1. Contextual Factors Block I

2. Classroom Characteristics: *Classroom Organization  ____ Homogeneous  ____ Heterogeneous  ____ Self-Contained  ____ Team Teaching  ____ Departmentalized  ____ Parallel Block  List other programs:

3. Classroom Characteristics: *Resources  ____ Television  ____ Classroom library  ____ Number of computers in classroom  ____ Estimate number of books  List other resources (such as math and science manipulative materials):

4. Individual Differences: *Students Attending Pull-Out or Supplementary Programs (number of students)  ____ Title I  ____ Reading  ____ Gifted  ____ Early Intervention Program  ____ Safety Net  List other programs:

5. Individual Differences: *Language Proficiency (number of students)  ____ English language  ____ Bilingual  ____ Other languages  List other languages:

6. Individual Differences: *Students with Individual Education Plans (number of students)  ____ Blind or visually impaired  ____ Deaf or hearing impaired  ____ Developmentally delayed  ____ Emotionally or behaviorally disordered  ____ Learning disabled  ____ MiMH  ____ OHI  ____ Physically disabled  ____ Speech  ____ Other