Student Teaching Diversity Report SurveyMonkey

#334
COMPLETE
Collector: Web Link (Web Link)
Started: Wednesday, January 20, 2021 4:01:50 PM
Last Modified: Wednesday, January 20, 2021 4:18:38 PM
Time Spent: 00:16:47
IP Address: 72.84.105.4

Page 1: Student Teacher Information

Q1
Student Teacher Name:

Kelsey Hayes

Q2 Student Teaching Placement 1

Please indicate on which of the following you are reporting

information:

Q3 Spring 2021

Semester and year in which you are reporting this

experience:

Page 2: Classroom Specifics

Q4
Description of the type of classroom (i.e. inclusive, gifted):

Block 1 (1) - advanced; Block 2 (2) - inclusion

Q5
Grade of the students for which you are reporting information:

8th

Q6
Number of students in the classroom:

1 - 24; 2 - 21

Page 3: Student Gender and Economic Status

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 Student Teaching Diversity Report SurveyMonkey

Q7
Male students:

1 - 12; 2 - 15

Q8
Female students:

1 - 12; 2 - 6

Q9
Free/Reduced Lunch students:

1 - 10; 2 - 9

Q10
Not Free/Reduced Lunch students:

1 - 14; 2 - 12

Page 4: Student Race/Ethnicity

Q11
American Indian or Alaskan Native:

1-0; 2-0

Q12
Asian or Pacific Islander:

1-2; 2-0

Q13
Black, non-Hispanic

1-13; 2-12

Q14
Hispanic:

1-4; 2-4

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Q15
Multiracial

1-3; 2-1

Q16
Non-resident Alien:

unknown

Q17
Race/ethnicity unknown:

Q18
White, non-Hispanic:

1-2; 2-4

Page 5: Special Needs

Q19 Gifted/Talented,

Please indicate whether you worked with students with the 504 Plan,
following special needs. Check all that apply.
IEP

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