Office E-mail Phone Appointment Select One Full Time Part Time Visiting

Course to be Modified

Accumulated Online Teaching Experience (Total number of semesters)

Currency of Online Teaching Experience (Taught Online within the last 18 months) Yes No

Training to Teach Online Select One No formal training Formal training (within Institution) Self-taught Formal training (External)

I agree to complete the QM Online Peer Reviewer Training
Agree Disagree

I agree to redesign the identified course to address all review elements found in the QM rubric
Agree Disagree

I agree to attend monthly meeting throughout the semester (face-to-face, online, and videoconference possible)
Agree Disagree

I agree to review at least one other course for other participants in this pilot project
Agree Disagree

Discuss your interest in course redesign and a collegial peer-review process