School of Allied Health Course Request Form

Instructor Information
First Name:
Last Name:
Email Address:
Phone/Extension:

Course Information
Course Title:
Course Number:	(e.g. ICM801)
Line Number(s):	(e.g. 15783, 15784)
Semester:
Content:	If content from a previous class/semester's coursesite is needed for this coursesite, please specify the course number (i.e., CLS 123) and semester (i.e., Fall 2006) where that content can be found. Enter 'none' if there is no content.
Needed Assistance
	I don't need any assistance at this time. I will create and edit my own content. I need assistance changing/modifying my course content. For example: uploading PowerPoint files, entering test questions, adding a graphic. I would like an instructional designer to review my existing coursesite and assist me with improving it. For example, creating more engaging learning activities, adding more opportunities for feedback, reorganizing the content. I need assistance creating a new coursesite.
Comments and Special Instructions Use the comments section below to list additional instructors, describe cross-listed courses, or provide any other special instructions for this coursesite. Also, if your course falls outside of the regular university schedule, please indicate a preferred start date and end date.

For questions about completing this form, please contact:

Stephanie Gerald
TLT Liaison to Allied Health
913-588-5532
sgerald@kumc.edu