| *Name of Requester |
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| *Email |
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| *Department |
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| *Course (Please include the prefix, course number, and title) |
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| *Location of Class |
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| *Preferred Dates |
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| *Time of Class |
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| Estimated Number of Students |
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*Workshop Requested (A complete list of the workshops we offer is available under
“Faculty Resources") |
Special Requests |
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