Application for Faculty Fellows/Mentor Program
Jan 2004 - Dec 2004
Applications Due Due Date: OPEN, meaning simply that proposals will be 
received at any time convenient to the proposers.


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 Fall semester 2004) 


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 within 2-3 weeks of submission of complete proposal.