Request For Dialogues

Your Name: *

Your Email: *

Your Phone Number: *

School/College *

Your Campus Department/Unit: *

Department or Unit Program Assistant/Coordinator:

Department or Unit Program Asst/Coordinator Phone:

Course Number and Name (e.g. HIST 1015: U.S. History to 1865) or Event Title:

Date:

Month

Day

Year

Time:

Hour

:

Minute

am

pm

Building:

Room Number:

# attending course/event:

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

Which of the above is your primary reason for holding a dialogue?

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.

What course content do you want this dialogue to highlight, illustrate, or emphasize?

Is there a campus or community group whose members would serve as logical community participant for this dialogue?

Do you have a contact person for the group you have in mind?

There are various ways to prepare students for a classroom dialogue. What kind of pre-dialogue preparation do you plan to provide? Please select all that apply.

Explain the process of dialogue to your students before the dialogue.

Provide students with context for the dialogue before it occurs.

Inform students about who is attending as community participants (if applicable).

Foreground connections you hope students to make between the dialogue and course material.

Other (please explain in the text field below).

Other pre-dialogue preparation plans:

Would you like assistance in planning to integrate the dialogue in your class?

Yes

No

There are various ways to follow up after a classroom dialogue. What kind of follow-up do you plan to provide after the dialogue? Please mark all that apply.

Written reflection assignment (please explain your plan briefly in text field below)

Debriefing the dialogue in class (please explain your plan briefly in text field below)

Connecting the dialogue to other course material/topics (please explain your plan briefly in text field below)

Would you like assistance in creating follow-up materials to use in your class after the dialogue?

Yes

No

Would you like any other form of assistance or to meet with the CU Dialogues Program Coordinator/Facilitator before setting up a dialogue for your class?

Yes

No

Are interpreter services requested for this Dialogue?

YES

NO

CU Dialogue Interpreters are contracted at $65.00 per hour and is charged to the dialogue requester's sponsoring unit. Please provide the appropriate speedtype:

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Request For Dialogues