The Residential Learning Communities
International Clearinghouse
Data Submission Form

Please remember your username and password so that you can login into the system to update your data in the future.
If you lose your username or password, contact Dr. Robert Midden

User Name: (required)

Password: (required)

Re-enter Password: (required)

Name of Learning Community (required)

Institution (required)

Address

City (required)

State or Province (required)

Zip or Postal Code(required)

Country

Name of director or primary contact (required)

Email address (required)

Phone (required)

FAX (required)

Web Address

Brief description of your program goals and structure (<100 words): (required)

Sources of funding:

To which administrative officer(s) does your program report?

Do you charge students a fee for participation in the learning community? Yes No

How many faculty are involved in the program fulltime in the following categories? (Faculty are defined as those involved in teaching academic credit bearing courses.)
Tenured (e.g., 3)
Tenure Track Probationary (e.g., 3)
Instructors or Lecturers
Graduate Students
Residence Life Staff
Adjunct Faculty
Retired Faculty

How many faculty are involved in the program parttime in the following categories?
Tenured (e.g., 3)
Tenure Track Probationary
Instructors or Lecturers
Graduate Students
Residence Life Staff
Adjunct Faculty
Retired Faculty

How many academic staff are involved in the program that weren't included as faculty above? (Academic staff are personnel who are involved in providing academic services to students such as advising.)
Fulltime Academic Staff (e.g., 3)
Parttime Academic Staff

How many non-academic staff are involved in the program? (Non-academic staff are personnel who are involved in providing services that do not directly involve academics such as residence hall staff or staff who organize social activities that are not tied to academics. If you are uncertain to which category an individual belongs, use your best judgment based on your knowledge of your program.)
Fulltime Non-Academic Staff (e.g., 3)
Parttime Non-Academic Staff

Number of faculty offices in the residence hall (e.g., 3)

Please indicate the approximate percentage of your students in each of the following grade levels:
First Year (e.g., 25)
Second Year (e.g., 25)
Third Year (e.g., 25)
Fourth Year & Above (e.g., 25)
Graduate Students (e.g., 3)

Total number of students in your program (e.g., 3)

Year your program started (e.g., 1998)

Please list the titles of courses that you offer from your program. Indicate whether the courses are required and the number of credit hours:

Please list other general academic offerings:

Number of classrooms in the residence hall (e.g., 3)

Brief description of facilities and facilties budget (if available):

Computer resources in the residence hall:

Please briefly describe the role of community partnerships in your program:

Please briefly describe the role of leadership development in your program:

Please briefly describe the role of research in your program:

Please briefly describe your assessment activities:

Please briefly describe extracurricular activities formally associated with your program:

Please briefly describe the role of role of interdisciplinary studies in your program:

Please briefly describe how you address issues of diversity in your program and courses:

Please briefly describe how you address issues of diversity among faculty and student populations:

Please describe any information that you have about your student demographics (age, gender, race/ethnicity, general socioeconomic level, family education level, average ACT/SAT, high school GPA) and indicate whether the data is estimated or exact:

Faculty rewards for participation in your program (check all that apply):
Release time
Salary supplement
Travel funds
Other

Disciplines represented by your faculty:

Are you available as a consultant to other programs? Yes No

Please list any seminal books, articles or other references that you consider important to the philosophy or origins of your program or that might be helpful to others who are designing new programs or revising old ones.

What do you see as the greatest challenge to your learning community?

Thank you very much for completing this form.

To submit your information to the Clearinghouse click the "Submit" button below. After you press the Submit button, BE SURE that you print the next page that you see and also save a copy as a text file. We have had problems with our computer system that have resulted in at least one submission being lost. If a problem arises and your submission is lost by the computer system, you will be able to send me the text file by email and avoid the work of rekeying your submission. To save the page as a text file choose "Save As..." from the "File" menu in your web browser.