Diversity of University Peers 4.C Form

Current Status: Undergraduate Student Teaching Internship Graduate Student Teaching Internship

Intern Name: Please select one

Major(s):

Today's Date: 10/14/2024 12:43:41 PM

For program improvement purposes, the School of Education is collecting information about specific interactions with diverse peers. Self report your experiences interacting with diverse peers in your classes or through other experiences during your program of study.

Race or Ethnic Group (other than your own) of Diverse Individual 1: 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):    In Class    Via Distance Learning    Student Visitor    Social Media    University Sponsored Student Activity    Student Organization    Volunteering    Other

If Other, please describe:

Was this peer of a different gender than yourself?

YesNoUnknown

Was this peer of a different socioeconomic group than yourself? YesNoUnknown

Select a Race or Ethnic Group (other than your own) with whom you have had experience (2): 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):    In Class    Via Distance Learning    Student Visitor    Social Media    University Sponsored Student Activity    Student Organization    Volunteering    Other

If Other, please describe:

Was this peer of a different gender than yourself?

YesNoUnknown

Was this peer of a different socioeconomic group than yourself? YesNoUnknown

Have you interacted with a peer with identified exceptionalities? YesNOUnknown

Semester and Year:

School(s) or Sites(s):

Identify Type of Experiences (Select all that apply):    In Class    Via Distance Learning    Student Visitor    Social Media    University Sponsored Student Activity    Student Organization    Volunteering    Other

If Other, please describe:

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