Academy of Distinguished Teachers

2002 Fall Retreat Registration

Greetings! The Academy of Distinguished Teachers’ annual Fall Retreat is scheduled for Friday-Sunday, October 4-6, 2002 at Ruttgers Bay Lake Lodge in Deerwood, Minnesota. Below is the registration form for the retreat. NOTE: PLEASE complete sections A, demographic information and B, working groups, even if you are unable to attend the retreat. Return your completed form to Karen via email, fax, or regular mail no later than Friday, September 20. Thank you.

Contact Karen Zentner Bacig, kbacig@umn.edu or 612.624.5082 (phone) 612.624.5824 (fax), 234 Morrill Hall, 100 Pleasant Street S.E., Mpls., MN 55455, with any questions.

Section A. Demographic Information

Name:__________________________________________________________________

Campus: [ ] Crookston [ ] Duluth [ ] Morris [ ] Twin Cities

Department and College:___________________________________________________

Mailing Address:__________________________________________________________

Phone:______________________ Fax:_________________ Email:____________

I [ ] WILL [ ] WILL NOT attend the fall 2002 ADT retreat. (If no, complete Sections A & B only)

Section B. Working Group Information

The Academy has a number of working groups. If you have previously responded to a recent inquiry regarding your interest in the working groups, please disregard this section. The working groups will actively set an agenda for their work at the fall retreat, and we would like to be able to know, prior to the retreat, who is interested in which groups. If you are unable to attend this year’s retreat, your name will be included on the list of those wishing to work on the group(s) you select, and you will be contacted after the retreat.

Please indicate, by checking the box, your interest in the following working groups*

(Check as many as you would like):

[ ] Faculty Development and Renewal

[ ] Relationship Between Teaching and Research

[ ] Status of Teaching in Merit Assessments

[ ] Teaching and Assessment

[ ] Teaching and Diversity

[ ] Spring 2003 University-wide teaching conference

[ ] ADT website development

*Descriptions of each working group can be found on the ADT Retreat website, www.morris.umn.edu/~ratliffj/ADT/

Section C. Retreat Information

Please respond to the following questions regarding your retreat participation:

Driving: I plan to

[ ] drive myself

[ ] carpool (please note if you want to ride with someone else or if you are willing to take passengers. If the latter, indicate the numbers of riders you can accommodate.) ____ number of riders you can take.

[ ] I would like to ride in the van (TC members only

[ ] I am willing to drive a van (TC members only)

Meals: Please make a note here if you have any special dietary considerations (vegetarian, vegan, etc.) Also note you are responsible for the meals of any guests who accompany you.

Lodging:

I prefer: [ ] private room [ ] roommate (Please note the name of the person with whom you will share a room)________________________

[ ] smoking room [ ] non-smoking room

Please note if you have any accessibility needs.

Please note if you are bringing a guest (spouse/partner; children). We will need to know number, names, and any special considerations needed. Again, please note that expenses associated with any guests are your responsibility (i.e., food, any activities).

Please note your arrival and departure:

Arrival: [ ] Friday p.m. [ ] Saturday a.m.

Departure: [ ] Saturday p.m. [ ] Sunday 1 p.m.

Activities:

We would like to arrange some informal activity groups for Saturday’s afternoon time (1:30-6:00 p.m.) for those who are interested in participating. Below are listed a number of ideas. Please check the ONE that you would be most interested in participating in, and/or add your suggestions in the space provided. If you would prefer not to participate in a Saturday afternoon activity, you do not need to check anything. We would be especially interested in hearing from you if you have a talent you could share (i.e., leading a sing-along, teaching a new game, sharing information about a teaching-related area, etc.) and would be willing to “lead” a small group in that activity.

[ ] golfing [ ] willing to lead

[ ] pontoon ride [ ] willing to lead

[ ] fishing [ ] willing to lead

[ ] hiking/walking [ ] willing to lead

[ ] biking [ ] willing to lead

[ ] discussion of teaching-related article [ ] willing to lead

Article suggestions?:______________________________________________________

[ ] Other activity suggestions (that you are willing to lead)?:___________________________________________________________

Thanks! Please return no later than September 20, 2002.