Individual Consultation Request Form

First Name

Last Name

Department

Course Name and Number (e.g., BIOL 411)

Please indicate the reason for a consultation (you can choose more than one):

Work on specific aspect of my teaching - course design, grading systems, class discussion, large lectures, active learning. etc.

Try something new - case method teaching, active learning techniques, service learning, problem-based learning, etc.

Better understand student reactions to my teaching as reported in end-of-course student evaluations and to make improvements to my course

Improve the preparation of the teaching documentation included as part of a pre-tenure review, a promotion and tenure review, or a post tenure review

Discuss my teaching challenges and successes

Learn ways to become more efficient in the use teacher preparation time for teaching

Reason for consultation request (if not listed above):

Days/Times Available to Meet

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