Parapprofessional Demographics Form

Appendix K

A

OMB Number: xxxx-xxxx

Expiration Date: xx/xx/xx

ppendix K

Paraprofessional Demographics Form

Name School Name

Teacher Number _________ School Number________

Birth Date (Month, Day, Year): ___/_____/____

1. What is your gender? _____Female _____Male

2. What is your race? _____African American _____American Indian

(Select one or more) _____White _____Pacific Islander/Hawaiian

_____Asian _____Multiracial

_____Unknown

2. What is your ethnicity? _____Hispanic

_____Non-Hispanic

_____Unknown

2. 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.)

2. 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

2. Do you have any other special training? _____Yes _____No

Please describe.

2. Please describe any relevant experiences, other than education or training, that prepare you for your work in the classroom?

2. How many years have you been working in a classroom? ___________

3. How many years have you been working in kindergarten? ___________

1

Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific district or individual. We will not provide information that identifies you or your district to anyone outside the study team, except as required by law.