MC Room Change Request Form
Please put an
X in the appropriate field
Room too hot/cold
*: ……………………………………………………………………… _____
Computer and/or projector not working
*: …………………………………….. _____
Room too small for amount of students enrolled: ………………………. _____
Room too big for amount of students enrolled: ………………………….._____
I need a Computer Lab: …………………………………………………………….... _____
Room too noisy due to construction: ………………………………………..…… _____
*(It’s the responsibility of the originating instructor to submit a Facilities or ETS Work Order to have the problem(s)
fixed)
Your current section details
Your printed name & signature: ______________________________________________________
Course Name (e.g., ACC-001A): _______________________________________________________
Course CRN (aka: Section Number): ___________________________________________________
Your current classroom location (Building & Classroom): __________________________________
For the classroom you would like to move to. Is the room currently occupied? __________
If occupied: Have you talked with the instructor to arrange a classroom swap?* __________
o *Please fill out the information of the swapping instructor (only if swapping rooms).
Swapping instructor’s name: ______________________________________________________
Course Name (e.g., ACC-001A): _________________________________________________
Course CRN (aka: Section Number): ______________________________________________
Location of other instructor’s classroom (Building & Classroom): _____________________________
Will the Instructor use your current room, or will she/he need a new classroom? ________________
__________________________________________________________________________________
This form will need your Division Dean’s approval
Dean’s Printed Name: _______________________________________________________________________
Dean’s Signature: ___________________________________________________________________________
Date: ____________________
For Office of Instruction use only
Staff member’s name: ________________________________________________________________________
Date: ____________________
click to sign
signature
click to edit
click to sign
signature
click to edit