Learning Community
Application Form

Please complete the application form below, then click on the "SUBMIT" button to submit your application electronically.

After clicking the "SUBMIT" button, the next page that will appear will be what you submitted.
You may print this page for your own records.

Title of Proposed Learning Community:
Name of Course: Note: If more than 2 courses are involved in this L.C., please use the Comment box at the bottom of the application to list the other course(s).
Course Name #1:
Course Name #2:
Preferred Course Schedule:
Schedule for Course #1:
Schedule for Course #2:
Type of Learning Community (Please check one):
	Linked Courses
	Integrated
	Other
If other, please describe:
Proposers' Information:
Proposer #1:
Name of Proposer:
Department:
Campus Phone: (If you do not have a campus extension, please put N/A for not available)
E-mail Address (Please put in a valid e-mail address in order for the form to be submitted electronically):
Proposer #2:
Name of Proposer:
Department:
Campus Phone: (If you do not have a campus extension, please put N/A for not available)
E-mail Address (Please put in a valid e-mail address in order for the form to be submitted electronically):

Individual Courses (which will comprise the Learning Community):
Are there room or equipment needs for this Learning Community?
	Yes
	No
If you answered yes to room or equipment needs, please describe:
Course #1 Information:
Course Title:
Course Number:
Professor:
Course Credits:
Course #2 Information:
Course Title:
Course Number:
Professor:
Course Credits:
Narrative Form
Please answer the following questions in a narrative format of no more than 250 words per question.
What are your goals for combining these courses? How will you be integrating/linking the concepts and content from each discipline in this Learning Community?
How does your Learning Community fulfill the goals of the Learning Community Initiative?
Describe any particular activities or innovative pedagogies that will benefit the students.
What particular activities/pedagogies will you use to develop community in this Learning Community?
How are you going to assess your effectiveness in fulfilling your goals?
How do you anticipate your participation in this Learning Community will enhance your professional growth as a teacher?
If you have taught this Learning Community before, do you plan to make any changes this time and if so, what are they and why?
Other Comments (if any):
Have you discussed this proposal with your Dean(s):
	Yes
	No
Name of Dean:
Name of Dean (if more than one):
Have you discussed this proposal with your Department Chair(s)/Coordinator(s):
	Yes
	No
Name of Dept. Chair/Coordinator:
Name of Dept. Chair/Coordinator (if more than one):