MBCDOE3TEST | QuestionPro

Thank you for wanting to register for possible participation in a focus group discussion for NYC public schools. We need to ask you a few questions to see which of several focus groups you may be best suited for. Please start by answering the question below and press the CONTINUE button to answer each of the next questions:

Please click on one of the three buttons below:

I am a Parent/Guardian of a student in a NYC public school

I am a Student in a NYC public school

None of the above

Is the school a charter school?

Yes

No

Don't know

PLEASE CLICK ON THE BOX BELOW IF IT APPLIES TO YOU:

I have one or more children in Kindergarten, 1st grade or 2nd grade

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I have one or more children in Grades 3 to 5

I have one or more children in Grades 6 to 8

I have one or more children in Grades 9 to 12

None of the above

Where in New York City do you live? PLEASE CLICK ON ONE OF THE 5 BUTTONS BELOW

What language do you speak most at home?

English

Spanish

Chinese

Other

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

Are you comfortable speaking Spanish? PLEASE CLICK ON Yes or No

Yes

No

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I am comfortable speaking Mandarin

I am comfortable speaking Cantonese

I am not comfortable speaking either of these

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON ONE OF THE 4 BUTTONS BELOW:

I don't have a cell phone

I have a basic cell phone that only makes or receives calls

I have a feature phone (e.g. Nokia, Samsung, Motorola)

I have a smart phone (e.g. iPhone, Android, Blackberry, HTC)

Do you ever access the Internet? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I access the Internet from a home computer

I access the Internet from a work computer

I access the Internet from a cell phone

I access the Internet at the library

I access the Internet from a friend's home

I access the Internet at an Internet café

Other

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I have one or more children in a Special Education Program

I have one or more children in an English Language Learner (ELL) Program

I don't have children in either of these programs

When you want to communicate with one of your child's teachers or school administrators, how do you usually do it? Please CLICK ALL THE BOXES BELOW THAT APPLY TO YOU:

I do not communicate with my child's teachers or school administrators

By phone

By email

Face-to-face

Text on a cell phone

Letter sent in the mail

Other ways? Please specify below:

A couple of questions now for classification purposes: Are you…

Male?

Female?

What year were you born? CLICK ON THE DROP-DOWN ARROW TO SELECT YEAR

How many children do you have in a New York City public school?

1

2

3

4 or more

PLEASE CLICK ON A BUTTON BELOW THAT CORRESPONDS TO YOUR ANNUAL HOUSEHOLD INCOME:

Is your school a charter school?

Yes

No

Don't Know

In order for you to register for participation in the focus group discussions for NYC public schools, permission is needed from your parent or guardian. Please ask your parent or guardian to join you now and click on the box below:

I want to let my child register for participation in NYC public school focus groups.

My contact information for verification of my permission is provided below:

Parent/Guardian First Name: :
Parent/Guardian Last Name: :

Day Phone Number xxx-xxx-xxxx :

Evening/Weekend Phone Number (Please repeat if same as day number) :

Email Address :

THE REMAINING QUESTIONS SHOULD BE COMPLETED BY THE STUDENT WHO IS REGISTERING

What grade are you in? Please CLICK ON THE BUTTON FOR YOUR GRADE

Where in New York City do you live? PLEASE CLICK ON ONE OF THE 5 BUTTONS BELOW

What language do you speak most at home?

English

Spanish

Chinese

Other

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

Are you comfortable speaking Spanish? PLEASE CLICK ON Yes or No

Yes

No

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I am comfortable speaking Mandarin

I am comfortable speaking Cantonese

I am not comfortable speaking either of these

Are you comfortable speaking English? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON ONE OF THE 4 BUTTONS BELOW:

I don't have a cell phone

I have a basic cell phone that only makes or receives calls

I have a feature phone (e.g. Nokia, Samsung, Motorola)

I have a smart phone (e.g. iPhone, Android, Blackberry, HTC)

Do you ever access the Internet? PLEASE CLICK ON Yes or No

Yes

No

PLEASE CLICK ON EACH OF THE BOXES BELOW THAT APPLIES TO YOU:

I access the Internet from a home computer

I access the Internet from a work computer

I access the Internet from a cell phone

I access the Internet at the library

I access the Internet from a friend's home

I access the Internet at an Internet café

Other

When you want to communicate with one of your teachers or other school staff, how do you usually do it? PLEASE CLICK ALL THE BOXES BELOW THAT APPLY TO YOU:

I do not communicate with my teachers or other school staff

By phone

By email

Face-to-face

Text on a cell phone

Letter in the mail

Other ways? Please specify below:

A couple of questions now about yourself: Are you…

Male?

Female?

What year were you born? CLICK ON THE DROP-DOWN ARROW TO SELECT YEAR

Thank you for your interest in the focus groups we are planning. On which of the following dates are you available to participate in a two-hour focus group? PLEASE CHECK THE BOX OR BOXES THAT APPLY TO YOU ON EACH DAY THAT YOU ARE AVAILABLE.

Please check the times you are available on Saturday April 16

	Available from 12:30 to 2:30 PM	Available from 4:30 to 6:30 PM
Saturday April 16

Please check the box below if you are available on Saturday April 30 at 12:30 PM

	Available from 12:30 to 2:30 PM
Saturday April 30

Based on the input that you have provided, we're happy to say you match our selection criteria! Your name will be placed into a lottery with other qualified people and, hopefully, selected to participate. If you are selected, you will get a phone call from us.

PLEASE PROVIDE YOUR CONTACT INFORMATION BELOW SO THAT WE CAN REACH YOU

First Name :
Last Name :

Day Phone Number xxx-xxx-xxxx :

Evening/Weekend Phone Number (Please repeat if same as day number) :

Email Address :

IMPORTANT: Students can also participate in focus groups with other students, if a parent or a guardian gives their permission.

IF YOUR CHILD WANTS TO PARTICIPATE IN A STUDENT DISCUSSION GROUP AND YOU ALLOW IT, HE OR SHE MUST REGISTER AS SOON AS POSSIBLE BY

(1) GOING TO THE REGISTRATION WEBSITE, www.2011HelpStudents.org

OR

(2) CALLING THE REGISTRATION PHONE NUMBER, 1-718-684-9718

Based on the input that you have provided, we're happy to say you match our selection criteria! Your name will be placed into a lottery with other qualified students and, hopefully, selected to participate. If you are selected, you will get a phone call from us.

PLEASE PROVIDE YOUR CONTACT INFORMATION BELOW SO THAT WE CAN REACH YOU

First Name :
Last Name :

Day Phone Number xxx-xxx-xxxx :

Evening/Weekend Phone Number (Please repeat if same as day number) :

Email Address :

Thank you for your time, and have a great day!

Thank you for indicating an interest in this activity, and thank you for your time.
Since today we are looking only for families in the New York City public school system, we will not be asking any further questions. Thank you again, and have a great day!

Thank you for indicating an interest in this activity, and thank you for your time.
Based on your answers, we will not be able to include you in the focus groups. However, we would like to invite you to participate in our survey which will be conducted in May.

If you would like to participate,
please type in your email address here :

Thank you for participating in this survey, but at this time your profile does not fit our criteria for the focus groups.