Course Request

Use this form to request a course or lab at WISE.
Contact Information
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General Information
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Learner (check all that apply)






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Is there a research component attached to this educational activity


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IRB


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Objective Type(s) (check all that apply)



Course Requirements
A Needs Assessment was performed


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Methods used in Needs Assessment (check all that apply)






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Course Material
Please list any guided study questions and references students are expected to cover (check all that apply).





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Didactic Presentation at Center
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Indicate the Resources/Equipment Required for this Session
Check all that apply




Is there any industry involvement in your session?


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Is there any sponsorship from industry?

Assessment of Learner Performance
What assessment instrument(s) will be used? (Example: an on-line multiple choice exam to be handed in upon arrival, a checklist for communication or technical skills to be completed by tutors, peers or examiners (check all that apply)







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Program/Session Evaluation
Feedback from the learner to the instructor closes the educational loop. Please indicate how feedback will be obtained (check all that apply):



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