Community Engagement Institute Registration_TEST

VCU 2015 Community Engagement Institute
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Exit Survey
 
 
We are excited to open registration for VCU's 2015 Community Engagement Institute.  This year's Community Engagement Institute will be divided into two mini-institutes: the Service Learning Institute (May 11th and 12th) and the Community-Engaged Research Institute (May 13th-May 15th).  Please take five minutes to register for either or both mini institutes.  Registration for all sessions will close on Friday, April 17, 2015.  

Capacity is limited.  Attendance will be capped at:
25 registrants for Monday and Tuesday's Service Learning Institute (Monday & Tuesday)
50 registrants for Wednesday-Friday's Community-Engaged Research Institute (Wednesday-Friday)

If you need to cancel your registration prior to the institute, please contact the VCU Division of Community Engagement in a timely manner.  Registration confirmations or notice of wait list will be sent to each registrant no later than Monday, April 27, 2015.
 
 
 
Contact Information
 
 
 
* First Name : 
* Last Name : 
Phone (XXX-XXX-XXXX) : 
Email Address : 
 
 
 
Role at VCU
 
 
 
What best describes your role with VCU?
 
Student
 
Faculty
 
Staff with teaching responsibilities
 
Staff without teaching responsibilities
 
Community Partner
 
 
 
* Community Partners, please briefly describe how you are engaged with VCU.
   
 
 
 
* What type of student are you?
 
Undergraduate
 
Graduate, Masters
 
Graduate, Doctoral
 
Non-degree seeking
 
 
 
* What is your faculty rank?
 
Professor
 
Associate Professor
 
Assistant Professor
 
Instructor
 
 
 
* What is your faculty appointment type?
 
Tenured
 
Tenure-track
 
Term
 
Administrative
 
Professional
 
Adjunct (Part-Time)
 
 
 
* With which of these schools/units is your primary VCU affiliation? If you are a community partner, with which of these school/units are you primarily engaged?
 
College of Humanities and Sciences
 
School of Arts
 
School of Business
 
School of Dentistry
 
School of Education
 
School of Allied Health
 
School of Engineering
 
School of Medicine
 
School of Nursing
 
School of Pharmacy
 
VCU Libraries
 
Center for Clinical and Translational Research
 
Division of Community Engagement
 
Other
 
 
 
 
* How would you like your title to appear on your name-tag? Include all titles, roles, or other information you would like printed.
   
 
 
 
Event Registration
 
 
 
* Please describe your interest in this institute. What do you hope to learn? What are your expectations?
   
 
 
 
* For which event are you registering? 
 
Full Community-Engagement Institute (Both SL and CEnR mini-Institutes)
 
Service Learning (SL) Institute: May 11th & 12th
 
Community-Engaged Research (CEnR) Institute: May 13th-15th
 
 
 
Service Learning (SL) Institute:  Monday & Tuesday, May 11 & 12, 2015
 
 
 
* Which day(s) of the Service Learning Institute do you plan to attend?  Check all that apply.
 
Monday, May 11th
 
Tuesday, May 12th

 
 
 
* Do you teach any courses at VCU?
 
Yes.
 
No.
 
 
 
* How many years teaching experience do you have?
   
 
 
 
* Please describe the context in which you teach. Please describe 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).
   
 
 
 
* Please provide a brief statement about your teaching philosophy.
   
 
 
 
Community-Engaged Research (CEnR) Institute:Wednesday-Friday, May 13-15, 2015
 
 
 
* Which day(s), if any, of the CEnR Institute do you plan to attend? Check all that apply.
 
Wednesday, May 13th
 
Thursday, May 14th
 
Friday, May 15th
 
None, I do not want to register for the CEnR Institute

 
 
 
* Which of the following best describes your knowledge and skills related to Community-Engaged Research (CEnR)
 
Extensive
 
Moderate
 
Limited
 
None
 
 
Please select a break-out session to attend each day of the institute. Session Descriptions
Wednesday, May 13th: CEnR SkillbuildingThursday, May 14th: Responsible PartnershipsFriday, May 15th: Dissemination
Break-Out Sessions
 
 
 
Help us make sure your environment is comfortable.
 
 
 
Do you have any dietary restrictions that we should know about? Please note that we cannot guarantee that food will be 100% gluten free, vegan or vegetarian as all items may be cooked in a common kitchen. We will do our best to accommodate your needs.
 
Gluten Free
 
Vegan
 
Vegetarian
 
Other
 
 
 
 
* Please list any accessibility needs that we should know about.