E-pedagogy for teacher in higer education

Fill in this form for the E-pedagogy course that runs from 29 November 2021 until 19 April 2022

A. PERSONAL INFORMATION
Name Name * First Last
Email *
Dateof Birth Dateof Birth * / MM / DD YYYY
Sex *

Sex Male Female X
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nationality *
Phone *
Name of the institution that you work for *
Address of your institution Address of your institution *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Institution phone number *
Institution Email *
B. PROFESSION AND TEACHING SUBJECTS
Please describe your professional background *
Your professional title *
Your position at the institution *
Your main teaching/subject area *
C. MOTIVATION, EXPERIENCE AND SKILLS
Your motivation for taking the course *
Maximum of 300 words allowed. Currently Entered: 0 words.

Your experience with e-teaching or e-learning *
	Yes	No
I have been working as an e-teacher	I have been working as an e-teacherYes	I have been working as an e-teacherNo
I have participated as student in online courses	I have participated as student in online coursesYes	I have participated as student in online coursesNo

Digital skills *
Digital skills	Yes	No
I have good digital skills	I have good digital skillsYes	I have good digital skillsNo

English skills *
English skills	Agree	Neather agree / nor disagree	Disagree
English is my mother tongue	English is my mother tongueAgree	English is my mother tongueNeather agree / nor disagree	English is my mother tongueDisagree
I have moderate English language skills	I have moderate English language skillsAgree	I have moderate English language skillsNeather agree / nor disagree	I have moderate English language skillsDisagree
I have good English language skills	I have good English language skillsAgree	I have good English language skillsNeather agree / nor disagree	I have good English language skillsDisagree
I speak and write fluent English	I speak and write fluent EnglishAgree	I speak and write fluent EnglishNeather agree / nor disagree	I speak and write fluent EnglishDisagree

D. PAYMENT INFORMATION
Applicants from HEI not partners in SW-Vircamp will have to pay € 1.500 for the course.
If you are obliged to pay the course fee, who is going to pay?
The invoice should be send to this address:
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature.

By sending this application form I confirm that I have read the curriculum plan and want to participate in the online course of 10 ECTS credits Clear

Full Name

I understand this is a legal representation of my signature.

By sending this application form I confirm that I have read the curriculum plan and want to participate in the online course of 10 ECTS credits