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FormDWorksheet Form D Worksheet

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Form D Worksheet
FORM D WORKSHEET (WITH EXAMPLES)
Use this FORM D WORKSHEET as a tool to help you to develop the distance education component of your
course. After completing this form and reviewing it with the Distance Education Department, you can cut
and paste the information into WebCMS.
On this worksheet you will find more detailed information/suggestions/examples of the information you
can include. Please remember to delete any extra text before submitting your information to WebCMS.
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Form D Worksheet
PASADENA CITY COLLEGE
DISTANCE EDUCATION ADDENDUM
COURSE INFORMATION
Course Title & Number:
Department:
Effective Term:
COURSE TYPE
INSTRUCTIONS:
SELECT ALL THAT APPLY. (IF THERE IS ANY CHANCE A COURSE MIGHT BE DELIVERED IN BOTH
MODALITIES ATANYTIME SELECT BOTH.)
HYBRID: The course has online components and requires regularly or irregularly scheduled face
to face meetings
FULLY ONLINE: The course has no required face-to-face meetings
COURSE REQUIREMENTS FOR ALL
DISTANCE EDUCATION COURSES
Must be taught using the
College’s Learning
Management System.
Must be U.S. Government ADA
and Section 508 compliant
(all online content must be
accessible for students with
disabilities).
HYBRID DELIVERY REQUIREMENTS
Date and times of required
meetings must be included in
the Schedule of Classes.
FULLY ONLINE DELIVERY
REQUIREMENTS
Any planned face-to-face
meetings, such as an
orientation or study session,
must be optional.
Students must be notified via
the college Schedule of Classes
and the online syllabus for the
class if proctored tests are
required for this course.
The use of asynchronous
discussion is a required
component of every fully online
course.
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Form D Worksheet
REGULAR & EFFECTIVE CONTACT
Before filling this out, use the Form D Interaction Worksheet (97-2003) or the Form D Interaction
Worksheet, Accessible Version (DOCX) to help you complete this section.
INSTRUCTIONS:
Describe how course interactions will promote a learning community with instructor to student, student to
student, and student to content interactions. Title 5 (Section 55204) mandates regular and effective
contact with students. Be specific.
For each type of interaction (instructor to student, student to student, and student to content) consider:
What types of interactions will occur?
What types of communication/technology tools will be used and why?
How will the tools be used?
How frequently will communication/interaction occur via these various tools?
INTERACTION
DESCRIPTION
1. INSTRUCTOR TO STUDENT:
Describe how both instructor-initiated and
student initiated interaction will occur.
2. STUDENT TO STUDENT:
Describe how the instructor will ensure a
community of learners so that student to
student interaction will occur.
3. STUDENT TO CONTENT:
Describe how the course curriculum will
promote interaction with course content.
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Form D Worksheet
COURSE OUTLINE
Before filling this out, use the Form D Course Outline Worksheet (97-2003) or the Form D Course Outline
Worksheet, Accessible Version (DOCX) to help you complete this section.
INSTRUCTIONS:
Describe how students will achieve Student Learning Outcomes (SLOs) for this course as described in
the official Course Outline of Record (in WebCMS):
1. Copy the SLOs from the course outline into the left column of the table below.
2. For Method of Instruction (center column), provide an example of an assignment that will
facilitate achieving the associated outcome. Also specify any adaptations in instructional
methodology resulting from offering this course in a distance-learning mode (online or hybrid), as
opposed to the face-to-face mode assumed by the current course outline.
o For ideas of assignments/tasks that apply to distance education, please see the Course
Design section of the Distance Education Faculty Handbook.
3. For Method of Evaluation (far right column), list how the assignment or activity you specified in
the center column will be assessed in the online environment.
o For more information about assessment and distance education, please see the Course
Assessment section of the Distance Education Faculty Handbook.
The sample table on the next page contains examples from various PCC courses.
