Please fill in the information below to request a Moodle course (New or Based on an Existing Course). To avoid delays with your request(s), please provide all information requested.

Instructor Name: *
Department:
Full Course Title: *
Instructor Email Address: *
Course Code: *
Course Section: *
Course Start Date (mm/dd/yy):
Course End Date (mm/dd/yy):
Previous Course to base this one on?:	(please include name & section #)
Additional Instructor(s):
Additional Designer(s):
Comments:
* indicates a required field

Thank you! By using this form, the request will be placed in our work queue to act upon.
We will email you when your course is ready.