Faculty Support Request Form

Fields marked with * are required for submission

• Instructor Name *
  First Name Last Name
• Email*
• Session*
  Select one Spring 2013 Spring Intersession 2013 Summer 2013 Fall 2013 Fall Intersession 2013 Winter 2013-2014 Spring 2014 Spring Intersession 2014 Fall 2014 Spring Intersession 2014 Winter 2014-2015
• Course*
  Course Number Select one EXC EXD EXE EXP EXQ EXR EXU EXW GLO Section Course Title
• Textbook required?*
  Yes No
• Textbook Information
  
  Note: all textbooks are ordered through Iowa Book and Supply.
  Please include author, title, edition, and ISBN #.
• Course packet required?*
  
  Note: If yes, you must complete the Course Packet form.
  Yes No
• Do you require exam booklets for your course?*
  Yes No
• For which exam(s)?
  Midterm Final Both
• Format:
  8 1/2 x 11 6 1/2 x 8 1/2
• Do you require any special software, equipment, and/or computer support in your classroom?*
  Yes No
• Please list, if any:
• Are you requesting a grader for your MBA-PM course?*
  
  Note: course must have over 40 enrollments and must be approved by dean in advance.
  Yes No
• Please check the transportation option you wish to use:*
  I am teaching in Des Moines and would like to ride in the SOM van with a student driver, I am teaching in Cedar Rapids or the Quad Cities and would like to arrange for me to drive a university vehicle. I will make my own transportation arrangements. Other
  
• Are you requesting hotel accommodations?*
  The MBA-PM program will pay for hotel accommodations for faculty who travel to Des Moines or the Quad Cities to teach classes that are held on consecutive evenings or days.
  Yes No
• Please list dates for the nights you wish to stay:
• Are there any dates when you don't plan to hold an in-person class session?*
  
  Note: For example, dates when students will be asked to complete a take-home exam or group project instead of coming to the classroom. This information is helpful for scheduling rooms, drivers, and staff, as well as for calculating inconvenience stipends.
  Yes No
• Please list dates you will NOT be holding an in-person class session.
• Will you need any breakout rooms during any of your course sessions?*
  Yes No
• Please list date(s), time(s), quantity of rooms, capacity of rooms, and any special equipment desired in rooms.
  
  Note: Although we can't guarantee we can meet every request, we will work with each facility to identify accommodations to best meet your needs.
• Do you require any guest speaker expenses (i.e., stipend, mileage, thank you gifts, training fee)?*
  
  Note: All of these expenses require prior approval.
  Yes No
• Please list, if any.
• Leave this field empty