school or district staff .....
1
2
3
4
e. Conflicted with feedback that I received
from other school or district staff ....................
1
2
3
4
c.
13
D3.
Please indicate your level of agreement with each of the following statements about observations
and feedback that you received from [program name].
MARK ONE BOX ON EACH LINE
DISAGREE
STRONGLY
DISAGREE
SOMEWHAT
AGREE
SOMEWHAT
AGREE
STRONGLY
a. It was difficult to find time to review
videos of my teaching...........................
1
2
3
4
b. It was difficult to find time to meet
with the coach to discuss feedback ......
1
2
3
4
It was difficult to teach when the
classroom was being recorded ............
1
2
3
4
d. Determining how to change my
teaching practices based on
reviewing videos of my teaching was
difficult ..................................................
1
2
3
4
e. It was difficult to use the selfreflection form to review video
recordings of my teaching ....................
1
2
3
4
Written feedback I received was
difficult to interpret ................................
1
2
3
4
g. Too much time elapsed between the
time the video was recorded and
feedback I received ..............................
1
2
3
4
c.
f.
D4.
If you have any additional thoughts you would like to share about the [Program Name], please use
the space below.
14
E. YOUR BACKGROUND
E1.
What is the highest degree you have completed?
MARK ONE ONLY
E2.
1
Associate’s degree
2
Bachelor’s degree (B.A., B.S., etc.)
3
Master’s degree (M.A., M.A.T., M.Ed., M.S., etc.)
4
Education specialist or professional diploma (at least one year beyond master’s level)
5
Doctoral degree or equivalent (Ph.D., Ed.D., J.D., M.D.)
In what area(s) does your teaching certificate allow you to teach in this state?
SELECT ALL THAT APPLY
E3.
1
Preschool (early childhood or Pre-K)
2
Elementary (any of grades K-5)
3
Middle grades (any of grades 6-8)
4
Secondary grades (any of grades 9-12)
5
Specific subject areas (Specify): ___________________________________________________
6
Exceptional children (Specify): _____________________________________________________
7
Other (Specify): _________________________________________________________________
Are you male or female?
MARK ONE ONLY
E4.
1
Male
2
Female
Are you of Hispanic or Latino origin?
MARK ONE ONLY
1
Yes
0
No
15
E5.
What is your race?
YOU CAN MARK ONE OR MORE RACES
E6.
1
White
2
Black or African American
3
Asian
4
Native Hawaiian or other Pacific Islander
5
American Indian or Alaska Native
What is your year of birth?
| 1 | 9 |
|
|
16
F. CONTACT INFORMATION
F1.
Please provide your contact information below. We will use your email or telephone number to
reach you in case we need to clarify one of your responses. We will use the address you provide
below to mail your $30 check for completing the questionnaire. If you do not provide an address,
we will mail your check to your attention at your school.
Providing this information is voluntary.
Name: ____________________________________________________________________________
Street address: _____________________________________________________________________
City: ______________________________________
Home Telephone: |
|
|
|-|
|
|
Area Code
Cell Phone: |
|
|
|-|
|
Area Code
|-|
|
State: _________
|
|
Zip Code: ___________
|
Number
|
|-|
|
|
|
|
Number
Work email: ________________________________________________________________________
Home email: _______________________________________________________________________
Best time to reach you by phone:
Day: ____________________________________
Time: _______________________________
Thank you for completing this questionnaire!
17
NONRESPONSE FOLLOW-UP EMAIL REMINDER
TO:
[Email]
FROM:
Sheila Heaviside [HelpDesk Email]
SUBJECT: Survey for the U.S. Department of Education’s Impact Study of Teacher Feedback
Dear [Teacher First Name] [Teacher Last Name]:
We recently asked for your help with completing a survey for the Impact Study of Feedback for Teachers
Based on Classroom Videos. Mathematica is conducting this important study on behalf of the U.S.
Department of Education (ED). Your participation will inform ED and policy makers about the impact
of coaching and feedback based on classroom videos on teaching practices and student achievement.
