This form must be completed with all necessary signatures before instruction in the proposed course is begun.
The student should complete the form and get the necessary signatures. The department administrative
assistant creates the course section and the student can then register into the class by submitting the completed
form to either in person to Enrollment Services, or via email (welcome@cocc.edu
) or via fax (541-318-3700).
Copies are distributed to: Department (copy is kept as a permanent record), Instructor and Student.
Student ID No.:
Course Title:
Course No.:
Number of Credits:
Grading Method:
( ) Standard
( ) Pass/No Pass
Course Objectives/Competencies:
How will objectives/competencies be achieved: (Include readings, texts, reports, research,
schedule, etc.)
How will achievement of objectives/competencies be measured? (Consider tests, assignments,
other assessment tools, tangible evidence of achievement, etc.)
I recognize that registration in this course carries the same responsibilities as in enrolling for
credit in other college courses.
Student Signature: Date:
In my professional judgment, the content, objectives and methods of this course justify the
college credit offered.
Instructor Signature: Date:
The course described above is consistent with the criteria for such classes and I approve
offering it.
Department Chair Signature: Date:
Rev. 01/21/16