P-12 STUDENT DIVERSITY DEMOGRAPHICS (OF STUDENTS SERVED BY WSU EDUCATION MAJORS fd Check one! Licensure Area/s: Packt = Field Experience C_| Practicum A fd Student Teaching Education | Practicum B WSU Student's Name Classroom Teacher's Name Eon ily —Thornp sor Poul Wire School District So eee = Ausiia Ma W472 outhacte Elementary | Please estimate the number of students you Please specify the number of students with served who are described by the following | Individual Education Programs (IEPs): categories: | | 1. autism spectrum Disorder | Zattican-american O Blind-vVisually Impaired 2. American Indian 2 Deaf-Blind 2 Asian © Deaf and Hard of Hearing L Hispanic & Developmental Cognitive Disabilities O Migrant S Developmental Delay (Birth to Age 7) Z Multi-Ethnic Emotional/Behavioral Disorders 14 white 2, Learning Disabilities © Other Health Disabilities (includes Attention Deficit Disorders} SS Gifted and Talented © Physically Impaired Limited: English Proficiency > Traumatic Brain Injury 12 Title | (Reading/Math) Please return this form by to Please will out this form electronically. Form Available On-Line at: http://www.winona.edu/teacherd/coopteachers.asp Ee Section VI- Forms Page 2