Complete this form if you would like to be considered for participation in the
Supervisory Learning Series. Your supervisor must also submit the
supervisor's form prior to the deadline. Forms will be submitted individually, but both are
Please consult our web site for specific program information and dates.
*Your Telephone Number
*Your Supervisor's Name
*How long have you been a supervisor?
*How many people do you currently supervise?
Summer 2012 Intensive: July 23 through 27
Early Spring 2013 Session: Feb 7 and 21, Mar 14 and 28, Apr 11 and 25
* Please choose the session to which you are applying:
Early Spring Session
What specific results do you hope will come from this experience?
How does this supervisory program align with your professional or personal goals?
(Please be as specific as possible.)
How do you hope to be able to incorporate your learning?
Anything we haven't asked that you would like us to be aware of:
Attendance at all six days and three electives is required. Will you able to make the required
meetings? (Consult the schedule on the web site for specific dates.)
The series requires 50 hours of class time and an anticipated 10 additional hours
of independent work. Is your department
willing and able to support the time away from the office necessary to
complete the requirements?