The MLA CE Institute

Developing Web-Based Instruction

Institute Admissions Application

May 13-16, 2008

Cosponsored by the Greater Midwest Region, National Network of Libraries of Medicine (GMR, NN/LM)

Note: Web applications are due March 28, 2008.

Applicant Information

Limit one applicant per MLA-approved CE course. Required fields are marked with a red asterisk ( * ).

First Name *
Last Name *
Institution name *
Mailing address
Mailing address 2
City
State or Province (if in the US or Canada)
Zip code/Postal code
Country (if outside the US)
Phone *
Fax
Email address *
A) List the Web platform (i.e. Blackboard, WebCT, Moodle, etc.) you are considering using for developing and implementing your Web-based course, the location of that platform (i.e., at your institution, through a Moodle service provider, etc.), and describe how you will facilitate registration, authentication/access (i.e., over a duration of time), and any other logistical issues for your course on the platform. If you do not have a platform, please indicate that you would like to use MLA's Moodle server. There will be an administrative cost associated with using MLA's Moodle Server. If you have questions, please contact Kathleen Combs, mlapd1@mlahq.org.

B) Do you have institutional support for the continued development and implementation of your Web-based course?	Yes (skip item C below) No (please answer item C below)
C) If not, how do you intend to support the course (e.g., development time, platform availability, authentication, access)?

Directions
To be eligible for the MLA CE Institute, each applicant must list the MLA-approved CE course that you plan to convert to a web format. If the course you submit is not already approved for MLA CE hours, please visit the MLA Continuing Education Clearinghouse to submit your application and appropriate fees.

Part I: MLA-approved CE Course
Provide answers in each area below; all fields in this section are required.

Check this box if you have recently applied for course approval.

A) MLA-approved CE course title:

B) Classroom-based course length:

C) CE course description:
Provide a brief (maximum of 150 words) summary of the major concepts and goals of this class. Include the overall goal, behavioral objectives or outcomes anticipated, and specific content.

D) List the target audience(s), prerequisites, and level of instruction (e.g., beginning, advanced) for this course:

Part 2: Supporting Information
Responses for this entire section should be no more than the equivalent of two pages long. All fields in this section are required.

A) Why do you wish to attend the institute? How will the institute benefit your work?

B) Briefly describe your previous experience with Web-based learning:

C) What are you going to do with what you learn? Where do you see your course going once you finish the institute?

Thank you for your application! You will receive email confirmation that your application has been received. Applicants will receive notice of admission in April.

By Fax or Mail
Fax or mail a copy of the Admissions Application Form (PDF, 28KB) to:

Medical Library Association
Attn: Kathleen Combs
65 E. Wacker Place, Suite 1900
Chicago, IL 60601-7246

Fax, 312.419.8950

For more information, contact Kathleen Combs, mlapd1@mlahq.org, 312.419.9094 x29.