Appendix K

P-12 STUDENT DIVERSITY DEMOGRAPHICS

OF STUDENTS SERVED
BY WSU EDUCATION MAJORS
Check one:

Licensure Area/s: _____________________

Field Experience

_______Elementary Education K-6________

Practicum A

____________________________________

Clinical Practice

____________________________________

Practicum B

____________________________________

WSU Students Name

Melissa Oliver
School District
Rochester Public School District

Classroom Teachers Name

Cassie Wilson
School Name
Bamber Valley Elementary

Please estimate the number of students

you served who are described by the
following categories:

Please specify the number of students with

Individual Education Programs (IEPs):

_1_
___
_1_
_4_
___
___
_15
_1_

African-American
American Indian
Asian
Hispanic
Migrant
Multi-Ethnic
White
Indian

___ Gifted and Talented

_4_ Limited-English Proficiency
___ Title I (Reading/Math)

___
___
___
___
___
___
___
___
___

Autism Spectrum Disorder

Blind-Visually Impaired
Deaf-Blind
Deaf and Hard of Hearing
Developmental Cognitive Disabilities
Developmental Delay (Birth to Age 7)
Emotional/Behavioral Disorders
Learning Disabilities
Other Health Disabilities
(includes Attention Deficit Disorders)
___ Physically Impaired
___ Traumatic Brain Injury
_2_ Speech & Language

Please return this form by __________ to

_________________________________________.
Address:
___________________________________________________________________.