General Teacher Feedback

1. School Level Demographic Data

	MM		DD		YYYY
Date	Please provide today's date. Date Month	/	Day	/	Year

Can you provide the location of the school where you will be implementing Culturally Situated Design Tools (CSDTs)? Name:
Address:
Address 2:
City/Town:
State:
ZIP:

What is the name of the school principal? Principal Name

What is the name of your school district? District Name

What is the ethnic breakdown for the student population at the school site? School A

How many students attend this school? School A

What percentage of the school population is on free/reduced lunch (SES status)? Total Percent

What is the teacher-student ratio for the entire school? School A

50%