School of Medicine Course Request Form

Instructor Information First Name: Last Name: Email Address: Phone   Course Information Course Title: Course Number: (e.g. ICM801) Course Start Date: (MM/DD/YYYY) Line Number(s): Comments and special instructions If your course falls outside of the regualr university schedule, please indicate a preferred start date and end date in the comments section below:

For more information about this service, please contact:

Teaching and Learning Technologies
913-588-7107