Student Success Center Resource Team Form | VCCS Student Success Center

Part of the work of the VCCS Student Success Center is to develop resources for faculty and staff for learning and development. The Student Success Center is building a network of VCCS professionals with expertise in a range of subject areas.

The purpose for this form is to capture information from VCCS professionals who are interested in sharing their knowledge and expertise with colleagues around the state for the 2019-2020 academic year. Interested individuals may be invited to assist with Regional Resource Center events, system office trainings and peer-to-peer consultation. Completing this form does not obligate the professional to accept an invitation. All requests are negotiable and subject to the availability of the speaker's schedule.

Please complete the information below if you would like to be considered for facilitating professional development trainings/event/activities for your colleagues.

Name*

First Last

College/Agency*

Job Title*

Role*

Discipline Area*

Work Email*

Enter Email Confirm Email

Office Phone*

Mobile Phone

Brief Bio*

Please provided an abbreviated bio.

Topics of Expertise*

Please indicate one or more topics for which you have expertise.

Advising/Coaching
Holistic Student Support
Leadership Development
Research and Data
Student Success
System Initiatives and Updates
Teaching & Learning
Technology & Learning

Presentation Information*

Please provide detailed information on a presentation(s) you could provide on your topic(s) of expertise. Click the "+" sign to add another row for a different presentation.

Presentation Title	Presentation Description	Presentation Learning Objectives	Presentation length (1 hour; 2 hours; half-day; full day)

Presentation Venue*

Please indicate where you would be available to present. You may choose more than one option.

Select All
System Office (Richmond, VA)
Central Virginia Regional Resource Center (venue could be any college in the region: BRCC, CVCC, DCC, DSLCC, PHCC, VWCC)
Mid-Central Virginia Regional Resource Center (venue could be any college in the region: JSRCC, JTCC, PVCC, RCC, SSVCC)
Northern Virginia Regional Resource Center (venue could be any college in the region: GCC, LFCC, NVCC)
Southwest Virginia Regional Resource Center (venue could be any college in the region: MECC, NRCC, SWVCC, VHCC, WCC)
Tidewater Virginia Regional Resource Center (venue could be any college in the region: ESCC, PDCCC, TCC, TNCC)
Individual Colleges upon request

One-on-One Peer Support*

Would you be available to serve as a resource to fellow VCCS colleagues on an individual basis? For example, a VCCS employee is looking for some resources in a subject area that you have expertise. Would you be available to talk with this person by phone or correspond by email?

Yes
No

Professional References*

Please provide 2-3 professional references who could speak to your expertise and presentation skills. Click the " + " sign to add another row for a different reference.

Reference (first and last name)	Reference title	Reference place of employment	Reference email	Reference phone number	In what capacity did you work together?

Supervisor Approval*

I have or could secure support from my direct supervisor for me to provide presentations upon request (schedule permitting).

Yes
No

Terms of Understanding*

I understand that I may be invited to present but there is no obligation to accept an invitation. If I agree to present, I understand there is no payment nor honorarium for services. Travel expenses may be covered on a case-by-case basis but is not guaranteed.

Yes, I understand these terms
No, I do not understand these terms

When you are satisfied with your answers, please hit the "Submit Form" button below.