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    • CHAUTAUQUA SHORT COURSES
    FOR COLLEGE TEACHERS

    2006 Faculty Development Program

    Conducted by:   The University of Pittsburgh, the Council of Chautauqua Field Center Directors and the Regional Centers; supported by the National Science Foundation Division of Undergraduate Education.

    Please submit the $50 Application Fee ($5.00 for graduate students) by regular mail. Directions for doing so will be displayed after this electronic Application Form is submitted. The check should be made out to the Chautauqua Program.

    Application to Field Center Director at:

    CAL DAY HAR PITT RPI SBU TXA UWA UPR

    You may have to scroll right to read and fill in this form.

    Application for:
    Course:
    Number:
    Alternate Course:
    Number:
    Center(Alt Course):
    Name: Mr.Ms.Mrs.Dr.
    First: MI: Last:

    Office Address:
    Department:
    Institution:
    City: State: Zip:
    Phone: Ext :
    Fax:
    Email:

    Home Address:
    Number Street:
    City: State: Zip:
    Home Phone:

    Preferred Mailing Address: Office Home
    General Background: Male Female
    Year of Birth:
    Your Highest Degree:
    Institution:
    Year:
    Current Position:
    Type of Institution:
         Public      Private      Two-Year      Four-Year
    Highest Degree Offered in Your Dept:
         Associate Bachelors Masters Doctorate
    Your Main Responsibility:
         Teaching
         Research
         Administration
         Other
    Your Major Subject Matter Responsibility:
    Teaching Background:
    Number of Years Taught at:
         College:
         Secondary:
         Other: (Specify):

    Courses Ordinarily Taught:
    Previous Chautauqua Experience:
    (Please list Course, Center, and Year)
    Required Statement of Interest:
    In the following space indicate why you want to take this course (and alternate). How will you use it back at your home institution?

    Lodging Preference (Lodging available at some centers):
    Single Double No Lodging
    How did you learn about this year's program?
    Printed brochure mailed to you
    Someone else's brochure
    Web Site
    Other (specify)
    Did you receive a Chautauqua brochure addressed to you?
    Special services or accommodations needed to disability:




    Important questions can be addressed to eror@pitt.edu

    National Program Administration

    This project was supported, in part by the National Science Foundation.

    Opinions expressed are those of the authors and not necessarily of the Foundation.