Peer Coaching Program Application Form
Please respond to the questions on both sides of this form. The information you provide will assist in pairing you with a Peer Coach, assist the Coach in understanding what you hope to gain from this experience, and provide a basis for discussion at your first meeting.
Please send completed form to Sally Lange in the LEARN Center (2015 Roseman). A copy will be returned to you prior to your first meeting with the Peer Coach.
Download Peer Coaching Program Application Form in Word format
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Schedule for Semester (Course Titles, Days, Times, Rooms)
Describe briefly the context for your peer coaching experience. (e.g., How long have you been at UW-Whitewater? How long have you been a full-time instructor? Are you responsible for primarily upper or lower division courses, large lecture or small seminars, etc? Why enroll in peer coaching now?)
Describe your instructional philosophy. (e.g. How do you believe students learn best? What do you value happening in and out of the classroom?
Based on feedback from student evaluations, peer evaluations and self-reflection, what would you identify as your strengths as an instructor?
Based on feedback from student evaluations, peer evaluations and self-reflection, what would you identify as areas where you might improve as an instructor?
By participating in this program, what goals (at this point) do you hope to achieve or what questions would you like answered relative to your instruction specifically, and student learning?
I would prefer a Peer Coach from the following discipline-based area (check, at least, one of following):
_____I have no preference
Term Prefer Peer Coach: