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University of Illinois at Urbana-Champaign 2017 Mobile Summer Institute Registration
Name
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Preferred Name (for name tag if applicable)
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Title/Position
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Department/School
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Institution
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Departmental Mailing Address (for the certificate to follow the SI)
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Telephone
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Email
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Will you be teaching any courses during the 2017-2018 academic year?
List the course(s) you expect to teach during the 2017-2018 academic year, the anticipated enrollment, and if the course is designed for primarily for majors, non-majors, or both. In addition, describe your role in the course (e.g., course coordinator, lead instructor, only instructor, one of a team).
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Participants at the Institute will be divided into small, discipline-specific groups to develop instructional materials. Please choose the top four topic areas which match your disciplinary interests. We will use these general classifications to form the groups.
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How will your participation in the Summer Institute benefit your students as well as your own teaching and career? You may wish to describe teaching challenges you have encountered that you hope to address by participating in the Institute.
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Please briefly describe your previous involvement with faculty development and research on undergraduate science education (e.g., workshops and conferences, research activities in science education, formal coursework).
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I will be attending the following:
Please check any dietary needs:
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