Course Request for Blackboard

Directions: You should complete this form if you want a new or copied course. Please complete one request form for each class.
You MUST complete all appropriate sections. Incorrect or incomplete information given could lead to a delay in completing the request.
(For help completing this form, see the instructions below.)

New Course Information:

*Instructor Name:
*Instructor Email Address:

New Course Title: (ex: Intro to Computers)*
New Course Number: (ex: CIS110)*

*Course Delivery Method: Choose one of the following options.
	This is a completely online course.
	This is a course where the primary delivery is on-line with a requirement that students also meet in traditional (face-to-face) sessions.
	This is a course where the primary delivery is via traditional face-to-face method with a Blackboard supplement.

*Course Creation Options: Choose one of the following options.
	I would like a completely blank course.
	I would like to copy the content from an existing course taught at PCC to a new course. (see copy course info below)
	I would like to use the customizable PCC template w/ icebreaker assignment.
	Other: (VLC, publisher cartridge or other college course):

Copy Course Information: Complete the fields below to identify the source course you wish to be copied.

Source Course Number:

Instructor Name:

Delivery Method:

Version #:

Special Instructions: Do not list student enrollment information here. A link to the student enrollment request form will be available after you submit this form.

* required information

Form Instructions:
Instructor Name: - List the name of the instructor requesting the new course.
Instructor Email Address: - List the email address of the instructor requesting the new course.
New Course Title: - List the name of the course.
New Course #: - List the new course number. (example : CIS110)
Course Delivery Method: - Select one of the choices listed that best describes the courses delivery method.
Course Creation Options: - Select one of the choices listed for course creation.
Copy Course Information: - If you selected copy course from the course creation options, this section appears with the following fields to complete:
- Source Course Number: - List the course number for the course you want to be copied.
- Instructor Name: - List the first initial and last name of the course's instructor. (example: jsweetin)
- Delivery Method: - Select the delivery method for the source course.
- IN = completely online course
- HY = primary delivery is online with a requirement that students also meet in traditional (face-to-face) sessions
- WB = primary delivery is via traditional face-to-face method with a Blackboard supplement
- Version #: - Select the Version # for the course where the material will be copied from.
Special Instructions: - List any special instructions for the BB admin. Please do not list student enrollment request information it this area. All enrollment information should be address on the student enrollment request form.

Contact Info: If you need help completing this form, please contact the Distance Learning Office at (252) 493-7608 or (252) 493-7256.