Application Form for Development of a Hybrid Course
Kellogg Community College
February 2013
This form is to be used in preparation for the development of a hybrid course. The department
chair or director should complete this form and secure the necessary signatures. The steps for
submitting an application and securing approval for developing hybrid course are listed in a
separate document (Hybrid Course Development Process).
Course Description and Department Statement
(to be completed by the department chair or director)
Name of instructor(s) developing the course:
Name of department chair or director:
Course acronym – number and title:
(e.g. ANTH 200, Introduction to Anthropology)
Semester in which the course is projected to be first offered:
Year
Choose an item.
1. Why do you propose that this course be offered as a hybrid? Discuss benefits to students,
department, and the college.
2. What is the development team’s experience with online teaching and learning?
3. Based on your distance learning strategy, how important is the offering of this course as a hybrid?
Choose an item.
4. Provide the author(s), title, edition, ISBN, and publisher of the textbook to be used.
5. Does the textbook publisher offer a Moodle 2.x cartridge for the course?
Choose an item.
6. Describe any portion of the course already online and provide the URL(s).
7. Is this course to be offered fully online in addition to being offered as a hybrid course?
Choose an item.
8. Will students in the hybrid course accomplish the same outcomes as those in the course delivered
in the traditional and/or fully online sections?
Choose an item.
9. How does this course fit the online curricular strategy of the department?
General education core course
Satisfies MACRAO agreement
Course in a planned online degree or certificate
Course in a planned online sequence of course
Other
10. What is the audience for this course?
General, course included in the curricula of many programs
Primarily transfer
Primarily career or occupational
Primarily developmental
Other
11. How many students enrolled in this course in the last academic year?
12. How many sections of this course ran in the last academic year?
13. Provide the estimated number of contact hours that will be delivered online and the estimated
number of contact hours delivered in the classroom:
online,
classroom
14. Explain how the course will be listed in the schedule (for example, days of the week, etc.)
15. Will the department be able to use the freed classroom time in scheduling other courses?
Choose an item.
Learning Technologies Statement
(to be completed by the Director of Learning Technologies)
16. Semester in which the course faculty will attend the required Instructional Design course:
Year
Choose an item.
Comment
17. Semester in which the course faculty will attend the Online Teaching and Learning course:
Year
Choose an item.
Comment
18. Semester in which the course faculty will attend the required Introduction to Moodle course:
Year
Choose an item.
Comment
19. Semester in which the course will be developed:
Year
Choose an item.
SIGNATURES
Instructors developing the course
Date
Instructors developing the course
Date
Learning Technologies Director signature
Date
Chair/Director signature
Date
Dean signature
Date
OCDC Chair signature
Date
Academic Cabinet signature
Date