Curriculum Committee
New Course Form
(duplicate on pink paper)
Curriculum Document Number
Agenda Item No. Month Year
(for committee use only)
Initiated by: __________________________________________________________
Signature of full-time faculty member
Date:
Information Proposed Course Details
Prefix/Number
Title
Full (catalog)
ICCB
(36 characters and spaces)
Prerequisite
Recommended
Required (will block registration)
If none, please
state none.
Lab/lecture hours: credit hours
Lab hours Lecture hours Credit hours
Repeatable/variable credit
You must explain reasons for
requesting variable and/or
repeatable credit. (Attach form 11A
for requests for 0.5 credit hour
courses.
Repeatable
Repeat how many times (up to 3x)
0.5 credits minimum
Variable credits
to
Explanation
Catalog description
(Use complete sentences)
Course type
Select a type that best represents
the primary instructional
methods to be used.
L-Lecture
D-Discussion/Lecture
S-Seminar
X-Laboratory/Discussion
I-Independent Study
E-Internship/Field Experience/Other
A-IntAct Inst/Distance Learning
C-Non-Internet Computerized
O-Other
N-Internet/www
T-TV (1 way)/Radio/News
Course fee required?
Yes No
If yes, list amount
and what fee will
cover.
PCS.CIP code (generic number) Non-generic course
For courses with PCS code of 1.1, is
ICCB Form 13 attached?
Yes No
Will this course seek IAI approval?
Yes No
If yes, identify the IAI Gen. Ed. or Majors
panel(s) and relevant IAI code number(s)
If yes, identify the kind of proficiency credit
(e.g., testing, work experience, etc.)
Will proficiency credit be available
for this course?
Yes No
Department
Effective Date
Term first offered
(semester/year)
List maximum number of students (consult
current faculty contract) and reason why.
Class Size Limit
Anticipated enrollment
No. of Students per section Anticipated No. of sections
Explain
Program Impact: List all programs in
which this course is required. If
more room is needed, attach a
separate sheet.
Program Impact: List all programs in
which this course appears as an
elective. If more room is needed,
attach a separate sheet.
List names of Program Advisory
Committee and department
members with whom this course
has been discussed.
Name(s) and
positions:
Staffing Existing full-time faculty New full-time faculty Adjunct faculty
ICCB Curriculum Prefix #
Clinical/Internship sites required?
External licensing or Accreditation
required?
Students served by this course?
Signatures Required
Coordinator/Department Chair Date
DateDivision Dean
DateCurriculum Committee Chair
DateVice President of Academic Affairs
Provide details for any costs beyond
normal salary costs.
If yes, describe
space needed.
Specialized Classroom Needed
NoYes
Specialized Equipment Needed
NoYes
List items
needed and
estimated cost
Print Form
Submit by E-mail