Course Module Application

Name(Required)
Institutional Address(Required)
For the delivery of your curriculum enhancement kit. Please be sure to collect your kit soon after delivery, as kit materials may be time and/or temperature-sensitive.
Please select the module(s) you are interested in.(Required)
Select as many as apply.
Course Semester(Required)
Select the semester you intend to instruct using the enhanced curriculum.
Which month of your above selected semester do you intend to instruct using the curriculum enhancement kit? (For timely delivery of kit materials)
Please state your institution's course catalog number for the course(s) you wish to enhance.
Please state the number of students currently attending this course or the number you expect to attend this course.
Please describe the course and how the module(s) you selected will enhance your course curriculum. 250 words maximum.