Instructor Application Form: Student Review of Teaching

fields marked * are required

Instructor Information

[First Name] *

[Last Name] *

[Email Address] *

[Office Location] *

[(xxx) xxx-xxxx] *

Course Information



[Course Name]

[Course Number]

[Section Number]

[Course Location]

Course Meeting Days

What days does the course meet? Check all that apply.

Course Meeting Times

[Course Start Time]     

[Course End Time]     

Student Visitor

Would you have a date preference for the student visitor?

[Date Preference]