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Credit Course Request Form

BEFORE YOU BEGIN!!
1) If you see a button here -> [] with an X or checkmark in it, which you can select and deselect, then the application you are using DOES support interactive forms, and you can submit a request using this form.


2) This form is a request for a CREDIT, interactive television course, and is NOT a request for other types of VNS services or equipment. To request a NON-CREDIT interactive television event go to the Non-credit online request form


Since you are still here, you obviously have a web browser that is able to use the interactive form, and need to request a CREDIT interactive TV course. Please use the interface below to provide the information we need. Please fill in ALL pertinent fields; the processing program will send you back to the form interface if key fields are left empty (use "NA" or "As above", if necessary).

This form is appropriate for most requests for UMITV credit classes that meet more or less regularly over a course term. Note any exceptions to the presumptions of this form in the "comments" field at the end of the form. Once you've entered the relevant information, via text entries and pull-down menu and button selections, go to the bottom of the screen and use the "Send Booking" button to send off your request. Please note! Your submission is a request, NOT a booking. You will be contacted within a few days about your request.

Frequent Users

If your name is listed in one of the table cells below, click on your name, and your administrative information will be downloaded into the appropriate fields (the ADMIN fields occur near the top of the form). If any of the downloaded data is incorrect, please overwrite it with the correct information. PLEASE NOTE!! If you elect to download this information, please do so BEFORE entering any data in the form fields, because the admin info download will reset those fields to empty.

[Please Note: if you'd like to use the "frequent users" function, e-mail VNS Web and provide your name, title, US Mail address, department, phone number, fax number, and your e-mail address. If you are a current frequent user and wish to correct part or all of the current, automatically inserted data, e-mail the changes to VNS Web]

Linda Vegell

Claire Voyant

Mary Gupta

Carolyn Gwinn

Mike Hanson

Charles Geyer

Barbara Jensen

Nan Kalke

Michelle Lewis

Sharon Norman

Sue O'Brien

Guy Piotrowski

Jeff Sinks

Billie Strand

Ed Thorud

Lyn Weiler

Mary M. Wrobel


THIS IS A...
New Request
Revised Request


Administrative Information

YOUR NAME:

YOUR TITLE:

ADDRESS:

DEPARTMENT:

PHONE # FAX #

E-MAIL ADDRESS:


Course Information

COURSE NAME:

COURSE #: # OF CREDITS:

PLEASE SELECT THE TYPE OF COURSE TERM:(Click on the menu bar)

-------------------------------------------
CAMPUS CALENDAR & SEASONAL TERM: If you selected "Semester", or "Summer Session" above, please select both the campus whose academic calendar pertains to your course, and the course's particular semester, or summer session. Otherwise, leave blank.

Select one, if appropriate:

Twin Cities Duluth Crookston Morris Rochester Moorhead State

Select one, if appropriate:
Summer Session '09 Fall Semester '09 Spring Semester '10 Summer Session '10
-------------------------------------------
If your course term does not fit neatly into one of the standard campus summer session or semester calendars, or if your use of interactive TV classrooms for this course will be a shorter or longer time period than the course term itself, please fill in the following, otherwise, leave blank. (This section does not refer to occasional days during the term when you may not meet in ITV classrooms)

START DATE OF FACILITIES USE:
END DATE OF FACILITIES USE:

DAY(S) THE CLASS MEETS
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
lt varies (Please list class dates in the arrangements/exceptions box at the end of this form)

CLASS START TIME: CLASS END TIME:

COURSE INSTRUCTOR:

INSTRUCTOR PHONE #:

Do you need ITV for your final exam? Yes No
if so...
Date: Start Time: End Time:


Site Information

Please complete the information for each site involved, otherwise, leave blank.

Please note: the selections below are for indicating a campus or major location, NOT a specific classroom on that campus/location. If you'd like a particular ITV classroom, note your preference in the comments section at the end of the form.Also, the "Twin Cities" selection means the Mpls/St.Paul campuses.

-------------------------------------------
ORIGINATING SITE: select one

Twin Cities Duluth Crookston Morris Rochester Other
Identify "other" if selected

MAXIMUM ENROLLED: select one
1-5 6-10 11-15 16-20 21-25 26-30 30+

-------------------------------------------
1st RECEIVING SITE: select one

Twin Cities Duluth Crookston Morris Rochester Other
Identify "other" if selected

MAXIMUM ENROLLED: select one
1-5 6-10 11 -15 16-20 21-25 26-30 30+

ON-SITE COURSE FACILITATOR:

FACILITATOR'S PH #:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2nd RECEIVING SITE: select one, if needed

Twin Cities Duluth Crookston Morris Rochester Other
Identify "other" if selected

MAXIMUM ENROLLED: select one
1-5 6-10 11 -15 16-20 21-25 26-30 30+

ON-SITE COURSE FACILITATOR:

FACILITATOR'S PH #:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3rd RECEIVING SITE: select one, if needed

Twin Cities Duluth Crookston Morris Rochester Other
Identify "other" if selected

MAXIMUM ENROLLED: select one
1-5 6-10 11-15 16-20 21-25 26-30 30+

ON-SITE COURSE FACILITATOR:

FACILITATOR'S PH #:

-------------------------------------------
4th RECEIVING SITE: select one, if needed

Twin Cities Duluth Crookston Morris Rochester Other
Identify "other" if selected

MAXIMUM ENROLLED: select one
1-5 6-10 11-15 16-20 21-25 26-30 30+

ON-SITE COURSE FACILITATOR:

FACILITATOR'S PH #:

-------------------------------------------
If you have more than 4 receive sites, please indicate other sites in the arrangements box below. PLEASE NOTE ANY SPECIAL ARRANGEMENTS/EXCEPTIONS


Billing Information

NOTE: Fields with an *** are REQUIRED fields

*** FUND: *** DEPT ID: ACCOUNT: *** PROGRAM: PCBU: PROJECT:

ACT: CHART FIELD 1: CHART FIELD 2: FIN EMPL ID: CST SHR:


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