Learning Group Program Step 2

Each group member must fill out a separate form as the learning group progresses.

Your Name*

First NameLast Name

Dept. / Workplace*

Phone Number

Area CodePhone Number

E-mail*

Butte College email address required

Job Classification*

Full-time facultyAssociate facultyClassified StaffManagement/Supervisory/Confidential (MSC)

Learning Group was for*

FallSpringAll year

Group Member Names (4 - 12 members):*

List names of group members participating in the Learning Group.

Attach pages if needed to answer questions below:

Browse Files

Please maintain a record of contacts made during the Learning Group.*

	Date	Nature and content of visit (attach pages if needed)	Time Spent

Overall Evaluation of the Experience*

Recommendations for Future Action*

Total Flex Hours Requested*

By selecting agree and clicking on submit you are certifying that the information provided above is true and accurate*

Agree