HIGH IMPACT PRACTICES (HIPs) INSTITUTE APPLICATION
2016 HIPs Summer Institute for Full Time and Adjunct Faculty
Growing a High Impact Culture through Course Redesign
Featuring Collaborative Learning, Service Learning, and Learning Communities
DIRECTIONS
 Completed applications must be signed by the department chair and submitted to Alison Albright
by noon on Tuesday, April 5, 2016. (Please check the deadline with your department chair to be
sure that you provide him/her with enough time to review your application.)
 Please submit a recent course information sheet with your application.
 For any questions, please contact: Alison Albright, High Impact Practice Specialist
2-418
aalbright@monroecc.edu
292-3182
FACULTY MEMBER INFORMATION
Name:
M Number:
Title/Rank:
Department:
Position:
Full-time faculty - tenured
Full-time faculty - untenured
Full-time faculty - temporary
Adjunct Faculty
Your primary campus:
Brighton Campus
Damon City Campus
Other
Number of years at MCC:
Number of years in higher education:
Will you be able to attend the entire Summer Institute July 25-28, 2016 from 8:30 am – 4:00 pm?
Yes
No
Acceptance is conditional on your ability to attend the Institute all four days.
Will you be collaborating with another faculty member who is also applying to the Institute?
Yes
No
If yes, who?
Please note any dietary restrictions:
Vegetarian
Vegan
Gluten-free
Other:
Which high impact practice would you be interested in incorporating into your course redesign?
Check all that apply.
Collaborative Learning
Service Learning
Learning Community
COURSE INFORMATION
Please select a course to redesign that you are scheduled to teach (or are likely to teach) during the
upcoming fall semester. Depending on your department’s process for assigning courses, we encourage
you to speak with your department chairs about your Fall 2016 schedule and the Institute. Acceptance
and participation to the Institute is conditional on your Fall 2016 course assignment.
Course Number:
Course Title:
Course Format: Traditional
Course Offered: Fall only
Hybrid
Spring only
Online
Web-enhanced
Both semesters
Number of credits:
Typical number of students in a course section:
The course has the following components (please select all that apply):
Lecture
Conference
Lab
Clinical
Other (Please explain):
Have you taught this class previously? Yes
No
If yes, please include a recent course information sheet with your application. If not, please include a
course information sheet from a course that you have taught.
Are you currently teaching this course? Yes
No
If yes, please list the meeting days, times, and locations:
Briefly describe the course.
Briefly describe the students who typically take this course.
APPLICATION QUESTIONS
For the following questions, please type your responses in the box below. The form will automatically
adjust to the length of your response.
1. To what extent do you use the following activities in the course you have selected to redesign
during the Institute?
None at all
Very little
Some
Quite a bit
Very much
Lecture
☐
☐
☐
☐
☐
Class discussions
☐
☐
☐
☐
☐
Peer / Student discussions
☐
☐
☐
☐
☐
Hands-on practice
☐
☐
☐
☐
☐
Working in pairs/groups
☐
☐
☐
☐
☐
In-class, informal writing (reflection,
journal)
☐
☐
☐
☐
☐
Formal writing (papers, essays, lab
reports, etc.)
☐
☐
☐
☐
☐
Presentations by students
☐
☐
☐
☐
☐
Technology (Blackboard, clickers, wikis,
etc.)
☐
☐
☐
☐
☐
Guided notes (partial/skeletal notes for
students to complete)
☐
☐
☐
☐
☐
Other activities? (Please explain.)
2. Please select the number that best describes your sense of the statement being true about you.
1-Not
at all
true
of me
2
3
4
5
6
7-Very
true of
me
I use active learning techniques in my
course.
☐
☐
☐
☐
☐
☐
☐
I use collaborative learning techniques in
my course.
☐
☐
☐
☐
☐
☐
☐
I use backwards design to plan my course
☐
☐
☐
☐
☐
☐
☐
I use formative and summative
assessments in my course
☐
☐
☐
☐
☐
☐
☐
I frequently discuss teaching with
colleagues.
☐
☐
☐
☐
☐
☐
☐
I value non-evaluative classroom
observations to get/share ideas for
teaching.
☐
☐
☐
☐
☐
☐
☐
I explore various themes in my
course that can be applied across
disciplines.
☐
☐
☐
☐
☐
☐
☐
I incorporate projects in my course
that make community connections.
☐
☐
☐
☐
☐
☐
☐
Comments? (Optional)
3. How would you describe the current level of student engagement and active learning in
this course?
4. What is your prior experience, if any, with the high impact practice(s) you are interested
in working on this summer?
5. What do you hope to achieve by redesigning this course? What would you like to see change? (If
you have any specific goals or plans, please include them here.)
6. Why are you interested in this opportunity?
7. Is there anything else that you would like to tell us? (Optional)
INSTITUTE EXPECTATIONS
If accepted to the HIPs Summer Institute, I agree to fulfill the following expectations:
1.
2.
3.
4.
5.
6.
Attend the entire Institute July 25-28, 2016 from 8:30 am – 4:00 pm and redesign additional lessons
during August 2016.
Commit to using redesigned lessons during the Fall 2016 semester.
Participate in the Fall 2016 Faculty Learning Community.
Participate in various assessments such as student opinion surveys, faculty surveys, and classroom
observations. Details will be provided during the Institute.
Share your innovations and experiences with the academic community (e.g., events sponsored by
the Teaching & Creativity center, conferences in your discipline, etc.).
Share your course data with Institutional Research.
Applicant’s signature
Date
Statement of Support: I support this application for participation in the 2016 HIPs Summer Institute. To
the best of my knowledge, s/he will be teaching the course indicated in the application during the Fall
2016 semester.
Department chair’s signature
Date