student Teaching Diversity Report

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LCCNTM^

1.

student Teacher Name:

2.

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

3.

Practicum Tier 1

r^tudent Teaching Placement 1

Practicum Tier 2

Student Teaching Placement 2

Semester and year in which you are reporting this experience:

r
4.
5.

Description
the typeyou
of classroom
(i.e.information:
inclusive, gifted):
Grade
of theofstudents
are reporting

6.

Number of students in the classroom

7.

Student Gender (number per category)

a. Male
i ^
b. Female \

8.

Student Economic Status (number per category)

a. Free/Reduced Lunch
b. Not Free/Reduced Lunch

1^

9. Student Race/Ethnicity (number per category)

a. American Indian or Alaskan Native
b. Asian or Pacific Islander
c.

Black, non-Hispanic

_2_

d. Hispanic
o
e. Multiracial
f. Non-resident Alien
g. Race/ethnicity unknown
h. White, non-Hispanic [ ^
10. Please indicate whether you worked with students with these special needs (check all that
apply):
If you are unable to obtain classroom level data for any
a. Bilingual
categories, seek out school level percentages and then
b. ESL
calculate the number of students in your class that would
c. GiftedAalented ^ ^
equal the school level percentages. (E.g., if you have 22
d. 504 Plan
^
students in your class and 75% of school students are on
e. lEP
free/reduced lunch, then 75% x 22 = 16.5 students in your
f. None
class on free/reduced lunch.)

student Teaching Diversity Report

O

Pi IT) y

] ^CCXX Kj

1.

student Teacher Name:

2.

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

Practicum Tier 1
Practicum Tier 2

Student Teaching Placement 1

(^^^Student Teaching P l a c e m e n t | p P I

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. Male
(a^
b. Female
O

8.

Student Economic Status (number per category)

a. Free/Reduced Lunch | ^
b. Not Free/Reduced Lunch ^

9.

Student Race/Ethnicity (number per category)

a. American Indian or Alaskan Native
^
b. Asian or Pacific Islander / c. Black. non-Hispanic 1
d. Hispanic
e. Multiracial ^
y
f. Non-resident Alien ^
g. Race/ethnicity unknown.

-0.0

PC
^

h. White, non-Hispanic

C7

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

Bilingu
ESL
Gifted/Talented.
d/Ta
504 Plai
7_
IEP
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.)