College of Education and Science
Teacher Education
HUMAN RELATIONS REPORT FORM -- ED439 Inclusive Classroom
(ECE 425 or ED 380 may be substituted)
Name of Student:
For Transfer Students
Higher Education Institution:
Course Number/Title:
Check professional program:
Public Teacher
Lutheran Classroom Teacher
Human Relations Experience:
Ages of Participants:
Location: City, State Zip
Date began:
Date ended:
Total Number of Hours:
Note: An Activity is an experience in which the student works with other people in a teaching, directive, or other helping
capacity. Observation alone does not constitute an activity. With preapproval from the instructor, experiences may be
completed up to two semesters prior to enrolling for the course.
In a separate report:
Describe the activity and the participants (one paragraph).
Describe the effect this activity had on your behavior with respect to human relations knowledge
and/or skills (one paragraph).
Reflect on and write a response using the following prompts. LABEL each response with the letters
A, B, C, D.
Describe an increase in your understanding of contributions and lifestyles of the various racial, cultural, and
socioeconomic groups.
B. Explain how you now recognize and address dehumanizing biases, discrimination, and prejudice toward different groups.
C. Describe and analyze how this experience will improve your ability to create learning environments which contribute to
the self-esteem of all people and build positive interpersonal relationships.
D. Describe how this experience will increase your respect for diversity and individual rights.
Verification & Evaluation: Briefly describe your observation of this student in relationship to learners from various racial, cultural and
socioeconomic groups.
Signature/Title of Person In Charge
Name of Place/Institution in which experience was completed:
Signature of Concordia University Instructor:
HR Folder
Online Folder
Revised 1/2013
College of Education and Science
Teacher Education
Field Experience for Human Relations Hours
The 15 hours each of four experiences to meet the human relations requirement for teacher
licensure must be completed prior to student teaching, totaling 60 hours.
The hours are divided among four classes with 15 hours assigned to each focused on specific target populations.
 ED 330 Human Relations and Diversity – diverse ethnic and cultural groups
 ED 201 Intro to and Foundations of Education - diverse socio-economic groups
 ED 439 Inclusive Classroom (ECE 425 Young Child with Special Needs or ED 380 Exceptional Child may
be substituted for ED 439) - diverse learning needs/disabilities
 ED 487 Reading Across the Content or ECE 324 Lang Development & Emergent Literacy – English
language learners
 The appropriate report form must be used for each experience.
 The experience must be done with learners, Birth through Grade 12.
 The experience should be done with the age group for which licensure is sought.
 The 60 hours must be completed in two or more settings.
 The reflective prompts on the report must explain in detail how the experience impacted your
knowledge, skills, and disposition.
Transfer Students: Candidates who are transferring to Concordia University to complete licensure and who have
already completed equivalent courses at a previous higher education institution, must still complete a report for
each course and have the report approved by an instructor of the Concordia University course.
HR Folder
Online Folder
Revised 1/2013