Regional Campus’ Course Proposal & Preference Form
Please enter the semester and year:
Spring
Summer
Fall ______
For Online Development ONLY, please list: Semester of Development ________ Semester of Delivery ________
Instructor Name: _______________________________________________________________________________________
Department(s), please list all, if joint appointment(s): ________________________________________________________
E-mail:
______________________________________________________________________________________
Phone:
Office: _____________________________ Home: ____________________________
Cell:
Address
_____________________________
Office: _________________________________________________________________________________
Home: _________________________________________________________________________________
Please send course-related communications to: **Required**
Office
Home
Proposed course designation(s):
Department:
Course Number(s):
Course Title(s):
__________________________________________________________
__________________________________________________________
__________________________________________________________
If you are proposing a topics course, please attach course description.
Please Note: While we make every attempt to honor preferences, we are not able to fulfill every request for curricula and/or
logistical reasons.
Day(s)/Time(s) ranked in order of preference (please circle: 1 = highest preference):
Mon Eve
Tues Eve
Wed Eve
Thurs Eve
Sat 9 am-12 pm
Sat 1-4 pm
1
1
1
1
1
1
2
2
2
2
2
2
3
3
3
3
3
3
4
4
4
4
4
4
5
5
5
5
5
5
6
6
6
6
6
6
Avoid
Avoid
Avoid
Avoid
Avoid
Avoid
_____ Blended online class with preferred start & face-to-face meeting dates: _______________________________________
Mark face-to-face meetings as mandatory? Yes No
_____ Fully Online Course
Preferred Start Date: _________________
Mark face-to-face meetings as mandatory?
Yes
No
Location ranked in order of preference (please circle: 1 = highest preference):
**Mark at least 2**
NIU-Naperville
1
2
3
NIU-Rockford
1
2
3
NIU-Hoffman Estates
1
2
3
Other: ___________________________________________
Avoid
Avoid
Avoid
In order to reduce competition, off-campus courses will be scheduled subject to on-campus offerings.
If submitting multiple courses within a single department, please rank this course proposal’s priority:
High
Medium
Approved
Low
Denied
________________________________________________________
Department Chair Signature
Date
Please return form to Anne Petty Johnson, CLAS External Programming - William Monat Building - 148 N. 3rd St. – DeKalb, IL