Course Adoption System

Instructor Information

First Name: [First Name Value]

Last Name: [Last Name Value]

I am filling out this request on behalf of an instructor.

Instructor First Name: [Instructor First Name Value]

Instructor Last Name: [Instructor Last Name Value]

Professional Title: [Professional Title Value]

Department: [Department Value]

Email: [Email Value]

Phone Number: [Phone Number Value]

Faculty Biography URL: [Faculty Biography URL Value]

Country: [Country Value]

State/Province/Region: [State/Province/Region Value]

City: [City Value]

Institution Name: [Institution Name Value]

Courseware

American Psychological Assn

Request Type: [Request Type Value]

Course Name: [Course Name Value]

Course Number: [Course Number Value]

Course Level: [Course Level Value]

Total Enrollment: [Total Enrollment Value]

Course Start Date: [Course Start Date Value]

Adoption Decision Deadline: [Adoption Decision Deadline Value]