This form helps the Osher Lifelong Learning Institute at Dartmouth Curriculum Committee and staff schedule and plan for your course. Please read the questions carefully, complete the form to the best of your ability, and include any additional notes or requests you wish for your course.

Click here for more information about Osher at Dartmouth.

Don't forget, your entries will not be saved or sent to the Osher staff until you hit the 'Done' button at the end of this form!

Thank you!

* 1. Please select the term:

* 2. Please enter your contact information:

* 3. Please provide a *head shot of yourself (optional).
*Head shot will appear next to your biography on the online registration site for your course.

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* 4. Are you a new Osher study leader?

* 5. If you are a returning study leader, what was the last term you offered a course?   

* 6. Would you like a *mentor?
*A mentor is a seasoned Osher study leader that new study leaders can communicate with or ask them to sit in your course for feedback.

* 7. Would you like to be a *mentor?
*A mentor is a seasoned Osher study leader that new study leaders can communicate with or ask them to sit in your course for feedback.

 
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