We will send you a check for $30 when you complete this survey. This survey is voluntary. However,
your participation is very important – the validity of the study results depends on the participation of all
teachers in the study. Please use the link below to access and complete the survey.
Go to [Link]
At the login screen, enter the following:
User ID: [UserID]
Password: [password]
Please do not reply to this email. If you do not have your login information or if you have questions about
the study, please call us toll free at [xxx-xxx-xxxx] between 9a.m. and 9p.m. Eastern Daylight Time any
day of the week. You may also email our help desk at [HelpDeskEmail] or contact me directly at
sheaviside@mathematica-mpr.com or 202-484-3096.
If you have already completed this survey, thank you for your support of this important study.
Sincerely,
Sheila Heaviside
Teacher Feedback Study Survey Director
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 20202. If you have comments or concerns regarding the content or the
status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW,
Washington, DC 20202.
Sheila Heaviside
Survey Director
1100 1st Street, NE, 12th Floor
Washington, DC 20002-4221
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com
NONRESPONSE FOLLOW-UP LETTER
[Month Year]
[Teacher First Name] [Teacher Last Name]
[School Name]
[Address]
[City], [ST] [ZIP]
Dear [Teacher First Name] [Teacher Last Name]:
We recently asked for your help with completing a survey for the Impact Study of Feedback for Teachers Based
on Classroom Videos. Mathematica is conducting this important study on behalf of the U.S. Department of Education
(ED). Your participation will inform ED and policy makers about the impact of feedback and coaching programs on
teaching practices and student achievement.
The survey takes approximately 30 minutes to complete. We will send you a check for $30 when you complete
this survey. Your participation is voluntary but very important – the validity of the study results depends on the
participation of all teachers in the study.
We have included a paper questionnaire for your convenience if you prefer to complete the paper version of the
survey and mail it in. Otherwise, you can complete the survey online. Please use the information below to access the
your teacher survey online. Do not share this information with anyone.
Go to [link]
At the login screen, enter the following:
User ID: [UserID]
Password: [password]
If you have any questions, please contact Eric Zeidman, the deputy survey director, toll free at [xxx-xxx-xxxx],
or by email at [Survey Help Desk] – or email me at sheaviside@mathematica-mpr.com.
If you have already completed the survey, thank you for your help.
Sincerely,
Sheila Heaviside
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 20202. If you have comments or concerns regarding the content or the
status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW,
Washington, DC 20202.
An Affirmative Action/Equal Opportunity Employer
Sponsored by the U.S. Department of Education’s Institute of Education Sciences
T
ake part in the survey for the Impact Study of Feedback for Teachers Based
on Classroom Videos being conducted in your school district! This survey
is part of an evaluation that will produce valuable information about the
impact of coaching and feedback on teaching practices and student achievement.
As one of only [200/300] teachers selected for the study, your survey responses
are critical for the study to produce meaningful and valid information. In addition,
you are irreplaceable! We are unable to replace you with another teacher without
compromising the study’s validity.
The information that you provide in this 30-minute survey will be used for
research purposes only and will remain confidential—no information or reports
will identify you or your school or district. To make this as easy as possible,
Mathematica has created a WEB survey for you to complete. If you have not
already sent your completed questionnaire to Mathematica, I urge you to take a
few moments now to log on to complete the survey on the Web by using the
user name and password that Mathematica created for you.
Go to: [Link]
Web username: [XXXX]
Password: [XXXXXXX]
Mathematica will send you a $30 check to thank you for your
help when you complete the survey.
If you have any questions about the study, contact us:
Sheila Heaviside
Mathematica Policy Research
SHeaviside@mathematica-mpr.com
(202) 484-3096
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 20202. If you have comments or concerns regarding the content or the
status of your individual submission of this form, write directly to: U.S. Department of Education, Institute of Education Sciences, 550 12th Street, SW,
Washington, DC 20202
| File Type | application/pdf |
| File Title | TPREP Teacher Surveys |
| Subject | SAQ |
| Author | MATHEMATICA |
| File Modified | 2017-05-05 |
| File Created | 2017-05-01 |