student Teaching Diversity Report

1.

Student Teacher Name

2.

Please indicate on which of the following you are reporting information:

Student Teaching Placement 1

Practicum Tier 1
Practicum Tier 2

^^^^ttJCtentTeaching P l a c e m e n t T ^ ] ] ^

3.

Semester and year in which you are reporting this experience:

4.

Description of the type of classroom (i.e. inclusive, gifted):

5.

Grade of the students you are reporting information:

6.

Number of students in the classroom:

7.

Student Gender (number per category)

a.
b.

8.

9.

l^'V

^^CXjr\-P

'SAuA PsTyA^

Male
\
Female ^

Student Economic Status (number per category)

a.

Free/Reduced Lunch

b.

Not Free/Reduced Lunch

\~7

Student Race/Ethnicity (number per category)

a.

American Indian or Alaskan Native

b.

Asian or Pacific Islander

c.

Black, non-Hispanic

d.

Hispanic

e.

Multiracial

f.

Non-resident Alien

g.

Race/ethnicity unknown

h.

White, non-Hispanic

C)

10. Please indicate whether you worked with students with these special needs (check all that
apply):
a.

Bilingual

b.

ESL

c.

Gifted/Talente

d.

504 Plan _

e.

lEP

f.

None

If you are unable to obtain classroom level data for any

categories, seek out school level percentages and then
calculate the number of students in your class that would
equal the school level percentages. (E.g., if you have 22
students in your class and 75% of school students are on
free/reduced lunch, then 75% x 22 = 16.5 students in your
class on free/reduced lunch.)