Fillable Form Alternative Location (Marquette University)

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Form Alternative Location (Marquette University)

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Alternative (Off-Campus) Location Request
Purpose: Used to by faculty, department and/or college/school to initiate the process to offer all, or any portion of a Marquette program or class, at an off-site location.
Instructions:
1. Complete Sections 1-3 of this form, using a computer.
a. complete one form for each course or degree program.
b. a handwritten form will not be accepted.
c. an incomplete form will not be processed and will be returned to you for completion.
2. Print the form using the 'Print Form' button.
3. Sign form in Section 4.
4. In Section 4 obtain the signature of Dean or Dean designee of the college/school offering the course or degree program.
5. Attach any relevant documents (e.g., contract, if available).
6. Email the form and relevant documents to the Office of the Registrar at otrdocs@marquette.edu.
Notes:
a. before submission of this form, ensure your request is aligned with the University Programs/Courses Offered at Alternative Locations policy.
b. the program or class must be approved in advance of the term in which the program or class will be offered.
c. for graduate and professional programs/classes in Section 4 the dean is the Vice Provost for Graduate & Professional Studies.
Section 3: Alternative Location Information
Rev. 4/2019
Section 1: Requestor Information
Name
Last name, first name, middle name
Title
Department
College/School
Email
Faculty teaching the course
@marquette.edu
Daytime phone
Section 2: Alternative Location Type
Check and complete one
SpringFall
Year/Term class to be offered at this location
Summer
Year
(YYYY)
Subject
(e.g., ENGL)
Percentage of degree program to be offered at this location
50% or moreless than 50%
Class
Course Number
(e.g., 1001)
Section Number
(e.g., 101, if known)
Degree Program
Program Director
Last name, first name
SummerSpringFall
Year
(YYYY)
Year/Term degree program to begin at this location
Degree Program
Proposed location
Full address
street, city, state zip code
Contact at proposed location
Last name, first name, title
Daytime phone of contactEmail of contact
Dates of contractCost
Rationale for this request
Page 1 of 2
Print Form
Section 4: Required Signatures
Rev. 4/2019
Alternative (Off-Campus) Location Request
(Page 2 of 2)
Requestor's signature
Date
Faculty's signature (for class) or Director's Signature (for program)
if different than requestor
Date
Dean/Dean Designee's signature
college/school offering class or degree program
DateRequestor's signature
Office of the Registrar (OTR) and Office of General Counsel (OGC) Use Only
OTR
Received in OTR by
Forwarded to OGC by
Date
Date
OGC
Contract/Document Number/Name
Contract/Approval Letter forwarded to Requestor by
Copy of Approved Contract/Approval Letter forwarded to OTR by
Date
Date
Date
OTR
OSFA notified by
Date
Vice Provosts notified by
Date
Rationale for denial
Vice Provost (for program locations only)
DeniedApproved
DateSignature:
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Completed 25 July 2020

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