My Students’ Ethnicities |
Hispanic
- Mexican
- Puerto Rican
- Cuban
- Dominican
- Honduran
- Spanish
- Portuguese
- Peruvian
- Other: ____________
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Black
- African American
- Jamaican
- Haitian
- Egyptian
- Somalian
- Nigerian
- West Indies
- Other: ____________
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White
- Irish
- Scottish
- German
- English
- French
- Italian
- Australian
- Canadian
- Other: ____________
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Asian
- Chinese
- Japanese
- Korean
- Cambodian
- Viet Namese
- Korean (N & S)
- Indonesian
- Pacific Islander
- Other: ____________
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Middle Eastern
- Iranian
- Iraqui
- Syrian
- Kuwaiti
- Afghani
- Indian
- Israeli
- Other: ____________
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My Students’ Religious Affiliations |
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- Christian
- Russian Old Believers
- Catholic
- Other: ____________
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- Buddhist
- Other: ____________
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My Students’ family structures |
- 2 parent home
- Incarcerated parent(s)
- Migrant
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- 2 parents + extended family
- Living with grandparents
- Other: ____________
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- Same sex parents
- Foster Home
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- Separated parents, shared custody
- Adopted
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- Separated parents, single custody
- Homeless
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My students’ special needs or significant characteristics |
- English Language Learner
- Trans-gender
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- Traumatized
- Deaf or Hearing Impaired
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- Blind or severe sight limitations
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- Developmental Delay
- Behavioral Issues
- Physical Limitations
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