CIRTL@Stanford Recording/Reflection Form for Associate level

Use this form to record any requirements completed for the CIRTL@ Stanford Teaching Certificate - Associate level.

University ID number*

Enter as an 8-digit number starting with a single 0. Be sure to enter this correctly (8 digits, no typos), or the system will not be able to count this toward your completed requirements.

First Name*

Last Name*

Stanford Email Address*

What type of activity are you recording?*

See details of requirements on our website (https://ctl.stanford.edu/cirtl-stanford-teaching-certificate-program).

Explore and develop: Evidence-based teaching in a local learning community

Explore and develop: IDEAL foundation (Learning-through-diversity)

Explore and develop: CIRTL network workshop

Engage and Practice

Select the evidence-based teaching in a local learning community opportunity you participated in to complete this requirement.*

Select

Select the IDEAL foundation (Learning-through-diversity) opportunity you participated in to complete this requirement.*

Select

Select the engage and practice opportunity you participated in to complete this requirement.*

Select

Please share the title of CIRTL network workshop you attended:*

Name of Instructor(s)*

Date(s) and Time(s) of Experience*

Email Contact (organizer, instructor, etc.)*

URL (if available)

File Upload

Upload a letter of completion (if applicable):

Drag and drop files here or

Total contact hours:*

This is time spent IN course/workshop(s) not including any preparation or assignments) - Please answer in hours and round to the nearest half hour.

Please share any additional details or description that may be helpful (i.e. description of project, etc.)

Share at least one specific thing you learned from this experience that you would like to (or plan to) apply in a future teaching or professional context and how you will do so. (Please provide as much detail as possible in 1-2 paragraphs.)*

How did your participation in this experience change your beliefs and values about your teaching?*

Send me a copy of my responses

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