BHSU - Field Experience: Diversity 4b Form

Diversity of Faculty/Clinical Educators 4.b Form

For program development purposes, the School of Education is collecting information about your interactions with diverse populations during your time in the education preparation programs. Self-report your experiences working with diverse professionals in your classes or through other experiences during your programs study.

Basic Information

Current Status: *

Undergraduate Student Teaching

Graduate Student Teaching

Intern Name: *

Major(s):

Today's Date: 10/17/2025 2:26:16 AM

Ethnicity/Race 1

For the following prompts, respond for an ethnicity/race different than your own.

Name of Faculty/Clinical Educator:

Identify Ethnicity/Race if known:

Semester and Year:

School(s) or Sites(s):

Identify Type of Experiences (Select all that apply):

Course Faculty

Guest Speaker

Clinical Educator

Faculty Exchange

Classroom Visitors

Online Experience

Field Trip

K-12 Teacher

Other

Ethnicity/Race 2

For the following prompts, respond for an ethnicity/race different than your own.

Name of Faculty/Clinical Educator:

Identify Ethnicity/Race if known:

Semester and Year:

School(s) or Sites(s):

Identify Type of Experiences (Select all that apply):

Course Faculty

Guest Speaker

Clinical Educator

Faculty Exchange

Classroom Visitors

Online Experience

Field Trip

K-12 Teacher

Other

Gender

How many education professionals have you worked with who identify as the same gender as yourself?

How many education professionals have you worked with who identify as a different gender from yourself?

Identify Type of Experiences (Select all that apply):

Course Faculty

Guest Speaker

Clinical Educator

Faculty Exchange

Classroom Visitors

Online Experience

Field Trip

K-12 Classroom

Other

English Language Learner (ELL) or English as a Second Language (ESL)

How many professionals have you worked with that you would identify as ELL or ESL?

Identify Type of Experiences (Select all that apply):

Course Faculty

Guest Speaker

Clinical Educator

Faculty Exchange

Classroom Visitors

Online Experience

Field Trip

K-12 Classroom

Other

Please describe additional interactions with diverse populations that were not represented on this form:

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Important: Click the 'Submit' button ONCE in a session. If you are unsure your form was submitted OR you got a 'critical error' notice in a pink box after form submission, please contact Kellie Hatch to verify if the form was submitted successfully.