Faculty With Disabilities Pre-Assignment Request Form printable pdf download

Faculty With Disabilities Pre-Assignment Request Form

***REVISED FORM***

FACULTY WITH DISABILITIES PRE-ASSIGNMENT REQUEST FORM

SELECT ONE TERM; DENOTE YEAR AND SESSION FOR SUMMER:

FALL

________________

SUMMER ________________

SPRING ________________

INTERSEMESTER ________________

_____________________________________________________________________________

SELECT THE TYPE(S) OF REQUEST:

SMART Classroom

Cross-Listed Pre-Assignment

General Purpose Pre-Assignment

_____________________________________________________________________________

COMPLETE EACH ITEM FOR A SUCCESSFUL REQUEST:

FACULTY NAME: ______________________________________________________________

CRN: ________________________

(course reference number required to submit a request)

CATALOG NAME: _____________________

DAYS: ________________________________

BEGIN TIME: __________________________

END TIME: ____________________________

QUOTA: ______________________________

CHOICE: ___________________________

IS THIS COURSE CROSS-LISTED?

YES

IF THIS COURSE IS CROSS-LISTED, INCLUDE ALL SUJECT, COURSE AND CRN INFORMATION

HERE:

____________________________________________________________________________________

______________________________________________________________________

COMMENTS:

_____________________________________________________________________________

: __________________________________

___________

DEPT. CHAIR SIGNATURE

DATE:

Rev. 09/28/09 CMF

Faculty With Disabilities Pre-Assignment Request Form