Att - LIC Teacher Report II SSRS-T Form

Teacher Report -- Part II

SSRS-T Form

Teacher Report (Part II)

LESSONS IN CHARACTER STUDY
Social Skills Questionnaire - TEACHER FORM
Grades 1-5
Thank you, in advance, for responding to the following questions. This instrument is being administered as
part of a long-term research project by WestEd to examine the impact of the Lessons in Character Program
(LIC) an English language arts-based character education program on student academic performance,
attendance, school motivation, and endorsement of universal values consistent with character education.
WestEd, a research, development, and service agency, works with education and other communities to
promote excellence, achieve equity, and improve learning for children, youth, and adults.
This survey is designed for you to rate the social skills (Part A) and academic competence (Part B) of specific
children in your classroom. 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 1850-0826. The time required to complete this
information collection is estimated to average 15 minutes per response, including the time to review
instructions, search existing data resources, gather the data needed, and complete and review the
information collection. If you have any comments concerning the accuracy of the time estimate(s) or
suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 202024651. If you have comments or concerns regarding the status of your individual submission of this form,
write directly to: Rafael Valdivieso, U.S. Department of Education, 555 New Jersey Avenue, NW, Room
506E, Washington, D.C. 20208.
Responses to this data collection 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 or
individual. We will not provide information that identifies you or your district to anyone outside the study team,
except as required by law.
Please contact Dr. Barbara Dietsch with any questions at 562.799.5126 or by email at [email protected].
Part A.
For items 1-48, read each item and think about this students behavior during the past month or two. Decide
how often the student does the behavior described.
If the student never does this behavior, mark the 11
If the student sometimes does this behavior, mark the 2
If the student very often does this behavior, mark the 3
Here are two examples:
How Often?
Never
Sometimes
Very Often
Shows empathy for peers.
Asks questions of you when unsure of what to do in schoolwork.
This student very often shows empathy for classmates. Also, this student sometimes asks questions
when unsure of schoolwork.
Please do not skip any items.
In some cases you may not have observed the student perform a particular behavior. Make an
estimate of the degree to which you think the student would probably perform that behavior.
Social Skills
1.
2.
3.
4.
Controls temper in conflict situations with peers.

Introduces herself or himself to new people without being told.
Appropriately questions rules that may be unfair.
Compromises in conflict situations by changing own ideas to reach
agreement.
5. Responds appropriately to peer pressure.
6. Says nice things about himself or herself when appropriate.
7. Invites others to join in activities.
8. Uses free time in an acceptable way.
9. Finishes class assignments within time limits.
10. Makes friends easily.
11. Responds appropriately to teasing by peers.
12. Controls temper in conflict situations with adults.
13. Receives criticism well.
14. Initiates conversations with peers.
15. Uses time appropriately while waiting for help.
16. Produces correct schoolwork.
17. Appropriately tells you when he or she thinks you have treated him
or her unfairly.
1 If bubble font is used in this survey administration, mark will be replaced with bubble in.
How Often?
Never
Sometimes
Very Often
Social Skills
18. Accepts peers ideas for group activities.
19. Gives compliments to peers.
20. Follows your directions.
21. Puts work materials or school property away.
22. Cooperates with peers without prompting.
23. Volunteers to help peers with classroom tasks.
24. Joins ongoing activity or group without being told.
25. Responds appropriately when pushed or hit by other children.
26. Ignores peer distractions when doing class work.
27. Keeps desk clean and neat without being reminded.
28. Attends to your instructions.
29. Easily makes transition from one classroom activity to another.
30. Gets along with people who are different.
How Often?
Never
Sometimes
Very Often
Problem Behaviors
31. Fights with others.
32. Has low self-esteem.
33. Threatens or bullies others.
34. Appears lonely.
35. Is easily distracted.
36. Interrupts conversations of others.
37. Disturbs ongoing activities.
38. Shows anxiety about being with a group of children.
39. Is easily embarrassed.
40. Doesnt listen to what others say.
41. Argues with others.
42. Talks back to adults when corrected.
43. Gets angry easily.
44. Has temper tantrums.
45. Likes to be alone.
46. Acts sad or depressed.
47. Acts impulsively.
48. Fidgets or moves excessively.
How Often?
Never
Sometimes
Very Often
Part B.
The next nine items (49-57) require your judgments of this students academic or learning behaviors
as observed in your classroom. Compare the student with other children who are in the same
classroom.
Rate all items using a scale of 1 to 5. Mark the number that best represents your judgment. The
number 1 indicates the lowest or least favorable performance, placing the student in the lowest 10%
of the class. Number 5 indicates the highest or most favorable performance, placing the student in
the highest 10% compared with other students in the classroom.
49. Compared with other children in my classroom, the

overall academic performance of this child is:
50. In reading, how does this child compare with other
students?
51. In mathematics, how does this child compare with
other students?
52. In terms of grade-level expectations, this childs skills in
reading are:
53. In terms of grade-level expectations, this childs skills in
mathematics are:
54. This childs overall motivation to succeed
academically is?
55. This childs parental encouragement to succeed
academically is?
56. Compared with other children in my classroom this
childs intellectual functioning is:
57. Compared with other children in my classroom this
childs overall classroom behavior is:
Lowest
10%
Next Lowest
20%
Middle
40%
Next Highest
20%
Highest
10%
<Repeated for each child in the SSRS sample>

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Teacher Report -- Part II

Teacher Report (Part II)

Shows empathy for peers.

Asks questions of you when unsure of what to do in schoolwork.

Controls temper in conflict situations with peers.

49. Compared with other children in my classroom, the

<Repeated for each child in the SSRS sample>

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