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yMb9w2ozoI6tNJFohHw68vGmikhAp3eyFVxxPupBjGCCtvULkCZws4QFAmVNtphnQppDV2dsQGbY9GbT2CBAvJTH9TYc4envgLPeA92KHDmXiQXYvRH73tUL

Community Engagement Institute Registration

Hello -

You are registering to attend Virginia Commonwealth University's Community Engagement Institute, to be held May 5-9, 2014 and hosted by the VCU Division of Community Engagement & Center for Clinical and Translational Research.

Capacity is limited, so please register promptly.

You may register for any or all of the 3 components of the Community Engagement Institute listed below:

Monday and Tuesday's Service Learning Institute, May 5-6

Wednesday's Partnership Institute, May 7

Thursday and Friday's Community-Engaged Research Institute, May 8-9

Registration for the Service Learning Institute will close on Monday, April 21. Participants must agree to complete the full 2-day training in order to register. You can download more info here: http://www.servicelearning.vcu.edu/teach/training-opportunities/institutes/

Note: If you have previously registered via email for the Service-Learning Institute, you do not need to re-register for this component. For questions about Service-Learning Institute registration, email Erin Brown directly at embbrown@vcu.edu.

Registration for the Partnerships and Community-Engaged Research Institutes will close as soon as seating capacity is reached. Registrations received after capacity is reached will be put on a waitlist. Registration confirmations or notifications of a waitlist position will be sent to registrants via email, with the expectation that we will have this information out to you by Tuesday April 15. You will also be provided with a link so that you can download and print Participant Information Packets for these events at a later date.

In order to register, please provide the information requested below.

First Name:

Last Name:

Please enter your email address:

Please enter your phone number:

Which best describes your role at VCU?

Faculty

Staff

Student

Community partner

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What type of student are you?

Undergraduate

Master's

Doctoral

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What is your title?

Please write in any title, role, or other information you would like us to know in order to help identify who you are and/or how you are affiliated with VCU:

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Would you like to register to attend the Monday and Tuesday Service Learning Institute?

Yes

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What is your faculty ranking?

Tenure-track, pre-tenure/assistant

Tenure-track, associate

Tenure-track, full

Term

Adjunct

Other

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Please describe "Other" as your faculty rank:

What is the primary school/department that you teach in?

How many years teaching experience do you have?

Please describe your interest in this Institute. What do you hope to learn? What are your expectations? What would you like to be able to do upon completion of the institute?

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Please describe the context(s) in which you teach. Give as much detail as possible regarding the nature of the course(s), the students, the curriculum, the subject matter, external governing agencies or forces, etc. i.e. class size, time of day, gen. ed. or capstone, undergraduates or graduates, classroom architecture, challenges and opportunities, etc.

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Please provide a brief statement about your teaching philosophy.

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I understand that upon my acceptance into the Service Learning Institute, I will be expected to attend the entire Institute and that if I need to cancel my registration prior to the institute, I will contact the VCU Service-Learning Office in a timely manner.

Yes

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Would you like to register to attend the Wednesday Partnerships Institute?

Yes

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Would you like to register to attend Thursday and Friday Community-Engaged Research Institute?

Yes

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May we include your name, title, and email address in a Directory of Attendees to facillitate networking?
(Note this document will NOT include phone numbers and will be provided to registered participants of the Institutes in thier Participant Info Packets).

Yes

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Do you have any dietary restrictions that we should know about?

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Do you have any accessibility needs that we should know about?

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.