SIMPLE RULES FOR THE MIDP UPDATE CONTACT INFORMATION FORM

  • Please ensure we have an email address for your and you fill out all of the information marked by a ** asterisk). These fields are required and you will be asked to go back and fill in any you leave blank.
  • The form will be automatically emailed to the SDRTC
  • If something goes wrong or doesn't seem right, you may always update the roster by telephone or fax.
  • If you do not receive an email confirmation of your update with four (4) working days, please contact us at (858) 550-0040.
  • ***PLEASE*** As a double check, to ensure we miss no one . . . once you have completed the form and hit the "SUBMIT" button and see a screen that says "Thank You for your submission, it has been emailed to SDRTC" select the BACK button and print out the screen. Hold on to that copy of your submission for your records (Michele will ask you to fax it if she finds out your original form did not go through).
  • Then, SEND an email message to Michele saying you have updated the roster by clicking this link thompmi@pacbell.net
  • We know there is some redundancy in doing it this way but we believe it is worth the extra effort to ensure no one gets missed; most especially you. Thank you!

 

 

 

 

 

 

 

 

 

 

 

 

2004 MIDP NETWORK ROSTER UPDATE
UPDATE ON-LINE
Subject
All field marked with a RED ** are mandatory
STEP 1
Enter YOUR contact information
** First Name and Middle Initial and Last Name    Example (John Q. Public)
** Your Email address
Email CC of registration form?
Second Email address (optional)
Agency
  Spell out- Please do not abbreviate
Your best
mailing and
contact address
to include
City, State
and Zip Code
 
** Work
Telephone
 
Area Code, Prefix and number
Please separate the prefix and
the number by a dash
EXAMPLE 558-550-0040
   EXT
 
Work
Fax
  Area Code, Prefix and number  Please separate the prefix and
the number by a dash
EXAMPLE 558-550-0040
 
   
PLEASE NOTE: There will be an MIDP INTERNAL staff roster (restricted distribution) and a roster for distribution to all Master Instructors. If you provide any home, cell phone or pager numbers in the blocks below you may elect to have any of those numbers not published on the distributed roster by checking the appropriate box.
Home
phone
  Area Code, Prefix and number Please separate the prefix and
the number by a dash
EXAMPLE 558-550-0040
 
   
Home phone on roster?
Yes No
Cell
phone
  Area Code, Prefix and number Please separate the prefix and
the number by a dash
EXAMPLE 558-550-0040
 
   
Cell phone on roster?
Yes No
Pager
  Area Code, Prefix and number
Please separate the prefix and
the number by a dash
EXAMPLE 558-550-0040
 
   
Pager on roster?
Yes No
STEP 2
Update SME, project and choose mentoring opportunities
Please enter SME areas separated by a comma. Example: ALC, communication skills, instructional design
** SME AREAS
 
MIDP PROJECT/COURSE
** MIDP
Project Title
 


*
MIDP Course
Synopsis
( 5 lines, 300
characters max)

 

 
MENTORING OPPORTUNITIES
Please select potential mentoring opportunities to share your skills. The names of those who are interested will be shared with the appropriate coordinators.
YES
  I would like to mentor an MIDP student (this is a commitment for the full year and you would be mentoring one of the candidates from the interview process through completion).
YES
  I would like to mentor an ICI Instructor student (this is a short term commitment-normally less than three months. You will assist them to plan and deliver their course material during training, as well as the evaluation of the delivery of their module to an ICI class).
STEP 3
  Select SUBMIT- Even if you get a "THANK YOU SCREEN" please contact the SDRTC if we do not contact you within 3-4 working days to confirm your registration.
The reset button DELETES all information and allows you to start over.