DYL Program Application

Thank you for your interest in the Design Your Life program. Please complete the form below to submit your application. Dr. Butler will review applications and get back to interested faculty after the deadline.

1. Your First Name:

2. Your Last Name:

3. Your Rank (e.g., assistant professor):

4. Your Department:

5. Your College:

6. Your email address: This question requires a valid email address.

7. Your Phone Number: This question requires a valid email address.

8. Name of Your Department Chair: This question requires a valid email address.

9. What is your department chair's email address? This question requires a valid email address.

10. Have you discussed your participation in the Design Your Life program with your chair or department colleagues yet?

Please enter an 'other' value for this selection.

11. In a few sentences, please explain why you would like to participate in the Design Your Life program:

12. Are you more interested in developing a module for an existing course or a new course?

13. Is you class online, hybrid, or face-to-face?