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Request for Instruction

Please fill out one of these forms for EACH of your classes. Prepared workshops can be scheduled with one week of advance notice. Customized instruction sessions must be scheduled two weeks in advance.

Instuctional Topic:	If Other, please describe:	# of Registered Students:

Instructor's Name:	Work Phone:	Best work time to contact:

Email:	Home Phone:	Best home time to contact:

Department:	Course Name & Number:	Date & Time of Class:

Please suggest some possible dates & times:

Briefly describe the focus of your class or the focus of your students projects:

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