Application Form
Developing context-rich education (Leergang)

Exploring boundaries and multiple perspectives at Utrecht University

Thank you for your interest in this programme. Please complete all sections below. Your responses will be used for the selection procedure.

1. Personal Information

Full name: *

Telephone number: *

Dietary wishes:

Solis ID: *

Email address: *

Name of supervisor: *

Name of Director of Education: *

2. Professional Background

Faculty / Department: *

Date of appointment at Utrecht University: *

Current position: *

Years of teaching experience: *

Experience with:

Interdisciplinary or Transdisciplinary Education

Community Engaged Learning (CEL)

Equality Diversity and Inclusion (EDI)

Challenged based learning (CBL)

Community based research (CBR)

Interprofessional Education (IPE)

Other,...

Please briefly elaborate on your answer: *

3. Motivation and Learning Questions

What motivates you to participate in this programme?
(Please describe your reasons for applying and what you hope to gain.) *

What learning questions would you like to explore during the programme?
(Please formulate the key questions that guide your participation.) *

4. Proposed Educational Intervention

During the programme, you will develop a project or intervention in your own teaching context. Please indicate the type of intervention you intend to work on (you may select more than one):

Programme-level initiative

Learning pathway / course sequence

Course redesign

Single learning activity

Vision or strategy on the Utrecht Educational Model

Advisory proposal for a curriculum committee

Other: ...

Please briefly describe your intended intervention and the context in which it will take place: *

Do you have the opportunity within your course or programme to implement changes or experiment with new approaches? *

Yes

Please briefly explain: *

Have you previously participated in any of the following CAT courses or trajectories?

Start to Teach

BKO

SKO

Interdisciplinary programme

Honours Education Programme

No experience

Otherwise, my experience in educational design and development is as follows:

6. Practical Considerations

Are there any circumstances we should consider ensuring your full participation in the programme?
(e.g. scheduling constraints, accessibility needs)

7. Institutional Support

To ensure that the outcomes of the programme are embedded within your programme and faculty, it is important that you have discussed your participation with your supervisor and Director of Education, and that they support your participation and the required time investment (approximately 60 to 80 hours). Check the intranet page in beforehand to see if you're available on all those dates *

I confirm that I have discussed my participation with my supervisor and Director of Education, and that they support my participation and the required time investment.

I am available on all the dates listed on the Intranet page

Please attach your supervisor's permission letter here:
*

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* = Invoer verplicht

Application Form Developing context-rich education (Leergang)

Exploring boundaries and multiple perspectives at Utrecht University

Application Form
Developing context-rich education (Leergang)