Instructional Skills Workshop Registration Form for Teaching Assistants

To confirm your registration, payment must be received in full.

Instructional Skills Workshop Registration Form for Teaching Assistants

Registrant Type: *

All registrants must agree to attend the full 3 day program.
Certificates will be awarded upon completion.

Registrant Name: *

Please write your name as you would like it shown on the certificate - eg. First Name Middle Initial Last Name

Department: *

Other Department:

Preferred Mailing Address: *

Department (as indicated)

Home Address (Please provide complete mailing address)

Address:

Telephone @ Brock :

Telephone @ Home/Mobile:

Registration Fee: *

Cash

Cheque

Transfer of Funds

Brock University TAs $50.00

Registration fee is payable by cash, cheque (payable to Brock University), or transfer of funds (payable to CPI Account 118-081-042). Payment must be delivered to the Centre for Pedagogical Innovation, Brock University, Thistle 253B to confirm registration. **Please note that registration fees are non-refundable to non-participants**

Confirmation of your registration in this program will take place once payment is received.

Workshop Dates: *

Please indicate the workshop dates in order of preference.

Courses Currently Teaching: *

I am currently teaching,

Length of Teaching Experience: *

I have been teaching for

Other Teaching: Workshops/Courses/Experiences:

E-mail: *

Use a Brock University e-mail if possible.

Please indicate which types of teaching methods you currently use. Record the percentage of your use of each teaching method.

Lectures: * %