Student Teacher Information

NOTE: If you are unable to obtain classroom level data for any categories, seek out school level percentages and then calculate the number of students in your class that would equal the school level percentages. (E.g., if you have 22 students in your class and 75% of school students are on free/reduced lunch, then 0.75 x 22 = 16.5 students in your class on free/reduced lunch.)

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* 1. Student Teacher Name:

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* 2. Please indicate on which of the following you are reporting information:

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* 3. Semester and year in which you are reporting this experience:

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