Course Information Form

Please submit this form to The School of Extended Learning when requesting that a course be built or modified in Banner.

Individual Completing Form Individual Completing Form * First Last
Email Address of Individual Completing Form *
Department Chair *
Email Address of Department Chair *
Dean of College *
Email Address of Dean of College *
Type of Course *

Type of Course Online Course Online: Contracted Credit/Sponsored Credit Special Topics Course Off-Campus Course F2F: Contracted Credit/Sponsored Credit
Sponsoring Agency
Faculty is approved to teach online? *

Faculty is approved to teach online? Yes Working on it No
Will a fleet vehicle be needed for off-campus teaching?

Will a fleet vehicle be needed for off-campus teaching? Yes No
Term *

Term Fall Spring Summer
Subject *
Course Number *
Section Number
Must be between 1 and 3 digits. Currently Entered: 0 digits.
Course Title
Student Credit Hours
Faculty Workload
Instructional Delivery Modes
Face-to-Face (F2F) or Traditional Lecture: 100% of the required contact hours occur face-to-face (i.e., in person) in regularly scheduled sessions. Online Synchronous or Asynchronous: All course activity is done online (i.e., asynchronously or synchronously via video conferencing platforms); there is no required face-to-face (F2F) sessions within the course and no requirements for on-campus activity. Hybrid: The course combines aspects of online and face-to-face (F2F) instruction in a manner that reduces the number of F2F or traditional classroom meetings.
Instructional Delivery *

Instructional Delivery Lecture (F2F) Lab Lab/Lecture Combined Online Synchronous Online Asynchronous Hybrid (online and F2F)
Enrollment Cap *
Is there a waitlist?

Is there a waitlist? Yes No
If yes, how many students can waitlist?
Is this course restricted to off-campus students? *

Is this course restricted to off-campus students? Yes No
Course Start Date Course Start Date * / MM / DD YYYY
Course End Date Course End Date * / MM / DD YYYY
Class Meeting Dates (F2F or Hybrid Only) [put N/A if not applicable] *
Class Meeting Times (F2F or Hybrid) [put N/A if not applicable] *
Class Meeting Location (F2F or Hybrid Only) [select N/A if not applicable] *

Class Meeting Location (F2F or Hybrid Only) [select N/A if not applicable] N/A Champaign/Ford Regional Office of Education 9 Danville Area Community College Danville Correctional Center Forest View Educational Center (District 214) Jasper County Community School District John A. Logan College Joliet Junior College Mattoon CUSD #2 School District Administrative Building Olney Central College Parkland College Regional Office of Education 13 Richland Community College Southeastern Illinois College Triton College University Center of Lake County Vandalia Professional Development Center Wabash & Ohio Valley Special Education District (WOVSED) Other Other
If you have a preferred room, please provide the room number and location. *
Classroom Needs *
Instructor Name Instructor Name * First Last
Instructor E# *
Instructor Email *
Faculty Type *

Faculty Type Unit A - Tenure/Tenure Track Unit B - Annually Contracted Unit B - Academic Support Professional Adjunct
Cell Phone # (if teaching off-campus)
Driver's License Number (off-campus teaching only)
I certify that I am duly licensed and have in force at least the minimum liability insurance coverage required by the Illinois Vehicle Code.

I certify that I am duly licensed and have in force at least the minimum liability insurance coverage required by the Illinois Vehicle Code. Yes No