Request to Teach an Online Course (MSVCC)
Please complete this form and acquire all required signatures.
Name:
Holmes Email:
Holmes ID Number:
Campus:
Phone Numbers:
Office:
Cell:
List All Courses That You Teach F2F
List All Courses That You are
Interested in Teaching Online in
Order of Preference
First Term To Be Taught:
Summer Fall Spring
Year
Is this your first time to teach online?
Yes No
Have you had Canvas Training?
Year
If yes, who provided the training?
Have you had Online Instructor Training?
Year
If yes, who provided the training?
Have you attended Virtual Training Sessions
within the last 2 years? If so, how many?
How Many?
List the Certificates you earned in these
Training Sessions
Please type your name and date.
Instructor
Date:
Division Chair
Date:
Campus Academic Dean/
Career Technical Director
Date:
District Vice President
Academic/Career Technical
Date:
eLearning Coordinator
Date:
October 29, 2019
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