Course Request for Faculty and Staff Use

Online and Distance Education: Course Request Form for Faculty and Staff Use

This is a form for faculty and staff members to use to schedule an online course or an off-campus course in the greater Indianapolis area. Questions regarding this form may be directed to Program Coordinator Kim Terrell in the Division of Online and Distance Education.

Items with an * indicate a required field.

Course Prefix and Number *
Course Title *
Delivery Method *
Which program, license, or certificate is this course associated with? (i.e. MA in Elementary Ed, teachers license renewal, etc . . .) *
Is this one of the online enrollment expansion model courses? *	Yes No
If your answered 'yes' to the question above, who is the lead faculty member for the course?
Is this an accelerated course, which is part of an accelerated program?	Yes No Not sure
If course will be offered online, will there be video enhancements that will require the students to have high-speed Internet connections?	Yes No
Is permission required? *	Yes No
If applicable, indicate taught-with course.
Course Term *
Course Start Date *
Course End Date *
Credit Hours *
Days *
Specific Dates (if needed)
Times *
Projected Enrollment *
Maximum Enrollment *

LOCATION INFORMATION (ONSITE COURSES ONLY)
Preferred Location
Have arrangements already been made with the site?	Yes No
Site Contact Person/Phone Number
If audio/visual equipment is needed, indicate type of equipment.

INSTRUCTOR INFORMATION
Instructor Name
Instructor Email Address
Instructor Payment Type
Travel Reimbursed from SEE *	Yes No

TEXTBOOK INFORMATION
Will SEE need to order texts or course packets for this course? *	Yes No
Vendor
Title
Author
ISBN
Edition/Year
Publisher

REQUESTOR INFORMATION
Person Requesting Course *
Phone Number *
Comments