NOMINATION FORM
Exemplary Online Instruction Awards
Date of nomination __________________________
Name of Instructor ______________________________________________________
Name of Nominator (if different) ____________________________________________
Name of Designer (if different) _____________________________________________
Department ________________________________________ Zip _______________
Email address _________________________________________________________
Phone _______________________________________________________________
Basic Course Information
Course (Dept. & Number) ________________________________________
Course Title ___________________________________________________
Semester taught _______________________________________________
This course is offered for _____ semester units
How often is this course offered? Annually Semesterly
The environment for this course can best be described as: (Check all that apply)
Enhanced - Class meets face-to-face all semester.
Bb Learn Collaborate Other ________________
Hybrid - Limited face-to-face meetings; extensive online work required.
Explain:
___________________________________________________
___________________________________________________
_______
Asynchronous Online - Using Bb Learn exclusively; not meeting face-to-
face; not using Collaborate, or synchronous deliverables.
Fully online, partially synchronous - using Bb Learn and Collaborate
Other _____________________
Students Target Level (Check all that apply)
1st year 2nd year 3rd year 4th year Graduate level
Certificate Credential Candidates Other ____________
The course has been offered in its present configuration for _____ terms.
Number of students typically enrolled in the course _____ .
Number online _____ number on campus _____ (if both)
Submission Instructions http://www.csuchico.edu/roi/chicofaculty/eoiprogram/eoinomination/eoi-nom