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Age:
 
< 25
 
25-34
 
35-44
 
45-54
 
55+

 
 
 
* Gender:
 
Male
 
Female
 
 
 
* Ethnicity
 
a. Caucasian/White
 
b. African-American
 
c. Hispanic
 
d. Asian or Pacific Islander
 
e. Native American
 
f. Other: (Please specify) __________
 
 
 
* Teaching Certiciation
 
 
 
Do you hold an ESL Endorsement on your Teaching Certification?
 
Yes
 
No
 
 
 
in your certification program, did you study a second or foreign language?
 
Yes
 
No
 
How many semesters?
 
 
 
 
Please indicate your teaching experience:
 
New to profession (less than one year)
 
1-2 years
 
3-4 years
 
5 years
 
More than 5 years
 
 
 
Please classify your main assignment and/or role at the school?
 
a. Regular teacher
 
b. Other staff who teach regularly schedule classes (i.e.: administrator, library, media specialist, support staff, counselor, other support staff)
 
Other
 
 
 
 
School instructional level:
 
Elementary school (K-5)
 
Other
 
 
 
 
Indicate whether you are a general-education or content area teacher (If content area, please specify content):
 
General Ed
 
Content-Area