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1. What is your:

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2. What course would you like to redesign?

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3. Into what format would you like to redesign your course?

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4. Have you ever taught online or hybrid before?

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5. If yes, which course(s) did you teach in an online or hybrid format?

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6. Which of the following characterize the course you would like to redesign? (Check all that apply.)

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7. What are your motivations for redesigning your class?

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8. What instructional technologies, if any, are you already using in your course?

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9. What are your current plans or thoughts, if any, about how you would like to redesign your course?

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10. Do you have the support and approval of your Department Chair to offer the course in a hybrid or online format, once it is redesigned?

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11. If yes, please write your Chair's name and e-mail address here:

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12. If you are accepted to the Institute, which of the following are you able to commit to?

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13. Is there anything else about your schedule that we should know about, that might influence your ability to attend the Institute in its entirety?

Thank you for your submision. You will receive notification by March 15, 2011.

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