Graduate Student Teaching Observation Request Form 2016-2017
Please use this form to request a CTL Teaching Observation.
Your Information
First Name: *
Your answer
Last Name: *
Your answer
Email Address: *
Your answer
Department: *
Your answer
Status: *
Cell Phone Number *
Required in case we need to contact you on the day of the scheduled observation.
Your answer
Observation Date & Time
Desired Date of Observation *
Enter a specific date you would like a consultant to observe your class. You must request your consultation at least 2 weeks in advance of the date you wish to be observed.
Your answer
Time of Day *
Please note that consultants will observe for up to 1 hour, even if the class may run longer.
Your answer
Is this a "one time" teaching opportunity? *
Is this the only date/time that consultants will be able to observe your teaching during this semester?
If you answered Yes to the previous question, please indicate why
Please let us know why this is the only time to observe your teaching this semester.
Your answer
2nd Choice - Desired Date & Time of Observation
(if this is not a one-time opportunity)
Your answer
3rd Choice - Desired Date & Time of Observation
(if this is not a one-time opportunity)
Your answer
Course Context
Please provide some context for the class session we will be observing. What, in particular, would you like the consultant to be aware of regarding this observation experience? *
Your answer
On which aspects of your teaching would you particularly like feedback? (Please select up to three.) *
Observation Logistics
Course Number & Title *
Your answer
Location (Building & Room Number) *
Please provide specific directions if needed for entering the building. If the room has not been confirmed, please enter TBD.
Your answer
Class Format *
Select the best description of your course.
Class Size *
Is this class conducted in a language other than English? *
Videotaping of Teaching Observations
CTL offers videotaping as an optional component of Teaching Observations. Videotaping gives an instructor an additional perspective on the class session, and provides a point of reference when debriefing about the session with a CTL teaching consultant. These tapes are for formative purposes, and they are shared just with the observed instructor.

If you opt for videotaping, please inform your students of the Teaching Observation process before it occurs. Inform them of the purpose of the taping, that the camera will not be focused on them, and that the video is given only to the instructor. If they are uncomfortable with the taping, suggest that they sit close to the camera person to ensure that they are not in the video.

Would you like your class session to be videotaped? *
Any additional information or comments:
Your answer
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