DL and Technology Faculty Mentor Sign-Up Form

1. I would like to be a mentor during the following term:

   Fall Term 2004 Spring Term 2005 Summer Term 2005 Fall Term 2005 Spring Term 2006 Summer Term 2006 Fall Term 2006 Every term from now on
   
   

2. Please provide the following contact information:

   First Name
   Last Name
   Phone
   E-mail

3. What is your academic department at the college?

   
   
   

4. At which campus location do you normally teach?

   Sanford/Lake Mary Oviedo Hunt Club
   
   

5. Which of the following course types have you taught or developed? Select any that apply.

   Online Courses
   Online/Campus Courses
   Video Courses
   Video/Web Courses
   Video/Campus Courses
   WebCT-Enhanced Campus Courses
   
   

6. Do you have experience working with publisher developed content (or epacks) for WebCT?

   Yes
   No
    

7. Please briefly describe any other experience that you have utilizing specific tools or technologies (i.e. WebCT, PowerPoint, FrontPage, HTML/web page authoring, etc.) that would be relevant to helping others develop online or technology enhanced course content in a mentoring capacity.

   
   
   

8. Do you have any mentor matching preferences (i.e. male/female, academic discipline, area of the college, campus location, etc.)?

   
   
   

*Note:  If you have any trouble submitting this web form, please email hodgesw@scc-fl.edu with the above information.