Appendix K

P-12 STUDENT DIVERSITY DEMOGRAPHICS

OF STUDENTS SERVED
BY WSU EDUCATION MAJORS

Check one: Licensure Area/s: _____________________

Field Experience __Elementary Education__K-6___________

Practicum A __Middle school Math__________________

Clinical Practice __Middle school Social_________________

Practicum B ____________________________________

WSU Student’s Name: William Miller Classroom Teacher’s Name: Cassie Wilson

School District: Rochester School Name: Bamber Valley

Please estimate the number of
students you served who are described Individual Education Programs (IEPs):
by the following categories:
_1_ African-American
___ American Indian
_5__ Asian
_3__ Hispanic
___ Migrant
_2__ Multi-Ethnic
_9__ White
_3__ Gifted and Talented (but not
identified until 2nd grade)
_3__ Limited-English Proficiency
_5__ Title I (Reading/Math)
Please specify the number of students with
_1__ Autism Spectrum Disorder
___ Blind-Visually Impaired
___ Deaf-Blind
___ Deaf and Hard of Hearing
___ Developmental Cognitive Disabilities
_1__ Developmental Delay (Birth to Age 7)
___ Emotional/Behavioral Disorders
___ Learning Disabilities
___ Other Health Disabilities
(includes Attention Deficit Disorders)
___ Physically Impaired
___ Traumatic Brain Injury
_3__ Speech

Please return this form by __________ to

_________________________________________.

Address:
___________________________________________________________________.