Application for Center for Web-based Research and Instruction
 Summer 2003
Applications Due May 31, 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 October 15, 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 to Sharon Gray, Instructional Technologist, Madsen Center 234, Augustana College.
All requests for participation will be reviewed by the Faculty Development Committee.  Decisions on participation will be made by June 15, 2003.