Learning Communities Institute Registration Form

REGISTRATION - 2010 Learning Communities Institute
Monday, May 10, 2010, Scheman Building, Iowa State University

ATTENTION - ISU Faculty & Staff: This is your invitation to attend this FREE event!

I. Participant Information

First Name:
Last Name:
Email:
Department:
LC Team Name:
	Other:

II. Classification (choose one)

Faculty
Academic Staff
Student Affairs Staff
Graduate Student/TA/RA
Other (please list):

III. My primary role with learning communities is:

What is your primary role with learning communities?
Coordinating Role
Teaching Role
Supporting Role (e.g., LC subcommittee membership)
Other (please list):

IV. How many previous LC Institutes have you attended at Iowa State?

None
1-5
6+

V. I intend to participate in the following meals:

Continental Breakfast
Lunch
Afternoon Awards Dessert

Special dietary needs:
Vegetarian preference
Other:

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