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Sample Questionnaire

1. In what grade were you when you first started in this school?
Kindergarten
1st Grade
2nd Grade
3rd Grade
2. Do you have a computer in your home?
Yes
No
Not sure
3. If you have a computer at home, do you use it for schoolwork?
Yes
No
I don't have a computer at home.
4. About how often do you read for fun during your free time?
Often (3 or more times a week)
Sometimes (3 or 4 times a month)
Not very often (3 or 4 times a year)
I never read for fun.
5. Did you ever stay in the same grade for more than one year?
Yes
No
Not sure
6. During the school week, how much do you usually watch TV?
Not at all. I don't watch TV during the week.
Less than 1 hour per day
1 hour per day
2 hours per day
3 hours per day
4 hours per day
5 hours per day
>5 hours per day
7. How often is English spoken in your home?
Only English is spoken in my home.
Sometimes another language is spoken.
Another language is spoken more often than English.
8. How often does an adult help you with your homework at home or after school?
Never
1-2 times a month
1-2 times a week
Every day

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