Tuberculosis contact investigations conducted in school settings in New York State (exclusive of New York City) from 1997-2001 were assessed to identify current practices and develop guidance for future investigations. Site visits were made to counties where 26 school-based contact investigations were conducted during the study period. Among the 4,070 individuals tested in the first round, the skin test positivity rate was 5.1%. Second round testing of 2,886 individuals produced 102 apparent converters for a rate of 3.5%. Many school contact investigations test more people than might be expected with community-based tuberculosis contact investigations, primarily due to parental concerns and "political" pressure on school and local public health officials. The study in this article identifies tuberculin positivity rates among school children and makes recommendations to improve the contact investigation process.