HSTWLogo TCTWLogo 2016  HSTW & TCTW Survey Order Form
    
 Administration Window: March 14 – April 8, 2016

About the Surveys: SREB is no longer administering the High Schools That Work Assessment. Schools are expected to participate in online HSTW and TCTW Student and Teacher Surveys. The surveys will be administered to all or a random sample of 60 or more 12th-grade students and all teachers grades nine through 12 between March 14 – April 8, 2016. Survey materials will be emailed to schools by December 4, 2015. Participating schools will receive a survey report by June 2016. The cost is $450 per school.

Instructions: A paper order form is available and can be used to collect necessary information before placing your order online. Orders must be submitted online. All requested information is required for your order to be processed. Please note that schools should follow their state coordinator’s instructions for ordering the assessment.  

Contact: If you have any questions about this order form, need to submit a change after an order has been placed, need to send a purchase order, or have questions about the assessment, please contact Fran Cowart by email at fran.cowart@sreb.org, by phone at (404) 875-9211, by fax at (404) 872-1477 or by mail at Southern Regional Education Board, 592 10th Street, N.W., Atlanta, GA, 30318-5776.

Ohio schools: order via your Regional HSTW Office. Do not order online.

* 1. Has your school previously participated in the HSTW Assessment or HSTW/TCTW surveys?
   

* 2. Please select the network to which your school belongs:
 

*  3. Official School Name: 		   

*  4. Contact Person (person in the school building who will receive all materials and communications):
       Name
       Phone (xxx-xxx-xxxx)     
       Email Address  
       School Shipping/Street Address (Do not use P.O. boxes)
       City
       State  Ohio - order via your Regional HSTW Office. Do not order online.
      Zip Code 		   

*  5. Principal:
     
       Name
       Phone (xxx-xxx-xxxx)     
       Email Address   		   

*  6. Person Placing Order:
     
       Name
       Phone (xxx-xxx-xxxx)     
       Email Address   		   

*  7. Total Number of Students Your School Plans to Survey:* 
*Schools must survey at least 60 students, or all students if  less than 60.

Select one of the following sampling options to indicate how your school will identify participants.*
*Schools with a contract with SREB should use the number of students and sampling method specified in their contract. 		 

  8. Total Cost: Please select if you will participate in further research options. More information is available on our website.
     (A) Cost of Teacher & Student Surveys   $450
     (B) Optional - Excel File of Survey Data $100
     (C) Optional - Research report linking survey data to test data $500
     (D) Total Cost $450  
   

 

*  9. Payment Information: If your school or district is paying for part or all of the surveys, a copy of your purchase order (P.O.) must be received by SREB by December 4, 2015, to confirm your order. Final payment is due to SREB by April 30, 2016. Please indicate how your school will pay for the surveys. (Select all that apply.)

     $ P.O. Number:  
     $ P.O. Number:  
     $  
     $    
     $ Please Explain:  

    The cost entered is $0

    School or District Billing Information: If your school or district is paying for part or all of the surveys, please provide the following billing information.

     Name   

     Phone     

     Email Address     

     Office/District/Agency Name   

 

     Mailing Address   

     City   

     State   

     Zip Code       

   

 

*  10. Survey Dates: Schools may administer the surveys any time between March 14 – April 8, 2016.

    

Please select the week that you intend to administer the surveys. 		   
     
*  11. Teacher Survey: Please indicate the number of full- and part-time teaching staff, grades nine through 12, in your building. Do not include non-teaching staff (e.g., administrators, media specialists, guidance counselors, custodians, etc.).
     Number of Teachers:  		   
   

* 12. Survey Participation Agreement: By submitting this order, our school understands and agrees to the following:
  • Unless we are surveying all seniors, we will select a true random sample of seniors to participate using the random sampling instructions provided.
  • We will ensure full payment arrives at SREB by April 30, 2016 .
  • We will be responsible for paying a $100 cancellation fee should we cancel our order after the survey window has begun.

          Name of authorizing individual:    
          Title of authorizing individual:    		   

Please click here to submit your order. After clicking submit, if you are not redirected to a confirmation page, your order has not been submitted. Please make sure you have completed all required fields. Please do not click the back arrow on your browser after submitting your order.