Adobe Connect Live Classroom Request Form

Please fill out as much info as possible.

* Denotes Required Fields.


 Primary Instructor:
* First Name:
* Last Name:
* Email:
* EMPLID
  
* Office Phone:
Office Building:
  Room:
Co-Instructor 1:
Co-Instructor 2:
Co-Instructor 3:
First Name:
First Name:
First Name:
Last Name:
Last Name:
Last Name:
Email:
Email:
Email:
EMPLID
  
EMPLID
  
EMPLID
  
Office Phone:
Office Phone:
Office Phone:
Office Building:
  
Office Building:

  
Office Building:
  
Room:
Room:
Room:
 Course Information:
Term:
Department
* Course Number:
 (Example: 300)
* Title:
* Course ID:
Purpose:
* Location of Class:
* Course Start Date:


(Format: mm/dd/yyyy)
* Course End Date:


(Format: mm/dd/yyyy)
NOTE: If you are not sure of your dates, please just pick a date and make note of it in the Notes/Comments section of this form.
Class Day(s):
 Monday
Tuesday
Wednesday
Thursday
Friday		 Saturday
Sunday
Class Time Start:
Class Time End:
Number of Students:
(Please enter the enrollment cap of course)
Notes/Comments: