Teacher certification(s)
Student and Class Composition
1. Enter the number of students who have primary disabilities:
Learning disabilities
Behavior disorders
Mild MR
Moderate/Severe MR
Other primary disabilities (please include number of students with each
disability):
2. Primary service delivery option of your classroom:
GE inclusion
Resource
Instructional Class
Special School
3.
Age or ages of students you serve in your classroom:
4.
Grade(s) or grade level(s) you serve in your class:
5.
What time is your planning period or slow period(s)?
6.
Which part of the day would you prefer SIUC students complete their practicum/pre-student teaching?
AM
PM
7.
Characteristics of daily instructional practices provided to the students in your classroom
(check as many as apply):
Large or small group instruction Direct instruction
Functional curriculum instruction Language arts instruction
Utilize classroom management plan Reading instruction
Utilize instructional accommodations Social skills instruction
Utilize curriculum-based assessment Alternative assessment
Utilize assisstive technology Co-teaching/collaboration with general education teachers
Study skills instruction Math instruction
8.
Any additional remarks?