Form M-11G-UF Education Staff Questionnaire

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OMB 0970-0564 [valid through MM/DD/2026]

(Revised: 3/16/2022

Staff Questionnaire – Teacher – Unlicensed Facility (UF) Quarterly Health and Safety Visit

Interview Details
Program Name:	Past and Current Position(s) at Program:
Level of Care:	Date/Time of Interview:
Full Name:	Interviewer:

*Note: Before beginning the interview and/or providing this questionnaire to staff, provide a brief introduction, including monitor role and purpose of monitoring visit, confidentiality of staff interview, and clarify any questions. See Introduction Prompt for Staff for additional guidance as needed. Questions in bold should be asked during the interview if possible. Other questions are optional prompts to assist the interviewer.

	NOTES
Tell me about your role and main responsibilities.
Explain how UC educational services are documented in the UC case file and in the UC Portal. Which documents do you prepare? Which documents, if any, do you upload to the UC Portal? How does that process work? How do you document daily class attendance?
Do you feel that you receive adequate training to perform your educational duties? If not, please explain. What additional training do you think a person in your position would benefit from? (Lead Teacher) Describe your system to assess ongoing staff training needs and opportunities for development? How is this working? As a supervisor, explain how you work with the training coordinator and staff to ensure completion of required and developmental trainings? Please describe any training needs that your staff currently has.
What does trauma-informed care mean to you? How do you deliver trauma-informed care as part of the education team?
(Lead Teacher) Explain how you communicate with your teachers and teacher aids. Explain how you monitor their effectiveness in the classroom. How do you communicate ORR policy updates to the education team?
How do you collaborate with other teams to ensure that UCs’ developmental, social, and educational needs are being met? What recommendations do you have to strengthen the collaboration and communication with other departments?
Do you feel that you have enough supplies and equipment to teach the minors successfully? If not, explain.
Are there any adjustments to the educational curriculum/schedule during the summer months and/or during long holidays/breaks? If so, please describe.
How is the educational assessment used by the education department? How is it administered? How are educational activities individualized for UAC?
How do you meet the individual academic needs of a child be it language, special needs (i.e. mental health), learning preferences, readiness level, etc.?
(Optional) Describe your vocational education curriculum and how do you track it? (if applicable)
Explain the methods that you use to check that youth are learning and that the material is meeting each child’s needs. (Lead Teacher) How do you evaluate the quality of educational services that are being provided by the teaching staff? Examples: Education curriculum? Various levels of education? Effectiveness/quality of the classroom instruction?
Describe the process for providing educational records at discharge.
How do you handle behavior problems that occur in the classroom? Can you provide an example of recent behavior issues that you have experienced? Have you received trainings on Behavior Management? How would you briefly describe the Behavior Management system at your facility? How do you implement the Behavior Management system in the classroom?
Describe how you receive support, guidance, and evaluations from your supervisor. Do you feel that your supervisor provides appropriate and timely support, guidance, and feedback?
Do you have any concerns about the treatment of UCs in care? Do you have any concerns about any particular staff members (any staff members you think should NOT be working with UC)?
What general recommendations do you have to strengthen the program? What improvements would you put in place? Have you shared these ideas with your supervisor or any other program staff?
What are the things that you love/enjoy about your job? What are the challenges you face in your job?
What recommendations do you have for ORR that I can take back to share with our headquarter teams?

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to allow ORR contractor monitors to interview and document responses from education staff during unlicensed facility quarterly site visits. Public reporting burden for this collection of information is estimated to average 1 hour per response for the care provider and 1 hour per response for the contractor monitor, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a mandatory collection of information (Homeland Security Act, 6 U.S.C. 279). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of information please contact UCPolicy@acf.hhs.gov.