1.Name ______________________________________

   Phone Extension ______________________

2.Course title

3.Department, Division

4. Applying for ____ 6 ECH Online Course Training and Development

____ 3 ECH Online Course Development

____ 3 ECH Online Shared Course

____ 3 ECH Tele/Web

5. Project Description

Please describe the course that will be adapted to online methodology. Include:

Why is this course suitable to be adapted to online methodology?

How does this course contribute to an online degree or certificate program?

What kinds of help do you anticipate you will need?

6. Background and experience

What previous experience/training do you have in adapting courses using non-traditional formats?

Do you have access to

___ Front Page in your office

___ Front Page at home

___ Internet Service Provider at home

Submitted by: __________________________________________________ Date: _______

Department Chair: _______________________________________________ Date: _______

Dean: _________________________________________________________ Date: _______

____ Approved for Fall 2002

____ Approved but deferred until _________________________

____ Not approved

Vice President for Instruction: _____________________________________ Date: _______