UVM At-Risk Faculty Request for Remote Instruction
Temporary in Response to COVID-19
Meet CDC guidelines for having an increa
sed risk for severe illness from COVID-19
Live with an individual identified as At-Risk for severe illness from COVID-19
Have concerns related to COVID-19 and pregnancy
Form Instructions
Please complete this form and send it to your Chair for consideration. The request must be
approved by the Dean’s Office and a decision will be provided to you in writing. The Dean’s
Office will retain a copy of your request along with a record of the plan that is implemented.
Faculty Member Information
Employee I
D Number:
Course Information
Approvals (for administrative use
Dean's Office:
Signatures and Dates
Faculty Member:
Purpose of Form
You may choose to request Remote Instruction for Fall 2020 if you:
List courses you are requesting to teach remotely
UVM fully supports requests for remote instruction for COVID-19 related health and safety
concerns and will grant as many requests as possible while ensuring adequate in-person
instruction during Fall 2020.