Appendix K
A
OMB Number: xxxx-xxxx
Expiration Date: xx/xx/xx
Paraprofessional Demographics Form
Name School Name
Teacher Number _________ School Number________
Birth Date (Month, Day, Year): ___/_____/____
1. What is your gender? _____Female _____Male
What is your race? _____African American _____American Indian
(Select one or more) _____White _____Pacific Islander/Hawaiian
_____Asian _____Multiracial
_____Unknown
What is your ethnicity? _____Hispanic
_____Non-Hispanic
_____Unknown
EDUCATIONAL BACKGROUND AND PROFESSIONAL EXPERIENCE
Please check and complete for all that apply.
|
Education |
Major |
Year Completed |
|
High School |
|
|
|
GED |
|
|
|
Non-degree program (e.g. Montessori, CDA) |
|
|
|
Some college/university |
|
|
|
Bachelor’s degree |
|
|
|
Other (Please describe.)
|
|
|
Please check all areas in which you have a current teaching certificate.
|
Early Childhood |
|
|
Gifted/Talented |
|
Middle Childhood |
|
|
Administration |
|
Secondary |
|
|
Reading |
|
ESOL |
|
|
Other |
|
Special Education |
|
|
|
Do you have any other special training? _____Yes _____No
Please describe.
Please describe any relevant experiences, other than education or training, that prepare you for your work in the classroom?
How many years have you been working in a classroom? ___________
How many years have you been working in kindergarten? ___________
File Type | application/msword |
File Title | Child File Evidence Form |
Author | pschwan |
Last Modified By | Sheila.Carey |
File Modified | 2007-08-31 |
File Created | 2007-08-31 |