REGISTRATION FORM FOR VIDEO CONSULTATION

Register For Video Consultations
Video taping your class is an excellent way for instructors to evaluate their teaching. TA Services at the Center for Instructional Development & Distance Education can arrange to have your class videotaped and can then work with you to evaluate your teaching. Please note that in order to assure the effectiveness of this self-evaluation tool, TA Services will only videotape your class in conjunction with a follow-up consultation.
To make an appointment, complete the following form or call us at Faculty Development at 412-624-6592.

FIRST NAME:
LAST NAME:
DEPARTMENT/SCHOOL:
EMAIL ADDRESS:
DAYTIME PHONE:	Ext.
WHEN WOULD YOU LIKE TO HAVE YOUR CLASS VIDEOTAPED? * FIRST CHOICE (Must be at least two weeks from present date.)
DATE:
TIME:
BUILDING AND ROOM:
*SECOND CHOICE (Must be at least two weeks from present date.)
DATE:
TIME:
BUILDING AND ROOM:
ARE YOU CURRENTLY A TEACHING ASSISTANT OR TEACHING FELLOW? I am currently a teaching assistant. I am currently a teaching fellow and teach my own class. No, I am not currently at graduate student instructor.
SPECIAL CIRCUMSTANCES/ NOTES