Summer Course Information Form

TI:ME Instructor or Summer Program Administrator:

Please fill out one form for each course you will be offering this year.
Fill out as much information as is applicable.

IMPORTANT - Be sure not to press the "return" or "enter" key while filling out this form. This will cause the form to be sent prematurely. Use the tab key to move from field to field.

Your Info

Name:
E-mail Address:
(Please let us know who exactly is filling out this form. We may need to contact you for verification, questions, or updates.)

Course Number


Course Title
Leave this space blank if you would like us to use the TI:ME "standard" name for your course number.

Dates/Times

 Start Date:
End Date:
Start Time:      
End Time:

Instructor

Name:
Title:
University or Other Affiliation:

Offering Institution

Name:
Institution Website:

Campus / Specific Location

Campus Location Name:
Street Address:
City: State: Zip: Country:

Shipping Address for Summer Packets
Street Address:
City: State: Zip: Country:

Contact for Registration

Name:
E-mail Address:
Office Phone:
Fax:

Notes / Other Info

Following are notes that some institutions include with their listings, you may choose not to include all or any of this information.
Room Name/Number:
Institution's Catalog Number: Credits:
Additional Instructors:
Prerequisites:
Course Specific Website:
Other:
(Please don't include any web addresses in the field below or your submission will be rejected as SPAM.)