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. 20202-4651. 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 bdietsc@wested. org.
Part A.

For items 1-48, read each item and think about this student’s 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 1 [1]

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. 1¨ 2¨ 3¨

Asks questions of you when unsure of what to do in schoolwork. 1¨ 2¨ 3¨

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
How Often?

Never Sometimes Very Often

1. Controls temper in conflict situations with peers. 1¨ 2¨ 3¨

2. Introduces herself or himself to new people without being told. 1¨ 2¨ 3¨

3. Appropriately questions rules that may be unfair. 1¨ 2¨ 3¨

4. Compromises in conflict situations by changing own ideas to reach agreement. 1¨ 2¨ 3¨

5. Responds appropriately to peer pressure. 1¨ 2¨ 3¨

6. Says nice things about himself or herself when appropriate. 1¨ 2¨ 3¨

7. Invites others to join in activities. 1¨ 2¨ 3¨

8. Uses free time in an acceptable way. 1¨ 2¨ 3¨

9. Finishes class assignments within time limits. 1¨ 2¨ 3¨

10. Makes friends easily. 1¨ 2¨ 3¨

11. Responds appropriately to teasing by peers. 1¨ 2¨ 3¨

12. Controls temper in conflict situations with adults. 1¨ 2¨ 3¨

13. Receives criticism well. 1¨ 2¨ 3¨

14. Initiates conversations with peers. 1¨ 2¨ 3¨

15. Uses time appropriately while waiting for help. 1¨ 2¨ 3¨

16. Produces correct schoolwork. 1¨ 2¨ 3¨

17. Appropriately tells you when he or she thinks you have treated him or her unfairly. 1¨ 2¨ 3¨

18. Accepts peers’ ideas for group activities. 1¨ 2¨ 3¨

19. Gives compliments to peers. 1¨ 2¨ 3¨

20. Follows your directions. 1¨ 2¨ 3¨

21. Puts work materials or school property away. 1¨ 2¨ 3¨

22. Cooperates with peers without prompting. 1¨ 2¨ 3¨

23. Volunteers to help peers with classroom tasks. 1¨ 2¨ 3¨

24. Joins ongoing activity or group without being told. 1¨ 2¨ 3¨

25. Responds appropriately when pushed or hit by other children. 1¨ 2¨ 3¨

26. Ignores peer distractions when doing class work. 1¨ 2¨ 3¨

27. Keeps desk clean and neat without being reminded. 1¨ 2¨ 3¨

28. Attends to your instructions. 1¨ 2¨ 3¨

29. Easily makes transition from one classroom activity to another. 1¨ 2¨ 3¨

30. Gets along with people who are different. 1¨ 2¨ 3¨

Problem Behaviors
How Often?

Never Sometimes Very Often

31. Fights with others. 1¨ 2¨ 3¨

32. Has low self-esteem. 1¨ 2¨ 3¨

33. Threatens or bullies others. 1¨ 2¨ 3¨

34. Appears lonely. 1¨ 2¨ 3¨

35. Is easily distracted. 1¨ 2¨ 3¨

36. Interrupts conversations of others. 1¨ 2¨ 3¨

37. Disturbs ongoing activities. 1¨ 2¨ 3¨

38. Shows anxiety about being with a group of children. 1¨ 2¨ 3¨

39. Is easily embarrassed. 1¨ 2¨ 3¨

40. Doesn’t listen to what others say. 1¨ 2¨ 3¨

41. Argues with others. 1¨ 2¨ 3¨

42. Talks back to adults when corrected. 1¨ 2¨ 3¨

43. Gets angry easily. 1¨ 2¨ 3¨

44. Has temper tantrums. 1¨ 2¨ 3¨

45. Likes to be alone. 1¨ 2¨ 3¨

46. Acts sad or depressed. 1¨ 2¨ 3¨

47. Acts impulsively. 1¨ 2¨ 3¨

48. Fidgets or moves excessively. 1¨ 2¨ 3¨

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