Published on Brock University (http://www.brocku.ca)

Instructional Skills Workshop Registration Form (Faculty & Instructors)

To confirm your registration payment must be received in full.

Instructional Skills Workshop Registration Form (Faculty & Instructors)

Registrant Name: *

Please write your name as you would like it shown on the certificate - eg. First Name Middle Initial Last Name

Department: *

Other Position:

Preferred Mailing Address: *

Department (as indicated)

Home Address (Please provide complete mailing address)

Address:

Telephone @ Brock :

Telephone @ Home/Mobile:

Payment: *

Registration fee is payable by cash, cheque (payable to Brock University), or transfer of funds (payable to CPI Account 118-081-042), TH 253B. **Please note that your registration fee is non-refundable**

Confirmation of your registration in this program will take place once payment is received.

Workshop Dates: *

Workshop Dates:

Courses Currently Teaching: *

I am currently teaching,

Length of Teaching Experience: *

I have been teaching for

Other Teaching: Workshops/Courses/Experiences:

E-mail: *

Use a Brock University e-mail if possible.

Please indicate which types of teaching methods you currently use. Record the percentage of your use of each teaching method.

Lectures: * %

Discussion Tutorials/Seminars: * %

Training/Workshops: * %

Science Labs: * %

Math/Computer Labs: * %

Other: * %

Of the six teaching methods listed, please rank in order of preference. (1 - Most preferred 6 - Least preferred)

Teaching Method 1: *

Teaching Method 2: *

Teaching Method 3: *

Teaching Method 4: *

Teaching Method 5: *

Teaching Method 6: *

What do you hope to gain from the Instructional Skills Workshop?: *

Source URL: http://www.brocku.ca/pedagogical-innovation/workshops/isw/instructional-skills-workshop