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Course Title:
Name of Instructor:
Preferred Mailing Address
Campus Phone
Home Phone (for emergencies only)
Email Address
University Status (choose one) Faculty
Visiting Faculty (appointment end date )
Graduate/Medical Student (anticipated graduation date: )
Post-Doc
Staff
Other (please explain:
)
Media Supplies
We will do our best to ensure that your media needs are supported. Indicate your equipment needs below. Please be as specific as possible with days and dates. Equipment will be set up in your room for the first day of class.
Classrooms Please detail any special features or accommodations that your classroom requires.
Computing Needs
Indicate below if your class will require use of a computer lab in the CIT. Be sure to specify what day(s) this will be necessary, and briefly describe the coursework that requires a computer lab. Our computing facilities are limited, so please note that we may not be able to approve all requests.
THANK YOU!
