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Distance Learning

eLearning & Instructional Innovation Center
Course Request Form

 

This form has been created to facilitate the creation of online, hybrid, videoconferencing and dual courses at the eLearning Center. It is important that you complete all of the fields in the form listed below. Please submit courses as they are approved by the Department Chair.   

Requested by:  
Phone:  
Email:  
Department Chair:  
Chair Email:  
Semester

 

 Please complete all fields.

Course # & Section
 Ex: ENGL1301E01

Will the Instructor use a
QM Master Course?
If using a QM Master Course, whose course is it? Max. Enroll. Instructor Name Instructor PID Dual Enrollment 
High School
Videoconference to Link Course To  Hybrid Info.
1.  Comments:
 
    Building:

Room:

Days:

Time: 
2.  Comments:
 
       Building:
  
Room:

Days:

Time:


3.  Comments:
 
 
    
    Building:

Room: 

Days:

Time:


4.  Comments:
 
 
    
 

 Building:
 
Room:

Days:

Time:


Course # & Section
 Ex: ENGL1301E01
Will the Instructor use a 
QM Master Course?
If using a QM Master Course, whose course is it? Max. Enroll. Instructor Name Instructor PID Dual Enrollment 
High School
Videoconference to Link Course To Hybrid Info.
5.  Comments:
 
 
    
 


 Building:

Room:

Days:
 
Time:

6.  Comments:
 
 
    
 



 Building:

 Room:

Days:

Time:

7.  Comments:
 
 
    
   Building:

Room:

Days:

Time:

8.  Comments:
 
 
    
   Building:

Room:

Days:

Time:



. 

 

We are currently experiencing a high volume of course requests at this time. Your request will be processed in 3 - 5 business days.