Course Instructor eClass Support Request Form

Course Instructor Information
Course Instructors Name Course Instructors Name * First Last
Email *

Please provide your email for confirmation purposes
Phone Number Phone Number * - ### - ### ####

Please provide for questions or clarification of information
Course Information

Provide details of the course you are requesting
Academic Year *
Subject (e.g. ADMS, CHEM) *
Must be between 2 and 4 characters. Currently Entered: 0 characters.
Course Number (e.g. 1000) *
Must be 4 characters. Currently Entered: 0 characters.
Section *
Must be between 1 and 4 characters. Currently Entered: 0 characters.
Term (e.g. F, W, Y, S1, S2, SU) *
Must be between 1 and 4 characters. Currently Entered: 0 characters.
Quiz/Test/Exam Information

A separate request must be submitted for each individual test date and time.
Quiz/Test/Exam Date Quiz/Test/Exam Date * / DD / MM YYYY

Please provide the Original/Start date of your Quiz/Test/Exam
Quiz/Test/Exam Start Time Quiz/Test/Exam Start Time * : HH MM AM/PM
Duration of Quiz/Test/Exam (in minutes) *
Must be a number between 1 and 240
Is there also a lecture on this Quiz/Test/Exam date? *

Is there also a lecture on this Quiz/Test/Exam date? Yes No
What time will the lecture start? What time will the lecture start? : HH MM AM/PM
Insert URL of the Quiz/Test/Exam *
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