Distance Education Proposal Form

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College of Agricultural & Life Sciences Distance Education Proposal Form Course proposal forms for new distance education classes are due one year before the semester in which you propose to teach the course. Please fill out this form and mail or fax to the Associate Dean: Dr. Mark Rieger 2002 McCarty Hall D PO Box 110270 Fax: 352-392-8988 Name:________________________ Email:______________________ Date:____________ Phone: _________________ Fax: ____________________ Department: _________________________________________________________________________ Course Prefix & Number: ______________________________________________________________ Title: _________________________________________________________________________________ Prerequisites: ________________________________________________________________________ Semester and Year Proposed for Course Delivery: ______________________________________ Funding: Self-Supported Request from Dept Dean If funds are requested, for what purpose? Check all that apply: TA Media Instructional Design Other (specify) ________________________ Primary Teaching Method: Lecture Method of Delivery: Web Videotape Discussion CD/DVD Learner Based Other Videoconference Proposed Market (audience) for this Course: ___________________________________________ Please attach additional information to this proposal if you wish to elaborate. Elaboration may include: • Special resource needs • Justification for your course • Summary of existing teaching materials • Marketing information Signature of Faculty Member: _______________________________________ Date: ___________ Approval of Dept. Chair / Center Director: ___________________________ Date: ____________ Approval of Associate Dean: ________________________________________ Date: ____________

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