Application for Faculty Fellows/Mentor Program
Spring-Summer 2003
Applications Due April 1, 2003

Funded by Bush Foundation
                                                                                                                                       
Date____________

Department ___________    Course Number ________      Course Title __________________________
 
Faculty Name____________________

Phone Number ___________________       E-mail Address ___________________

When do you intend to complete the technology integration? __________________________
(must be no later than August 31, 2003) 


Statement of agreement to participate in assessment of impact upon student learning:
I agree to participate in assessment of the impact on student learning of the instructional technology innovations made to my course.             
_____________________________________
Faculty signature

Send this form (or its equivalent) to Sharon Gray, Instructional Technologist, Madsen Center 234, Augustana College, or as an e-mail attachment to Sharon_Gray@augie.edu
All requests for participation will be reviewed by the Faculty Development Committee.  Decisions on participation will be made by April 15, 2003.