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Proposed Course Title
Course Code (if credit-bearing):
Name of Instructor:
Department
Preferred Mailing Address (Please note: we will use this address for payroll purposes)
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:
)
Course Supplies The Office of Summer and Continuing Studies seeks to support the use of resources that will enhance the classroom experience for your students. We will order your supplies via telephone or the web. Please be specific - list catalog numbers and estimated cost. When we place the order, we will inform you of the estimated time of delivery. All instructors are responsible for ensuring that the supplies have arrived and notifying us if delivery dates have passed; we will initiate further contact with the vendor. If you wish to purchase common school supplies for your own use during the course (maps, charts, graph paper, special markers, etc.) please let us know; if we approve the request, we ask that you purchase the items and turn your receipt in for reimbursement. Supplies:
Shipment Address for Supplies:
Media Supplies
Indicate your media 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. If you need extra assistance in connecting and operating your media equipment, you must contact Media Services directly at 3-2197 at least 7 working days in advance of the requested date. Please note: You MUST fill out this form by April 1 in order to receive media supplies/services. That is a FIRM deadline. We cannot process requests after that date.
Classrooms
All instructors: We will book non-departmental rooms and lab space for your classes. If your course content requires daily media usage, we will attempt to secure a room with installed equipment, although we cannot guarantee availability. If you wish to use classrooms or labs within your department, you must contact your department manager to reserve your own space. Please detail any special features or accommodations that your classroom requires. Please include any laboratory requests with days and times. Classroom space is at a premium – so we ask for your cooperation in this matter.
Returning Instructors Was last summer’s classroom satisfactory? Yes No
If not, please explain:
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.
Other Curriculum-Related Issues
Field Trips (for Pre-College courses) You must receive approval from Dean Elizabeth Hart prior to making any trip arrangements. Summer and Continuing Studies may not be able to cover costs for trips. Please provide us with as many details as possible, and keep in mind that field trips must support course goals:
Do you anticipate any field trips? Yes No
Destination
Date
Purpose of Trip
Guest Lecturers Please note that Summer and Continuing Studies cannot generally pay guest lecturers. Special requests for honoraria must be made to Dean Hart. If you intend on inviting a guest lecturer, please explain your reason, in addition to the guest’s credential and lecture topic below.
Teaching Assistants If your course enrollment reaches 17 or more students, you are eligible for a TA. Summer and Continuing Studies will notify you when enrollment is sufficient. You and the TA must fill out TA Authorization paperwork, and the TA must fill out a W-9 form (pending prior work at Brown) in order to process the hire.
