National Summer Institute on Learning Communities
Campus Team Application Form

Part 1: Institution Information
Institution:
Institution Type:
Institution Website:
Learning Community Website:

Part 2: Team Leader Information
First Name:
Last Name:
Title:
Department:
Email Address:
Campus Mailing Address:
City:
State/Province:
Zip Code:
Country:
Phone:
Fax:

Part 3: Team Member Information
List the name, title, department, and email for each additional team member. Teams must include a lead academic administrator and a student-affairs professional. Please limit total team size (including team leader) to eight.
NameTitleDept.Email
Member 1:



Member 2:



Member 3:



Member 4:



Member 5:



Member 6:



Member 7:




Part 4: Application Narrative
You may find it easier to compose the application narrative in a word processor such as Microsoft Word, then "cut and paste" the text into the fields below.

Purpose:
Are you launching or expanding a learning community program? What institutional needs are you trying to address? Which students are you trying to support? What challenges (pedagogical, curricular, and administrative) do you anticipate? For campuses with established learning community programs, please provide a brief history of you initiative to date, including strengths and difficulties.

Goals for the Institute:
What does your team hope to accomplish at the summer institute?

Rationale for team members:
Please indicate how the proposed team supports your learning community program goals.

Contributions to the institute:
Participating teams share good practices developed on their campus with other campus teams at the Institute. What practices on your campus lend themselves to learning community work?

Part 5: Senior Administrative Authorization
When you submit this form, the administrator named below will be included in an email acknowledging receipt of your application verifying that if selected your institution will accept financial responsibility for the Institute fees and travel costs of identified team members.
Administrator Name:
Administrator Email: