Fillable Thec Aa Notification A15h Change Of Instructional Delivery Mode Form

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Thec Aa Notification A15h Change Of Instructional Delivery Mode Form

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Form A1:5H
Policy A1.5 Academic Actions Notification
Form A1:5H: Amend Instructional Delivery Mode
Reporting Schedule Notification Dates:
_______ May 15 for all actions approved between Jan 1 and April 30
_______ Aug 15 for all actions approved between May 1 and July 31
_______ Jan 15 for all actions approved between Aug 1 and Dec 31
Instructional Delivery Mode: Descriptions below refer only to the way the actual instructional contact hours
each week are delivered. Using technology for some homework assignments or using technology in a face-to-
face class is not counted toward the amount of direct instruction delivered using technology.
• Traditional: None of the direct instruction of the program is delivered using some form of technology
when the student and instructor are separated by time, space or both.
• Hybrid: A majority of the direct instruction of the program is delivered using some form of technology
when the student and instructor are separated by time, space or both.
• Fully Online: All of the direct instruction of the program is delivered using some form of technology
when the student and instructor are separated by time, space or both.
Institution: ___________________________________________________________________________________________________
10 Digit Program CIP Code (XX.XX.XXXX.XX): ____________________
Academic Program Title: _________________________________________________ Degree Designation: __________
Current Delivery Mode(s): ___________________________ New Delivery Mode(s): _____________________________
Institutional or Governing Board Approval Date (month/year): _______________________________
Implementation Date (month/year): _______________________________
Provide a brief rationale for the update in the instructional delivery mode. Indicate if the current
delivery mode will be retained.
_________________________________________________________________________________ _________________________
Chief Academic Officer Signature (electronic signature acceptable) Date
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Thec Aa Notification A15h Change Of Instructional Delivery Mode Form

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Completed 7 March 2020

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