New Instructor Request Form

Name

Professional Title & Affiliation, if any

(This will be listed with your class)

Email

Phone

Proposed Class Title(s)

Class Description(s)

(Under 115 words each)

Technology Requirements

(Laptop, projector, screen, etc.)

Spring Semester

Yes

No

(April-July)

Fall Semester

Yes

No

(October-December)

Biography

(Under 150 words)

How Did You Hear About Us?

Reference

(Name, phone number, relationship)

Reference

(Name, phone number, relationship)