First Name: *

Last Name: *

Email Address: *

Please select your pronouns using the list below. *
She/Her
She/They
He/Him
He/They
They/Them
Other

Please list your pronouns below. *

Department or Unit *

Please select your College below. *
Brooks College of Interdisciplinary Studies (BCOIS)
College of Computing (COC)
College of Education and Community Innovation (CECI)
College of Health Professions (CHP)
College of Liberal Arts and Sciences (CLAS)
Kirkhof College of Nursing (KCON)
Padnos College of Engineering (PCE)
Seidman College of Business (SCB)
University Libraries (UL)
Other

Please list your "college" or assigned office/center below. *

Do you plan on attending the morning Keynote Address by Dr. Tracie Marcella Addy? *
Yes
No

Do you plan on joining us for lunch (served from 12pm-1pm)? *
Yes
No

Lunch will be served in a self-serve buffet style. Do you have any dietary restrictions we should be aware of? *
Yes
No

Please identify your dietary restrictions using the list below. Check all that apply. *
Gluten Free
Dairy Free
Vegan
Vegetarian
Nut-Free
Shellfish-Free
Other

Please tell us more about your dietary restrictions below. *

Do you require accommodations to attend this event? *
Yes
No

Please tell us more about the accommodations you require. *

What are you hoping to take away from the Fall Conference on Teaching and Learning?