The Knapsack Institute

Email address:

Full Name:

Mailing Address:

City: State:

Phone Number: fax:

Current Position, Area of specialization, and Employer:

If you are a teacher or faculty member, please list courses taught on a regular basis:

Have you ever participated in a curriculum transformation workshop before? Yes No

Please tell us about your interest in the Knapsack Institute, and identify your areas of greatest need. What do you hope to take away from the Knapsack Institute?

Why would you like to participate in this program? What are your specific goals?

Please tell us about your previous experiences and efforts. Have you taken any other workshops or courses focused on inclusive pedagogy?

Will you require housing on campus? Yes No

If yes, what type of room will you prefer? Single Private Semi-Private

Click to send or reset