Even though you may need to enter this information twice, please provide the name and email of the primary contact for this proposal.
It may be the instructor, it may be a departmental scheduler:

Primary Contact name:

Primary Contact email:

Course Information Section

Course title:

Course name and number (SIS designation):

Room size needed:   25   40   150
Instructor first name: Last name:

Instructor email:

Instructor phone:

Department name:

Course description (250 words max)

Enter description here

Describe how this course reflects innovative uses of technology and/or active student learning (up to 500 words)

Enter description here

Rank your preferred standard course meeting days and times (1 = first choice, 2 = second choice, 3 = third choice):

Monday, Wednesday, Friday (MWF) times:

Tuesday, Thursday (TR) times:

If your course does not meet at a standard time, please indicate your preferred days and times and reason(s) for non-standard meeting time (e.g., studio or lab course, recitation, etc.).

Enter preferred days and times and reason(s) here

Department Scheduling Liason Section

Department Scheduling Liason First Name:

Last name:

Scheduling Liason Email:

Scheduling Liason Phone:

Course approved by department? Yes     No

Course on SIS? Yes     No

Technology Use Section

Laptop Use

Please note: We do not have enough laptops to provide service to the auditorium. Laptop numbers are limited, and we cannot guarantee daily usage.

Need laptops? Yes     No

If yes, what is the laptop to student ratio? [select] n/a 1:1 1:2 1:5

What is the frequency of laptop usage? [select] n/a Daily Once a week Once a month Once a semester Other

Videoconferencing

Need videoconferencing? YesNo

If Yes, how often? [select] n/a Daily Once a week Once a month Once a semester Other

Additional Comments

Enter Comments Here


Once you submit your form, you will have a chance to print out what you submitted for your records.