Diversity of Faculty/Clinical Educators 4.b Form

Current Status: Undergraduate Student Teaching Graduate Student Teaching

Intern Name: Please select one

Major(s):

Today's Date: 4/25/2024 10:11:43 PM

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.

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

Name of Faculty/Clinical Educator:

Identify Ethnicity/Race if known: African American Alaska Native American Indian Asian Hispanic Pacific Islander White Other Race or Ethnicity Unknown

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

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

Name of Faculty/Clinical Educator:

Identify Ethnicity/Race if known: Please Select African American Alaska Native American Indian Asian Hispanic Pacific Islander White Other Race or Ethnicity Unknown

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

How many education professionals have you worked with who identify as the same gender as yourself?" Please Select 0 education professionals 1 education professional 2 education professionals 3 or more education professionals

How many education professionals have you worked with who identify as a different gender from yourself?" Please Select 0 education professionals 1 education professional 2 education professionals 3 or more education professionals

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

How many professionals have you worked with that you would identify as ELL or ESL?" Please Select 0 education professionals 1 education professional 2 education professionals 3 or more education professionals

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.

Anti-Spam - Enter the below Captcha Code:*

Please enter the Captcha Code.

click the 'Submit' button ONCE in a session. If you unsure your form was submitted OR you get a 'critical error' notice in a pink box after form submission, please contact Kellie Hatch to verify if the form was submitted sucessfully.