Data Collection Form

Participate in the National Renorming of Hawthorne Rating Scales
Hawthorne Educational Services, Inc., is offering you the opportunity to participate in a national data collection project that would provide extra funds to spend at your discretion. Non-identifying data is currently being gathered nationally to renorm various rating scales. Hawthorne Educational Services, Inc. will pay $6.00 for each set (i.e., 1 school form and 1 home form for a student) which is properly completed and returned to this office by a specific deadline dates established each fall. The data you collect will be combined with the data from other raters to establish new norms for our scales. Additional information on our scales can be found on this website.
A minimum of 10 sets of forms must be completed per selected age group. For each student chosen to be rated, a school form and a home form are to be completed.
SCHOOL FORMS *completed by educators on non-identified students*		HOME FORMS completed by parents/guardians on non-identified students	SCHOOL FORMS *completed by educators on non-identified students*	HOME FORMS completed by parents/guardians on non-identified students
5 yrs		5 yrs	12 yrs	12 yrs
6 yrs		6 yrs	13 yrs	13 yrs
7 yrs		7 yrs	14 yrs	14 yrs
8 yrs		8 yrs	15 yrs	15 yrs
9 yrs		9 yrs	16 yrs	16 yrs
10 yrs		10 yrs	17 yrs	17 yrs
11 yrs		11 yrs	18 yrs	18 yrs
		ADDITIONAL DATA:
Test-Retest (Qty)		(Educator and Parent/Guardian complete the same form on the same student approximately 4 weeks after the first form is completed)
Inter-Rater (Qty)		(Two Educators and two Parents/Guardians independently rate the same student.)
Contact Name:
School:			District:
Address 1:
Address 2:
City: State: Zip:
Fax: Phone:
	*or return form to:*
Adina Laird Hawthorne Educational Services, Inc. 800 Gray Oak Drive Columbia, MO 65201 FAX: 800-442-9509