SERVICE REQUEST FORM
Dean: Choose an item
Program
Associate Dean/CE Program Manager
CAMPUS
AD or CE PROGRAM MANAGER
PRIORITY (Describe the need or initiative that the department wants to address)
TARGET AUDIENCE (Describe the intended audience)
NUMBER OF EXPECTED PARTICIPANTS
TIMELINE (Define the timelines being proposed for completion of activity). If you have a
specific date, please indicate on document.
TO BE COMPLETED BY CTL
PLAN OF ACTION
RESOURCES
RESPONSIBILITY
SIGNED (ASSOCIATE DEAN OF CTL): DATE:
_____________________________________________________ ______________________________
STATUS OF PROJECT
COMPLETED
NOT COMPLETED
REMARKS
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signature
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