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Request to Teach an Extension Course


Please complete a separate form for each semester.


Employment Status *

Faculty Member requests to teach the following course(s):

Instructional Method *

For new courses or instructors, the items listed below must be electronically attached, when applicable.

  • Syllabus
  • Vita

For existing courses or current instructors, the items listed below must be electronically attached, when applicable.

  • Syllabus (if major changes are made)
  • Updated Vita (if major changes are made)

For all Instructors: If there are course and/or program fees, an itemized budget, student payment schedule, and refund schedule must be attached.


Will there be additional faculty compensated in conjunction with the course(s)? *
Do you plan on having any graduate students assist with the course(s)? *

PLEASE NOTE: All graduate student appointments must first be approved by the Graduate College.  It is the responsibility of the academic department to ensure that graduate students assisting with extension courses have an active assignment.



Please type your initials below the following statements: