Organisation and Educational Development
Application for Supporting Learning Programme (SLP) 2015/16
Please complete this form clearly, suitable for photocopying
This form is to be used for both the intensive and top up supporting learning courses. Please indicate
below which course you are interested in joining.
SLP Intensive Dates
(only attend if have not done a Survival Skills for
teaching workshop in last 2 years)
(You must be able to attend all 3 days)
Monday 28th & Tuesday 29th September and
Thursday 1st October 2015
I would like to attend SLP via the
SLP Top Up Dates
(only attend if you have completed a Survival
Skills for teaching workshop in last 2 years)
(Please circle your choice of date)
Friday 16th October 2015
or
nd
Friday 22 January 2016
Intensive route / Top Up route
(please circle as appropriate)
When completed please send this form to: oed@lancaster.ac.uk. If you are unable to email a copy through
please send a hard copy to Pete Clough, Development Programmes Coordinator, HR Building, Lancaster
University
1 Surname/Family Name
3 Title (Mr, Ms, Dr. etc)
2 Other names (in full)
4 Male/Female
5 Date of Birth
6 Nationality
7 Department
8 Address for correspondence (including postcode)
Address valid from:
Until:
Telephone No:
E-Mail (please use your Lancaster email address)
9 Network username (for granting Moodle access)
10 Please state any physical or other disabilities
which may necessitate special arrangements or
facilities.
11 From what source did you learn of this
opportunity for graduate teaching development?
12 Qualifications and Courses
Please enter a brief outline, in chronological order, details of all relevant qualifications held and courses
attended following your first degree.
Full –time
Dates
From
To
Or
University or College
attended (or other)
Part-time
Degree or other
qualifications
obtained/to be obtained
Class of degree
or GPA
13 Details of teaching role to be undertaken during this programme
To enrol for this course, you must have at least 10 contact teaching hours during the period of the
programme.
We would also find it helpful to know about your other teaching-related activities such as office hours,
preparation, marking etc that you may have during this time.
Main Role
(eg Postgraduate student,
Research Assistant/Associate, etc
and whether full- or part-time?)
Teaching Role/Position
(eg Seminar tutor, Demonstrator,
etc)
Teaching Hours per week
Teaching related activities: Please
summarise level of responsibility for
design and preparation of teaching
sessions, marking, student
support/office hours etc
Level of course and approx. student
numbers
e.g. Part 1/10 per group etc
Contact details of your
PG Teaching Coordinator or Course
Convenor
Please fill in their name and email
14 Details of prior teaching experience
Please give details of any previous teaching experience in HE or elsewhere
Dates
From
Name of organisation/employer
Post/occupation
To
Details of any professional development activities undertaken related to HE teaching
Dates
Nature and location of activity
e.g. subject centre teaching event, conferences on HE teaching in the discipline,
teaching seminars or events at Lancaster or elsewhere
15 Reasons for joining the course
Please give an indication of your reasons for wishing to join the programme, and what in particular you hope
to gain from doing it (continue on further sheet as necessary).
16 Agreement from Head of Department and/or Supervisor
In order to ensure you obtain the most from this experience and will have sufficient time to complete it, we
require confirmation from your head of department, (and from your supervisor if you are a postgraduate
student), that they support your registration for this programme, are aware of the commitment it will
involve and will ensure that you are able to attend the sessions.
Please discuss your application with your HoD and/or supervisor, and ask them to read the statement below
and sign and print their names in the boxes provided. If they need further details about the programme,
please show them the documentation available on the website at http://www.lancs.ac.uk/oed/slp
or ask them to contact the programme director, Susan Armitage s.armitage@lancaster.ac.uk tel: 510621
The application, and therefore consideration for a place on the programme, cannot be made without
completion of this section.
As HoD, I have discussed this application with …………………… and I am happy for her/him to undertake the
course. I am aware of the time commitment involved in attending the timetabled course and the need to
identify a departmental mentor to support the teaching work for the duration of the course.
I recognise that successful completion of the accreditation depends upon some studying and writing over
and beyond the attendance. This has been negotiated between us.
I confirm that the applicant will have a minimum 10 contact teaching hours throughout the year, and
responsibility for supporting students' learning during that time.
The department will provide a mentor to support the teaching work s/he is doing.
Name of mentor:
Head of Department Signature (please sign and print):
As ………………………………………….’s supervisor, I have discussed this application with her/him and I am happy for her/him
to undertake the course. I am aware of the time commitment involved in attending the course. I
recognise that successful completion of the accreditation depends upon some studying and writing over
and beyond the attendance. This has been negotiated between us.
Supervisor (please sign and print):
I certify that I have completed this application form myself, and that all the information I have given is
correct
Signed
Date
When completed please send this form to: oed@lancaster.ac.uk. If you are unable to email a copy please
send a hard copy to, Development Programmes Coordinator, HR Building, Lancaster University tel: 01524
510616
DATA PROTECTION ACT - The information contained in this form will be used for the purpose of processing your application and, if
your application is successful, will form the basis of your University record.