Request to Develop a Distance Learning or Hybrid Course

Please Read Carefully

This form must be completed and submitted by a PSC Department Head. Forms submitted by faculty or staff will not be accepted.
Submission of this form is required for distance learning or hybrid course development.
Note: A student enrolled in a distance learning course must be able to complete all course requirements from a remote location.
In a hybrid course, some portion of on-campus instruction is replaced with instruction delivered at a distance (off-campus) via the Internet.
If the course indicated below has been approved to offer in a distance learning format, and has been offered within the past three years as a distance learning course, it may be developed in a hybrid format with no further approval.
Course developers are given two adjacent semesters (summer included) to complete all course development. If the peer review process is not complete by the end of this period, the course will be dropped from the queue and a new request to develop must be submitted.

Department

Course Number

No spaces. Examples: DDD1234, ABC1234C,BSC9999L

Course Title

Same on District Syllabus

Credit Hours

Format

DL Hybrid

Target Year/Term/Session

Justification

Developer Experience

Online/On-Campus Percentage

Employment Type

Is the developer full-time or an adjunct?

Full-time Adjunct Other

Working Process / Expectations

The developer understands that specific competencies in distance learning technologies are required prior to developing (and teaching) this course, and that the developmental process may not proceed without assistance from an Instructional Technologist.

Yes No

Training

Has the developer successfully completed Canvas Basics training?

Yes No

Developer Name

Developer Contact

format: 850-484-1234

format: jdoe@pensacolastate.edu

Dept. Head Name

Dept. Head Contact

format: 850-484-1234

format: jdoe@pensacolastate.edu