Destination

2008 Participant Application

Please submit this form before the Wednesday, February 20, 2008 deadline.

Basic Information
All fields in this section are required*
Your Name
 Valencia ID
Valencia Email
 Daytime Phone
Primary Discipline Area
 Dean's Name

 
Program Information
All questions in this section are required*
Select a Program Learning Communities
Team Action Research Projects
Alternative Delivery
General Education Outcomes
Have you participated in the Destination program in the past three years?
Yes       No

Indicate Which Year(s)
How you like to be credited for your participation in the program?
Stipend       Professional Development Hours       No Preference