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Faculty/Instructor Dialogue Request Form
If you don't have all of the information to complete this form, please contact us to finish your request:
pilar.prostko@colorado.edu
Please allow 3-4 weeks to prepare for dialogue after request is submitted.
Your Name:
*
Your Email:
*
Your Phone Number:
*
School/College
*
Campus Department/Unit
*
Department or Unit Program Assistant/Coordinator
Department or Unit Program Assistant/Coordinator Phone
Course Number and Name (e.g. Hist 1015: US History to 1885) or Event Title:
Date
Month
Month
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Year
Year
2021
2022
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2025
Time
Hour
Hour
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:
Minute
Minute
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am
pm
Building & Room Number:
Expected Attendance:
Reasons for dialogue request: (mark all that apply)
To create a memorable learning experience for students
To extend student learning about a particular course topic/concept
To present students with perspectives on a topic that they would not otherwise hear
To address a controversial topic or complex issue that cannot easily be addressed through regular class discussion
To learn about dialogue as a pedagogical tool to use in my own teaching
What topic(s) would you like to address in the dialogue?
What are some specific questions you would like to address in the dialogue?
List your key learning goals (outcomes) for hosting a dialogue in your course. Please explain how and to what extent they align with course goals.
Would you like assistance in creating follow-up materials to use in your class after the dialogue?
No
Yes
Would you like any other form of assistance or to meet with the CU Dialogues Program Coordinator/Facilitator before setting up a dialogue?
Leave this field blank
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