BHSU - Field Experience: Diversity 4c Form

Diversity of University Peers 4.C Form

Basic Information

Current Status: *

Undergraduate Student Teaching Internship

Graduate Student Teaching Internship

Intern Name: *

Major(s):

Today's Date: 10/26/2025 2:36:39 AM

Identify Diverse University Peers

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.

Diverse Individual 1

Race or Ethnic Group (other than your own) of Diverse Individual 1:

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?

Yes

Unknown

Was this peer of a different socioeconomic group than yourself?

Yes

Unknown

Diverse Individual 2

Select a Race or Ethnic Group (other than your own) with whom you have had experience (2):

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?

Yes

Unknown

Was this peer of a different socioeconomic group than yourself?

Yes

Unknown

Individual with Identified Exceptionalities

Have you interacted with a peer with identified exceptionalities?

Yes

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:

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