Workshop Registration

Participant InfoFirst Name:

Last Name:

Institution

Institution Type

Two-Year College Four-year College Other

Department

Location (City, State)

Email Address:

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(Please Note: We use your email address to track your application and participation in the workshop and to communicate with you. Be sure to use the same email address in all forms relating to your workshop participation.)

Courses: List the titles of the courses that you teach, followed by the mode of delivery in parentheses (e.g. lecture, lecture/lab, lab, hybrid, online)

Number of years of full-time teaching experience:

Workshop Questions
Please list what you see as challenges of teaching all students in your college geoscience courses.

What are one or two important programs, strategies, activities, or resources that would improve your ability to teach all students?

If you have developed a resource or activity or initiated a program that relates to the themes of the workshop, please describe it.

Describe the populations/subpopulations of college students that you teach. These might include racial, ethnic or cultural groups, military veterans, first-generation in college, full-time/part-time enrollment, English-language learners, homeless, first-year in college, socioeconomic groups, and other populations).

Describe how adjunct and full-time geoscience faculty interact at your college (formal and informal interactions, consultations, supervision, mentoring, discussions about teaching, etc). Also, give us a sense of the relative numbers of full-time and adjunct geoscience faculty.

Research Release

I have read the Description of the Research Project and Implications for Participation (opens in a new window) or it was read to me. I know the possible risks and benefits. I know that being in this study is voluntary. I choose to be in this study. I know that I can withdraw at any time. I am at least 18 years of age and voluntarily grant permission for the described release and use of notes and comments regarding me in the workshop.

Please select one of the following choices to indicate your level of desired participation in the study:

I consent to participate in ALL aspects of this study. My pre-workshop information, all workshop information, and follow-on workshop information can be used in this study, and I agree to participate in a follow-up interview in approximately 6-9 months which will be audio taped. Video, still images, and audio collected at the workshop may also be used in the research project.

I consent to participate in all aspects of this study EXCEPT those listed in the box below:

Workshop Product Release

In confirming my registration for this workshop, I agree that any audio recording or images (still or video) made of me during the workshop may be used on the project website, in printed project publications, and in materials developed by the project. I further agree that my contributions to creative works that emerge from workshop activities (e.g., discussions on the email list, contributions to the web page, summaries of group discussion, etc.) may be used by the workshop series, PIs, and conveners for development of future workshop materials, for scholarly reports, and for promotion of the workshop series. Attribution for original contributions will be made whenever possible.