Exit this survey Fall Holyoke Bound 2017: Faculty Registration Question Title * 1. Contact Information: Name: Email: Department: Subject: Question Title * 2. School: UMASS Smith College Amherst College Mount Holyoke College Hampshire College Other Other (please specify) Question Title * 3. Why are you attending Holyoke Bound? Please check all that apply. Require all my students to attend. I am presenting. I am facilitating a workshop. To get a better idea of opportunities in the City of Holyoke for my students. To get a better oriented to the City of Holyoke. A peer, staff or faculty member suggested I attend. Other (please specify) Question Title * 4. Do you teach a designated Community Based Learning/Service Learning course? If you answered "yes", please identify the class and if Fall Holyoke Bound 2012 attendance is required by the students. Example: Sociology 101 Required Attendance. If you no, please just write "not designated". Question Title * 5. If you answered "yes" to question 4, how many students are in your class? Question Title * 6. If you do teach a designated Community Based Learning/Service Learning course or have a community component in your class, what type of community partnerships are/will your students/class be placed with? Elementary school High school Adult education After school programs Government Social service agency/organizations Environmental organizations Public health organizations Other (please specify) Question Title * 7. What is the name of the Community Partner(S)? Question Title * 8. If you do teach a course and would like to add a community component to the course, what type of community partnership would you be interested in building a relationship with? Please select all that apply. Elementary school High school Adult education After school programs Government Social service agency/organizations Environmental organizations Public health organizations Other (please specify) Question Title * 9. How many Holyoke Bounds have you attended? None, this is my first Holyoke Bound 1 2 3 4 5 Other (please specify) Question Title * 10. Transportation to Holyoke:Transportation to and from Holyoke Bound is provided. A bus will be picking students and faculty up from UMass-Amherst at Hagis Mall, Amherst College, Smith College and Hampshire in the morning to take them to Holyoke Bound. This bus will also bring students and faculty back to their respective campuses. More information on times of pick up and drop off will be emailed to you. I am driving my own car (I do NOT need bus or van transportation) Bus from UMass Question Title * 11. The events of the day will include walking. Will you need any accommodations for this part of the day? If so, please specify below. yes no If yes, please specify Question Title * 12. Lunch WILL be provided. Do you have any dietary restrictions? Vegetarian Vegan Lactose Intolerant Gluten-Free Other Other (please specify) Next