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Welcome to the CMPH Learning & Teaching Academy (LTA) at Flinders University. Please complete and submit this membership application form to register your interest in joining the Academy.
What is your name?
What is your email address
Where are you mainly located?
Bedford Park – main campus
Bedford Park – FMC
Bedford Park – Sturt
Tonsley
SAHMRI
NT – Alice Springs
NT – Darwin
NT – Katherine
NT - Nhulunbuy
NT – Tennant Creek
SA - Barossa
SA – Greater Green Triangle
SA – Hills, Mallee, Fleurieu
SA - Riverland
SA – Far North
SA - Mid North
Other – please specify [freetext]
Which CMPH Teaching Program do you mainly teach into? (select all that apply)
Medical Biosciences (Medical Biosciences, Biotechnology, Clinical Science)
Clinical Teaching (Medicine, Paramedics, Clinical Education, Cognitive Behaviour Therapy, Chronic Condition Management)
Public Health (Public Health, Research Methods, Remote & Indigenous Health, Remote Health Practice
What is your substantive appointment in CMPH?
Teaching Specialist
Balanced Academic
Casual Academic
Researcher
Academic Status holder
Professional Staff
Other – please specify
What is your discipline?
What is your age?
Under 24 years
25-34 years
35-44 years
45-54 years
55-64 years
65 years and older
Prefer not to say
What gender do you identify as?
Female
Male
Non-Binary
Prefer not to say
Are you of Aboriginal and/or Torres Strait Islander origin?
No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both
What Academy activities or initiatives are you interested in participating in? (select all that apply)
Attending workshops and training sessions
Participating in journal clubs related to education
Attending an Open Classroom
Participating in peer evaluation/ review activities
Developing a scholarly (evaluation or research) project
Developing a scholarly publication
Applying for learning and teaching awards
Applying for learning and teaching fellowships (e.g. Advance HE, ANZAHPE, HERDSA, IAMSE)
Participating in mentoring and coaching
Participating in networking activities
Other – please specify
In what ways are you interested in contributing to the Academy? (select all that apply)
Providing mentoring and coaching to others
Presenting a workshop, training session or journal club on education
Providing an Open Classroom
Other – please specify
Is there anything else the Academy can do to support you in education?
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