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: