OECD Programme for
International Student Assessment 2012
<country>
Date of Test (Main Survey PISA 2012)
2012
ORGANISATION FOR ECONOMIC Day Month
CO-OPERATION AND DEVELOPMENT
Student Questionnaire -
Form UH
School Name
Student ID
Student Name
Family name Given name
Date of Birth / / 19
Day Month Year
<Language of test> <ISO code>
Project Consortium
Australian Council for Educational Research (ACER)
cApStAn Linguistic Quality Control (Belgium)
Deutsches Institut für Internationale Pädagogische Forschung
(DIPF, Germany)
Educational Testing Service (ETS, USA)
Institutt for Lærerutdanning og Skoleutvikling (ILS, Norway)
Leibniz - Institute for Science and Mathematics Education
(IPN, Germany)
National Institute for Educational Policy Research (NIER, Japan)
The Tao Initiative: CRP - Henri Tudor and Université de Luxembourg
EMACS (Luxembourg)
Unité d'analyse des systèmes et des pratiques d'enseignement
(aSPe, Belgium)
Westat (USA)
In this booklet you will find questions about:
You (Section A)
Your Family and Home (Section B)
Please read each question carefully and answer as accurately as you
can. In the test you usually circle your answers. For this
questionnaire, you will normally answer by ticking a box. For a few
questions you will need to write a short answer.
If you make a mistake when ticking a box, cross out your error and
check the correct box. If you make an error when writing an answer,
simply cross it out and write the correct answer next to it.
In this questionnaire, there are no ‘right’ or ‘wrong’ answers.
Your answers should be the ones that are ‘right’ for you.
You may ask for help if you do not understand something or are not
sure how to answer a question.
Your answers will be combined with others to make totals and
averages in which no individual can be identified. All your
answers will be kept confidential.
3
SECTION <A>: ABOUT YOU
ST01
Q1 What <grade> are you in?
____________________________________________________
<grade>
ST02
Q2 Which one of the following <programmes> are you in?
(Please tick only one box.)
<Programme 1> 1
<Programme 2> 2
<Programme 3> 3
<Programme 4> 4
<Programme 5> 5
<Programme 6> 6
4
ST03
Q3 On what date were you born?
(Please write the day, month and year you were born.)
______ ____________ 19___
Day Month Year
ST04
Q4 Are you female or male?
Female Male
1 2
ST05
Q5 Did you attend <ISCED 0>?
No 1
Yes, for one year or less 2
Yes, for more than one year 3
5
ST06
Q6 How old were you when you started <ISCED 1>?
Years
ST07
Q7 Have you ever repeated a <grade>?
(Please tick only one box in each row.)
Yes, twice or
No, never Yes, once more
a) At <ISCED 1> 1 2 3
b) At <ISCED 2> 1 2 3
c) At <ISCED 3> 1 2 3
6
ST08
Q8 In the last two full weeks of school, how many times did you
arrive late for school?
(Please tick only one box.)
None 1
One or two times 2
Three or four times 3
Five or more times 4
ST09
Q9 In the last two full weeks of school, how many times did you
<skip> a whole school day?
(Please tick only one box.)
None 1
One or two times 2
Three or four times 3
Five or more times 4
7
ST115
Q10 In the last two full weeks of school, how many times did you
<skip> some classes?
(Please tick only one box.)
None 1
One or two times 2
Three or four times 3
Five or more times 4
8
SECTION <B>: ABOUT YOUR FAMILY AND HOME
In this section you will be asked some questions about your family
and your home.
Some of the following questions are about your mother and father or
those persons who are like a mother or father to you — for example,
guardians, step-parents, foster parents, etc.
If you share your time with more than one set of parents or
guardians, please answer the following questions for those
parents/guardians you spend the most time with.
ST11
Q11 Who usually lives at <home> with you?
(Please tick one box in each row.)
Yes No
a) Mother (including stepmother or foster mother) 1 2
b) Father (including stepfather or foster father) 1 2
c) Brother(s) (including stepbrothers) 1 2
d) Sister(s) (including stepsisters) 1 2
e) Grandparent(s) 1 2
f) Others (e.g. cousin) 1 2
9
ST12
Q12 What is your mother’s main job?
(e.g. school teacher, kitchen-hand, sales manager)
(If she is not working now, please tell us her last main job.)
Please write in the job title. _________________________________________
Q13 What does your mother do in her main job?
(e.g. teaches high school students, helps the cook 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.
______________________________________________________
ST13
Q14 What is the <highest level of schooling> completed by your
mother?
If you are not sure which box to choose, please ask the <test
administrator> for help.
(Please tick only one box.)
<ISCED level 3A> 1
<ISCED level 3B, 3C> 2
<ISCED level 2> 3
<ISCED level 1> 4
She did not complete <ISCED level 1> 5
10
ST14
Q15 Does your mother have any of the following qualifications?
If you are not sure how to answer this question, please ask the <test
administrator> for help.
(Please tick one box in each row.)
Yes No
a) <ISCED level 6> 1 2
b) <ISCED level 5A> 1 2
c) <ISCED level 5B> 1 2
d) <ISCED level 4> 1 2
ST15
Q16 What is your mother currently doing?
(Please tick only one box.)
Working full-time <for pay> 1
Working part-time <for pay> 2
Not working, but looking for a job 3
Other (e.g. home duties, retired) 4
11
ST16
Q17 What is your father’s main job?
(e.g. school teacher, kitchen-hand, sales manager)
(If he is not working now, please tell us his last main job.)
Please write in the job title. ________________________________________________
Q18 What does your father do in his main job?
(e.g. teaches high school students, helps the cook prepare
meals in a restaurant, manages a sales team)
Please use a sentence to describe the kind of work he does or did in that
job.
______________________________________________________
ST17
Q19 What is the <highest level of schooling> completed by your
father?
If you are not sure how to answer this question, please ask the <test
administrator> for help.
(Please tick only one box.)
<ISCED level 3A> 1
<ISCED level 3B, 3C> 2
<ISCED level 2> 3
<ISCED level 1> 4
He did not complete <ISCED level 1> 5
12
ST18
Q20 Does your father have any of the following qualifications?
If you are not sure which box to choose, please ask the <test
administrator> for help.
(Please tick one box in each row.)
Yes No
a) <ISCED level 6> 1 2
b) <ISCED level 5A> 1 2
c) <ISCED level 5B> 1 2
d) <ISCED level 4> 1 2
ST19
Q21 What is your father currently doing?
(Please tick only one box.)
Working full-time <for pay> 1
Working part-time <for pay> 2
Not working, but looking for a job 3
Other (e.g. home duties, retired) 4
13
ST20
Q22 In what country were you and your parents born?
(Please tick one box in each column.)
You Mother Father
<Country A> 01 01 01
<Country B> 02 02 02
<Country C> 03 03 03
<Country D> 04 04 04
<…etc.> <xx> <xx> <xx>
Other country <xx> <xx> <xx>
ST21
Q23 If you were NOT born in <country of test>, how old were you
when you arrived in <country of test>?
If you were less than 12 months old, please write zero (0).
If you were born in <country of test> please skip this question and go to
Q<x>.
Years
_____________________________
14
ST25
Q24 What language do you speak at home most of the time?
(Please tick only one box.)
<Language 1> <xxx>
<Language 2> <xxx>
<Language 3> <xxx>
< …etc. > <xxx>
Other language <xxx>
15
ST26
Q25 Which of the following are in your home?
(Please tick one box in each row.)
Yes No
a) A desk to study at 1 2
b) A room of your own 1 2
c) A quiet place to study 1 2
d) A computer you can use for school work 1 2
e) Educational software 1 2
f) A link to the Internet 1 2
g) Classic literature (e.g. <Shakespeare>) 1 2
h) Books of poetry 1 2
i) Works of art (e.g. paintings) 1 2
j) Books to help with your school work 1 2
k) <Technical reference books> 1 2
l) A dictionary 1 2
m) A dishwasher 1 2
n) A <DVD> player 1 2
o) <Country-specific wealth item 1> 1 2
p) <Country-specific wealth item 2> 1 2
q) <Country-specific wealth item 3> 1 2
16
ST27
Q26 How many of these are there at your home?
(Please tick only one box in each row.)
Three or
None One Two more
a) Cellular phones 4
b) Televisions 4
c) Computers 4
d) Cars 4
e) Rooms with a bath or shower 4
17
ST28
Q27 How many books are there in your home?
There are usually about 40 books per metre of shelving. Do not include
magazines, newspapers, or your schoolbooks.
(Please tick only one box.)
0-10 books 1
11-25 books 2
26-100 books 3
101-200 books 4
201-500 books 5
More than 500 books 6
Thank you very much for your co-operation in
completing this questionnaire!
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