METHOD OF INSTRUCTION:
PROVIDE AN EXAMPLE OF AN
ASSIGNMENT OR ACTIVITY FOR EACH
OUTCOME
METHOD OF EVALUATION:
PROVIDE AN EXAMPLE OF HOW THE
ASSIGNMENT OR ACTIVITY WILL BE
ASSESSED
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Form D Worksheet
SAMPLE TABLE
SAMPLE TABLESTUDENT LEARNING
OUTCOMES (SLOS)
METHOD OF INSTRUCTION:
PROVIDE AN EXAMPLE OF AN
ASSIGNMENT OR ACTIVITY FOR EACH
OUTCOME
METHOD OF EVALUATION:
PROVIDE AN EXAMPLE OF HOW THE
ASSIGNMENT OR ACTIVITY WILL BE
ASSESSED
Describe the formal features of
works of art from the material
covered in the course syllabus,
employing the language of formal
analysis modeled in the course and
the textbook.
Collaborate with one other student
to compose a 600-word essay in
which two works of art, chosen from
selected chapters in the textbook,
are compared and contrasted using
only the visual elements and design
principles learned in the previous
Learning Module (scaffolding). The
essay must contain a motive, thesis,
evidence, and a conclusion.
Assignment Rubric
Express an understanding of the
ways in which art has been
employed historically to express
fundamental human ideals, values &
beliefs.
Discuss how the use of materials,
approach to process and function,
OR meaning is different (or perhaps
similar) in the finished works of one
or two contemporary sculptors (as
assigned below) as compared to the
traditions of material, approach to
process, function, or meaning in
African sculpture that were explored
in the e-learning video and
discussed in our textbook. Write
one original Threaded Discussion
post and then reply to the postings
of two other class members by
commenting on their postings. All
postings should be original and add
value or new insight to the whole
discussion.
Assignment rubric and instructor
participation to encourage drive and
in some cases, steer the discussion.
Critique and evaluate cultural
patterns in both historical and
current events
Cultural Critique YouTube Video.
Students complete an original 3-
minute or less YouTube Video in the
format of a critique on a cultural
issue. Videos will: 1. Clearly state &
address one of the cultural issues
discussed in the lectures (5pts). 2.
Give a personal opinion about the
cultural issue (10pts). 3. Tell the
viewer why or how you formed that
opinion (10pts). Videos must be at
least 3 minutes and no longer than
3.5 minutes (5pts).
The YouTube Videos are
evaluated according to a detailed
rubric in the LMS accessible to the
students both before and after
the assignment is due. Detailed
feedback given based on rubric.
Demonstrate global literacy and
awareness by analyzing and
interpreting the complex global
patterns and processes of the
atmosphere, lithosphere,
hydrosphere, and biosphere.
Students watch a brief instructor-
prepared screencast about global
patterns and Google Earth on the
LMS and then use the free online
program Google Earth to interpret
patterns of elevation, slope,
hydrology, sun angle, and
vegetation growth.
While completing this activity,
students also complete an instantly
graded formative assessment in the
LMS to continually check their
progress of map analysis
and interpretation.
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Form D Worksheet
ACCESSIBILITY
INSTRUCTIONS:
Describe how the design of the distance education course will ensure access for students with disabilities
as required by The Americans with Disabilities Act of 1990 and the1998 Amendment to the Workforce
Rehabilitation Act (Section 508).
See the Accessibility Section of the Distance Education Faculty Handbook for more information about
accessibility or take this Accessibility Online Tutorial to get a better idea of what you will need to make
your course 508 Compliant.
STUDENT SUPPORT SERVICES & RESOURCES
INSTRUCTIONS:
Describe the resources or services that may be required for students to successfully participate in the
course. For each resource/service, identify/explain implications or impact in each of the areas specified
below.
Information Technology Services
College Helpdesk/Technical support
Computer labs
Student Services
Bookstore
Tutoring
Proctoring
Library
Online Library resources
Library facilities
Library Orientation
Other Required Support Services or Resources (i.e. additional materials or fees)
6 | P a g e
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Completed 8 February 2020

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