APSU Course for Credit Through Extended Education Proposal Sheet 

Course Name and Number                                                                                                  

Developer                                                                             Office Phone:                          

Campus Address:  _____________________________  Campus Phone: _____________

Home Address: _________________________________________________________

City/St/Zip: _______________________________  Home Phone: _________________

Home email: __________________________________________________________

Method of Delivery: (  ) Online  (  ) Hybrid-Online  (  ) Interactive Television

Location of Instruction: (  ) Main Campus  (  ) AP Center @ Fort Campbell   (  ) Both/either

Projected Beginning and Ending Dates of Development:                                                                                                                                           

Duration of Course (  ) 16 weeks  (  ) 8 weeks  (  ) 12 weeks  (  ) 10 weeks

Term of First Offering:	Term of Second Offering:
Academic Year	Academic Year
Semester	Semester

Special Requirements and/or Costs (Hardware, software, publisher resources, copyright permissions, etc.)                                                                                                                                                                                                                                                        

Other Notes:                                                                                                                      _____________________________________________________________________

 I understand that this proposal will be reviewed by the Dean, Extended and Distance Education, the Department Chair and distance education staff members prior to course development approval.
 Further, I understand the Dean, Extended and Distance Education, select Department members and members of the Online Review Team, will have access to the course to determine course completion.

Signature Authority:

Developer                                                                                           Date                    

Department Chair                                                                                Date                    

Instructional Technologist                                                                     Date                    

Dean of Extended & Distance Education                                              Date                    

Registrar                                                                                             Date                      

NOTE:  Upon completion of signatures, please forward form to Dean of Extended and  
              Distance Education.

     cc:   Dean of College
            Dean of Graduate Studies
            Registrar