An asterisk (*) marks a required field.

Instructor Name: *

Email: *

Phone: *

Course Name: *

Subject and Catalog Number: ( e.g., ENGL 1303 ) *

Five-digit Section Number: ( e.g., 13424 ) *

Course Enrollment: (ALC seats 72) *

Semester the course will be taught: *

Course mode: *

- Select one -   Face to Face   Hybrid

Day and time the class meets: *

Have you taught in an active learning environment before? *

- Select one -   Yes   No

If you answered Yes, give the name of the institution where you taught in an active learning environment:

I agree to work with an Instructional Designer (ID) who will assist me in designing this course for the ALC. *

  I agree   

Select an Instructional Designer:

- Select one - Brian Gharala, FDIS Dr. Jackie Hsu, FDIS Dr. Marsha Heard, FDIS Anjana Singhal, FDIS David del Pino Kloques, BAUER Velvette Laurence, COE Joseph McDonough, EGR Isa do Prado, GHL Fang Fang, CLASS Dr. Sunhong Hwang, CLASS Mahua Ghosh, Medicine Andrea Arias-Rodriguez, NSM Dr. Courtney Powell, GSW Dr. Bouchra Bakach, COT Keikei Porterfield, COT

OR Assign an Instructional Designer to me:

  Assign an ID to me   

I agree to share my experience about using ALC in a survey. *

  I agree   

I agree to conduct a student survey about their experience in ALC. *

  I agree   

Please provide a short synopsis of how you plan to use the active learning classroom. (250 words or less). *