Student UH Questionnaire – English

Instructions

In this questionnaire you will find questions about the following topics:

• You, your family, and your home
• Your science learning

Please read each question carefully and answer as accurately as you can.

In this questionnaire, there are no right or wrong answers. Your answers should be the ones that are right for yourself.

You may ask for help if you do not understand something or are not sure how to answer a question.

Some questions relate to science. Please think of all the different subjects and courses in your school that teach content related to science. Your school might teach science in different subjects such as physics, chemistry, biology, Earth and geology, space and astronomy, applied sciences and technology (e.g., engineering, robotics), or your school teaches a general, integrated, or comprehensive science course (e.g., anatomy and physiology, biological and physical science).

Please note that the forward button used to proceed to the next question is located at the bottom right hand corner of your screen. In some instances you may need to scroll down to the bottom of your screen to access this forward button.

Your answers will be combined with answers from other students to calculate totals and averages. All information (or responses) you provide may only be used for statistical purposes and may not be disclosed, or used, in identifiable form for any other purpose except as required by law [Education Science Reform Act of 2002 (ESRA 2002), 20 U.S. Code, Section 9573].

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 voluntary information collection is 1850-0755. The time required to complete this information collection is estimated to average 30 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 suggestions for improving the form, or comments or concerns regarding the accuracy of the time estimate(s) or the status of your individual submission of this form, please write to: Program for International Student Assessment (PISA), National Center for Education Statistics, U.S. Department of Education, 1990 K Street, N.W., Room 8122, Washington, D.C. 20006. O.M.B. No. 1850-0755, Approval Expires 08/31/2016

You, Your Family, and Your Home

What grade are you in?

(Please select from the drop-down menu to answer the question.)

Grade (7 – 12)

When were you born?

(Please select the month, day, and year from the drop-down menus to answer the question.)

Month (January – December)

Day (1 – 31)

Year (1998 –2001)

Are you female or male?

(Please select one response.)

Female

Male

Which best describes you?

(Please select one response.)

I am Hispanic or Latino

I am not Hispanic or Latino

Which of these categories best describes your race?

(Please select one or more responses.)

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

What is the highest level of schooling (not including college) completed by your mother?

If you are not sure which circle to choose, please ask the test administrator for help.

(Please select one response.)

She completed grade 12 (high school diploma or GED).

She completed grade 9.

She completed grade 6.

She did not complete grade 6.

Does your mother have any of the following degrees, certificates, or diplomas?

If you are not sure how to answer this question, please ask the test administrator for help.

(Please select one response in each row.)

	Yes	No
Master’s, doctoral, or professional degree such as medicine or law
Bachelor’s degree (4-year college degree)
Associate’s degree (2-year degree from a community college)
Vocational or technical certificate/diploma after high school (such as cosmetology or auto mechanics)

The following two questions concern your mother’s job:

(If she is not working now, please tell us her last main job.)

What is your mother’s main job? (e.g., school teacher, cook, sales manager)
Please type in the job title.

What does your mother do in her main job? (e.g., teaches high school students, helps prepare meals in a restaurant, manages a sales team)
Please use a sentence to describe the kind of work she does or did in that job.

What is the highest level of schooling (not including college) completed by your father?

If you are not sure which circle to choose, please ask the test administrator for help.

(Please select one response.)

He completed grade 12 (high school diploma or GED).

He completed grade 9.

He completed grade 6.

He did not complete grade 6.

Does your father have any of the following degrees, certificates, or diplomas?

If you are not sure how to answer this question, please ask the test administrator for help.

(Please select one response in each row.)

	Yes	No
Master’s, doctoral, or professional degree such as medicine or law
Bachelor’s degree (4-year college degree)
Associate’s degree (2-year degree from a community college)
Vocational or technical certificate/diploma after high school (such as cosmetology or auto mechanics)

The following two questions concern your father’s job:

(If he is not working now, please tell us his last main job.)

What is your father’s main job? (e.g., school teacher, cook, sales manager)
Please type in the job title.

What does your father do in his main job? (e.g., teaches high school students, helps prepare meals in a restaurant, manages a sales team)
Please use a sentence to describe the kind of work she does or did in that job.

Which of the following are in your home?

(Please select one response in each row.)

	Yes	No
A desk to study at
A room of your own
A quiet place to study
A computer you can use for school work
Educational software
A link to the Internet
Classic literature (e.g., Shakespeare)
Books of poetry
Works of art (e.g., paintings)
Books to help with your school work
Technical reference books or manuals
A dictionary
Books on art, music, or design
A guest room
A high-speed Internet connection
A musical instrument

How many of these are there at your home?

(Please select one response in each row.)

	None	One	Two	Three or more
Televisions
Cars
Bathrooms with a bathtub or shower
Cell phones with Internet access (e.g., smartphones)
Computers (desktop computer, portable laptop, or notebook)
Tablet computers (e.g., iPad®, Samsung Galaxy®)
E-book readers (e.g., Kindle™, Nook)
Musical instruments (e.g., guitar, piano)

How many books are there in your home?

There are usually about 15 books per foot of shelving. Do not include magazines, newspapers, or your schoolbooks.

(Please select one response.)

0-10 books

11-25 books

26-100 books

101-200 books

201-500 books

More than 500 books

In what country were you and your parents born?

(Please select one response in each column.)

	You	Mother	Father
United States*
Other country

* NOTE: The “United States” refers to the 50 states, District of Columbia, and U.S. military bases abroad.

What language do you speak at home most of the time?

(Please select one response.)

English

Spanish

Other language

How old were you when you started pre-school?

(Please choose from the drop-down menu to answer the question.)

Years

How old were you when you started first grade?

(Please choose from the drop-down menu to answer the question.)

Years old

Your Science Learning

How much do you disagree or agree with the statements about yourself below?

(Please select one response in each row.)

	Strongly Disagree	Disagree	Agree	Strongly Agree
I generally have fun when I am learning science topics.
I like reading about science.
I am happy working on science topics.
I enjoy acquiring new knowledge in science.
I am interested in learning about science.

How often do these things happen in your science classes?

(Please select one response in each row.)

	Every class	Most classes	Some classes	Never or hardly ever
Students don’t listen to what the teacher says.
There is noise and disorder.
The teacher has to wait a long time for students to quiet down.
Students cannot work well.
Students don’t start working for a long time after the lesson begins.

How often do these things happen in your science classes?

(Please select one response in each row.)

	Every class	Most classes	Some classes	Never or hardly ever
The teacher shows an interest in every student’s learning.
The teacher gives extra help when students need it.
The teacher helps students with their learning.
The teacher continues teaching until the students understand.
The teacher gives students an opportunity to express opinions.

Thank you very much for your cooperation in completing this questionnaire!