Registration Form

Presidents Institute • Chief Academic Officers Institute • Foundation Conversation • Workshops and Other Events •

2005 CAO Mentor Program Registration Form

Note: All participants in the New CAO Workshop will be paired with a Mentor.

Experienced Chief Academic Officer: I would like to serve as a mentor for a newly-appointed CAO at CIC's 2005 CAO Institute.

*Your Name:

*Title:

*Institution:

*Address:

*Telephone:

Fax:

E-Mail:

Institutional Data:

Size (FTE):

Affiliation:

Largest Majors:

Types of Off-
Campus Programs:

Degrees Offered:

EXPERIENCED CHIEF ACADEMIC OFFICERS:
List your areas of special experience, for example, general education reform, post-tenure faculty evaluation.

Other comments: