Instructor Name:

FOR OFFICE USE ONLY

COURSE TITLE

NEW

COURSE #

DAY(S) OF THE WEEK

START/END TIMES

# OF SESSIONS

DEPT:

Subject Code:

Cat.
Code:

BEGIN DATE

END DATE

MIN

MAX

GROUP(S)

EXCEPTION DATES
 

COURSE  FEE
 

OTHER  FEES (Lab fee, Materials fee)

COURSE DESCRIPTION:

Equipment / Supply / Room Setup Requests