Observation Request Form - Center for Teaching and Learning

Please identify the purpose of the observation:

To obtain feedback on my teaching from the Center for Teaching and Learning.
To create a recording of my teaching for another purpose ($25 fee) (e.g. to submit as part of a job-application process).

Name*

Firstname Lastname

Email Address*

University Role*

Role in Course*

Department or Primary Program*

Course Title*

Course Level/Student Population

Approximate number of students in the course

What are the students to know/be able to do as a result of the class period observed?

What are the elements of the class in which you particularly wish to receive feedback?

Suggestions: classroom management, clarity/organization of content, presentation skills, teaching methods, inclusive teaching)

How should staff observe your class?*

Course Meeting Day(s) and Time

e.g. T/Th, 11:30-1:00

Classroom

Include building and room number, e.g. Eads 112

Requested date of observation or recording*

(First Choice)

Alternate date of observation or recording

(Second choice: Please provide in case staff or equipment are not available on your first-choice date.)

Additional Information (optional)

If you there is any additional information that we need to know, please enter that information here.

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Name

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