Summary Diverse Field Experiences form Before using this Summary Diverse Field Experiences form you should have completed the following: Preservice Teacher Diverse Field Experiences Log on your website. Five mandatory Diverse Field Experiences: Race (race and ethnicity) Language (ESL/ELL) Socioeconomic (poverty) Gender (female/male) Special Needs (learning disabilities, physical disabilities, emotional disabilities, developmental disabilities, giftedness) Met with EDUC380 instructor or equivalent to determine if mandatory Diverse Field Experiences have been met. Additional field experiences if mandatory Diverse Field Experience were not met in 2 above. Met with University Supervisor (during EDUC455) to sign off on final Preservice Teacher Diverse Field Experiences log. Look over the form before completing. If you have any questions please contact your University Supervisor before entering data and submitting. Data is not recorded until the submit button is selected. It does not hurt to exit the form before it is submitted; however, no entered data will be saved. If you exit without submitting just return to the form when you are ready to complete and submit. The submitted data is to be used by the University of North Carolina Asheville Department of Education only. This form is to be completed only one time. Thank you. Candidate Information       Last Name     First Name     UNCA Student ID   Status  Undergraduate Post-Bac University Supervisor   Beck Becker Bowman Brown Byrd Chapman Cole Decatur   Hopper McGlinn (Jeanne) McGlinn (Jim) Ruppert Shaw Sidelnick Smith other   Major   Major   (Second) Major   (Third)   Primary Licensure Program (Licensure Area 1) Birth to Kindergarten Elementary Education (K-6) Middle School (6-9) English (9-12) Math (9-12) Social Studies (9-12) Physics (9-12) Earth Science (9-12) Comprehensive Science (9-12) Biology (9-12) Chemistry (9-12) Reading (K-12) Art (K-12) Theater Arts (K-12) French Spanish German Latin (9-12) Other Secondary Licensure Program (Licensure Area 2) Birth to Kindergarten Elementary Education (K-6) Middle School (6-9) English (9-12) Math (9-12) Social Studies (9-12) Physics (9-12) Earth Science (9-12) Comprehensive Science (9-12) Biology (9-12) Chemistry (9-12) Reading (K-12) Art (K-12) Theater Arts (K-12) French Spanish German Latin (9-12) Other     Diverse Field Experiences Summary Information     Mandatory Minimum Diverse Field Experiences (Note: First five entries are required to be completed by a set Type of Diversity Observed to complete form. )   Year Semester Course School or Educational Setting Click here for list Grade Level Hours Type of Participation Type of Diversity Observed (Static categories cannot  be changed)   yyyy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011   Not Applicable Spring Summer Fall   0 130 171 179 310 311 313 314 315 316 317 318 319 320 321 322 325 342 344 345 365 380 382 383 385 388 390 396 455 490 496 499 Other Service learn Tutor Work in school     - P-K K-2 3-5 6-8 9-12     Observation Interview Tutor Teach Substitution   Race   yyyy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011   Not Applicable Spring Summer Fall   0 130 171 179 310 311 313 314 315 316 317 318 319 320 321 322 325 342 344 345 365 380 382 383 385 388 390 396 455 490 496 499 Other Service learn Tutor Work in school     - P-K K-2 3-5 6-8 9-12     Observation Interview Tutor Teach Substitution   Language   yyyy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011   Not Applicable Spring Summer Fall   0 130 171 179 310 311 313 314 315 316 317 318 319 320 321 322 325 342 344 345 365 380 382 383 385 388 390 396 455 490 496 499 Other Service learn Tutor Work in school     - P-K K-2 3-5 6-8 9-12     Observation Interview Tutor Teach Substitution   Socioeconomic   yyyy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011   Not Applicable Spring Summer Fall   0 130 171 179 310 311 313 314 315 316 317 318 319 320 321 322 325 342 344 345 365 380 382 383 385 388 390 396 455 490 496 499 Other Service learn Tutor Work in school     - P-K K-2 3-5 6-8 9-12     Observation Interview Tutor Teach Substitution   Gender   yyyy 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011   Not Applicable Spring Summer Fall   0 130 171 179 310 311 313 314 315 316 317 318 319 320 321 322 325 342 344 345 365 380 382 383 385 388 390 396 455 490 496 499 Other Service learn Tutor Work in school     - P-K K-2 3-5 6-8 9-12     Observation Interview Tutor Teach Substitution   Special Needs   Additional Diverse Field Experiences   Year Semester Course School or Educational Setting Click here for list Grade Level Hours Type of Participation Type of Diversity Observed Race Language Socioeconomic Gender Special Needs Check all that apply R L S G N 0000 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Not Applicable Spring Summer Fall None 130 171 179 310 311 313 314 315 316 317 318 319 320 321