Academic Credit Approval
The information on this form will be used to determine if this course will be
approved for academic credit by the appropriate department of UC Davis.
Please answer all questions to the best of your ability.
UC Davis Extension
1333 Research Park Drive
Davis, CA 95618-4852
Use the Tab key to advance and the Shift Tab keys together to move back to the previous entry in this form.
Today’s date:
Please return completed form by:
UC Davis Extension contact:
Phone #:
Email:
Program Representative – Education
530-757-8512
Fax #: Please call if you wish to fax.
*** Please email this form to: edinfo@ucde.ucdavis.edu
Attach instructor biographies—Please list names, title and place of employment:
Title of proposed course:
1. Course description and objectives:
2. Who is the intended audience? Who would benefit most from the subject matter? Be as specific
as you can—provide job titles and whenever possible include how each would benefit from the
course.
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3. Prerequisites students should have before enrolling in this course:
4. Required reading, materials and equipment: List full citation including title, author, publisher
location & name (or journal name), date of publication, and number of pages of required reading for
each citation. If required reading includes a course reader, please provide at least 2-3 current articles
that reflect credible reference information. For non-published materials, samples must be provided.
5. Guest lecturers: List types of guests, affiliations and academic backgrounds. Include anything that
uniquely qualifies the speaker to present the proposed material.
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Topical outline
Present major topics related subtopics and approximate number of hours devoted to each topic.
Session #
Topical outline
Approx. hours
TOTAL HOURS
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Evaluation
Learning outcomes: List outcomes in detail by describing what participants will know or be able to do
at the conclusion of the course.
Instructional methods: How will the material be presented—lecture, media, group discussion,
activities, projects? Please remember to incorporate participant feedback.
Mode of grading: (check one)
Letter grade
Passed/not passed
P/NP Justification required.
(P/NP) justification
Grading criteria: Some formal, written evaluation is required. Provide percentages for each element.
Participation cannot count for more than 10 percent of the grade.
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Program director approval:
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Signature
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Date
Rev. 10/09