Teaching Consultation Request Form

Name: (required field)

Department: (required field)

Campus Building/Office: (required field)


Campus Phone Number: (required field)


Email address: (required field)

Please indicate how you heard about CELT's Consulting Program (check all that apply):
I was referred by:

As a follow-up to a CELT workshop I attended about:

I discovered the consultation program on the CELT web page.

Other (please specify):

We understand that individuals who are interested in CELT’s Teaching Consultation Program want to improve, refine, and/or further develop their teaching in some way. Our purpose in providing peer consultation is to engage interested colleagues in a reflective process of formative review. In contrast, we do not conduct summative reviews, which serve to provide evaluation and documentation of one’s teaching competence.

With the above in mind, please describe briefly but as specifically as you can what you hope to gain from the consulting process:



If the consultation relates to one or more courses, please indicate the course name and number, enrollment, and meeting times for each.

CELT’s Teaching Fellows can provide a number of services or
consulting activities–all grounded on a model of collegial, formative peer review–depending on the needs, goals, and interests of the individual seeking the consultation. To help us understand where you are in your process, please check as many of the following consulting activities as you find of potential interest to you at this time:
Syllabus review
Review of other instructional materials (e.g., exams, activities, CATs)
Classroom observation(s)
SGID (Small Group Instructional Diagnostic–a SGID is like a focus group conducted in your class by a CELT consultant)
Analysis of student evaluation data (e.g., end of semester course-evals; mid-semester evals)
Assessment of student learning
Other (please specify)

If you selected more than one consulting activity above, what would you say is your top choice/interest right now?

Most of the consulting activities noted above involve a minimum of three visits or conversations with a consultant. At this juncture, how much time might you want to invest in consultation to meet your instructional needs/goals?

PRIVACY STATEMENT:
All information shared during the consulting process
is strictly confidential. CELT consultants reserve the right to seek feedback and input from other CELT consultants, but no information will be shared with anyone who is not a CELT consultant.