Learning Design Submission Form
1. 	Details of the Learning Design
Please provide the following details.
Title of learning design:
		
Discipline for which learning design is implemented:		
Study program for which learning design is used:	(Eg., undergraduate, postgraduate, both, etc.)	
Size/scope of learning design:	Please select/highlight appropriate choice.
1. 	One learning session (eg., small scope of contiguous time such as 
	one tutorial, one week of the subject, etc.)
2. 	Over several learning sessions (eg., several weeks)
3. 	Entire length of subject/course
4. 	Over a program of study
5. 	Other, please specify:
	
Delivery size of learning design:	(Eg., For how many students does the learning design cater?)	
2.	Details of the designer(s) of the Learning Design
Please provide the following details. (If more than three designers, include their details below table.)
	Designer 1	Designer 2	Designer 3	
Name:			
	
Designation:	
			
Institution:			
	
Postal address:	

Telephone:				
Fax:				
Email:	
			
3.	Date of submission
Date: 

4. 	Description of the Learning Design
Please provide a description of the learning design in terms of the following.
Planned learning outcomes: 
What skills/outcomes does this learning design aim to achieve?

Activities/process/
theory that characterise the learning design:
What are students required to do in this learning setting and in what sequence?

What theory underpins this learning design?		
Resources that characterise the learning design:
 What are the necessary resources that support the implementation of the learning design and what form do they take? What is special or unique about the resource set used?

		
Support mechanisms that characterise the learning design:
What support strategies/mechanisms are critical to the learning design and what form do they take? (Eg., collaborative teams with defined roles, buddy system, workplace mentor, role of the instructor, etc.)

		

5. 	Description of the Learning Design context of implementation
Please describe the implementation context of the Learning Design in terms of the following.
Information Technology requirements:
What technology is required to implement the learning design? What is the minimum technology configuration that can be used?		
Delivery context:
What is the current context in which the learning design has been used? Eg., totally on-line, face-to-face support, etc. Is there a variety of ways in which the learning design can be used? 		
Learner profile:
What is the profile of the learners who have been exposed to this learning design? (Eg., educational level, expected prior knowledge and experience, etc.)		
Learner assessment:
How does the learning design relate to the assessment/grading process for the student?		
Broader context:
Describe how the learning design is positioned within the broader context of the student’s study program. (Eg., if the learning design forms one component of a subject, how does it relate to the other activities/components of the subject and how is the subject situated within the wider program of study?)		

6. 	Description and submission of data sources
Please submit all resources provided to the students when undertaking this Learning Design and any evaluative data/findings from the implementation of the learning design. Indicate in the table below the data sources available and submitted for evaluation. If some resources are not submitted, please state the reason for their exclusion.
	State resources available	Resources submitted? (Yes/No)	
Materials/resources used by the students to undertake the learning experience (eg., Subject Outline, CD-ROM, access to Web site, reading materials, etc).

			
Evaluative data/findings

			

Thank you very much for completing this form.

Please email your completed form to:

Shirley Agostinho (shirley_agostinho@uow.edu.au)
Project Manager, AUTC Project
Digital Media Centre
University of Wollongong NSW 2522
Telephone: 61 2 4221 5512
Fax: 61 2 4221 4321