PT/OVL Request Form
Requesting Department: _____________________________________________ Date: ______________
Course Information: ____________ ______________ _______________________________________
Academic Year CRN Course Number/Prefix/Section (e.g. CH181-01)
Workload Hours: _________ Student Credit Hours: _________ Anticipated Enrollment: _________
Preferred Delivery Mode: ______________________ Part of Term: ______________________
F2F, Web, Blended, ITV, Dual Credit, CCC
Faculty Information:
Adjunct _____ Overload _____ Faculty Name (if known): ____________________________________
Justification for request:
Is this request due to a vacancy in your department? Yes / No
Faculty Member Replacing __________________________________________________ ____________________
Name Positi
on Number
Is this request due to courses required beyond the ability for your faculty to teach in-load? Yes / No
Is this request due to increased enrollments or program interest? Yes / No
Could under-enrolled sect
ions within the department be combined? Yes / No
Could capacity be rai
sed on existing courses to accommodate enrollments? Yes / No
How many sections are on
the schedule? ______ How many seats are available? _______
How many students are currently on a wait list? ____________
Why is it important that this course is offered in this semester instead of a future term?
What type of students could take this course (i.e. majors, minors, or general education)?
Additional justification or information:
Department Chair Signature: Date:
Dean’s Approval Signature: Date:
Provost’s Approval Signature: Date:
Course Title: _________________________________________________________________________
Updated: 01/02/2019
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