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 needed:   Black Box   Production Studio  
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 (MW) 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

Please describe your technology needs

Additional Comments

Enter Comments Here


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