<h2>Faculty Fellows Participation Questionnaire</h2><br />We are thrilled that you would like to help University Housing create a "seamless" learning environment on campus! By interacting with residents outside of the classroom as a Faculty Fellow, you will bridge the gap between in class and out of class experiences. In addition to serving as an academic and personal resource, we hope you will have a lot of fun in the process. To help us get to know you better, please complete the following form.<p>Click with a mouse or use the TAB key to advance fields. If information is incorrect, click the "Reset" box and enter again. When the information is complete, click on the "Submit" button to send your request. A screen will appear to verify the request was sent.</p><form name="mail" action="http://www.siue.edu/cgi-bin/FormMail.pl" method="post"><input name="recipient" type="hidden" value="lisrael@siue.edu" /><input name="subject" type="hidden" value="Faculty Involvement" /><input name="required" type="hidden" value="realname,email" /><input name="redirect" type="hidden" value="http://www.siue.edu/housing/livingandlearning/thanks.shtml" /> <table border="0" width="100%" cellspacing="0" cellpadding="5"> <tr> <td valign="middle" align="right"></td> <td valign="middle"></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Name:</td> <td valign="middle"><input name="realname" size="25" maxlength="25" type="text" /></td> <td valign="top" width="15"></td> </tr> <tr> <td valign="middle" align="right">Department:</td> <td valign="middle"><input name="department" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Office location:</td> <td valign="middle"><input name="office location" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Campus box #:</td> <td valign="middle"><input name="campus box" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">E-mail address:</td> <td valign="middle"><input name="email" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Campus phone:</td> <td valign="middle"><input name="Campus Phone Number" size="4" maxlength="4" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">How long have you worked at SIUE?:</td> <td valign="middle"><input name="employment length" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Teaching/research areas of specialization:</td> <td valign="middle"><textarea name="teaching, research areas" rows="5" cols="50"></textarea></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right"><span class="xsubheader">I prefer to work with:</span></td> <td valign="bottom"><span class="bodytext"><span class="xbodytext"><select multiple="multiple" name="select" size="3" class="xbodytext"><option value="FR">Freshmen</option> <option value="SO">Sophomores</option> <option value="UCS">Upper Class Students</option> <option value="FAM">Family residents</option> <option value="NP">No Preference</option> </select></span></span></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">What are your interests outside of SIUE? What do you like to do for fun? Do you have any hobbies or special talents that you could share with residents?(i.e. basket weaving, harmonica playing, cooking, hiking, etc.)</td> <td valign="middle"><textarea name="fun" rows="8" cols="50"></textarea></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Any personal information you would like to share? (i.e. family, pets, travels, unique factoids, etc.)</td> <td valign="middle"><textarea name="personal information" rows="5" cols="50"></textarea></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Summer mailing address:</td> <td valign="middle"><textarea name="summer mailing address" rows="5" cols="40"></textarea></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Summer e-mail address:</td> <td valign="middle"><input name="summer email address" size="25" maxlength="25" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Summer phone:</td> <td valign="middle"><input name="Summer Area Code" size="3" maxlength="3" type="text" />- <input name="Summer Prefix Number" size="3" maxlength="3" type="text" /> - <input name="Summer Phone Number" size="4" maxlength="4" type="text" /></td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">May we add you to our faculty e-mail listserv?</td> <td valign="middle"><input name="add to faculty listserv?" type="checkbox" value="yes" />Yes <input name="add to faculty listserv?" type="checkbox" value="no" /> No</td> <td valign="top"></td> </tr> <tr> <td valign="middle" align="right">Would you be interested in attending 1-2 brown bag lunch meetings per semester to socialize with other faculty members and discuss current student development issues/trends?</td> <td valign="middle"><input name="attend brown bag lunch meetings?" type="checkbox" value="yes" />Yes <input name="attend brown bag lunch meetings?" type="checkbox" value="no" /> No</td> <td valign="top"></td> </tr> <tr> <td valign="top"></td> <td valign="top"><input name="Submit" type="submit" value="Submit" /><input name="Reset" type="reset" value="Reset" /></td> <td valign="top"></td> </tr> </table></form>