Outreach Exception Course Approval Form

College of Human Sciences

A completed/signed form with attached budget and syllabusis required each semester that a course is taught in order to process expenses including instructor compensation.
This form is for requesting travel courses and courses for cohorts with Approved Program Exceptions. Regular online courses may be scheduled directly with classroom scheduling if the course has previously been approved as an online course.

Year: Semester: Fall Spring Summer

Course Prefix: Course Number:

Course Title:

# of Credit Hours:Minimum Enrollment Maximum Enrollment

Course Start Date (including pre-trip meetings):

Course End Date (including post-trip meetings):

Travel Start Date: Travel End Date:

Travel Destination/Itinerary (list country and all major cities with approximate dates):

For international Travel Courses we can set up an Honors section of the course. Honors students enroll in the Honors section and automatically earn Honors credit if they make an “A” or “B” in the course.
Should we request an Honors section of this course? Yes No

Course Meeting Times:

Include days of week (i.e. TR or MW), course time (8:00-9:20), pre-and post-trip dates and times

Course Meeting Room:
(Location for course or pre- and post-trip meetings. If online list WEB.)

Tuition Rate per credit hour (do not include travel/program fees):

Instructor Agreement

I understand that the College of Human Sciences Outreach office, in collaboration with my Unit Head, has the right to cancel the identified Outreach course due to low enrollment. I have attached a syllabus and an Outreach Course Budget form listing all expenses for this course. I understand that course expenses not included on the form may not be covered.

Instructor SignatureDate:

Instructor Name and CWID Printed:Phone:

Unit Head Review and Approval

This course is In Load Over Load for the identified instructor of record.

If the assignment is Over Load, list salary and benefit amounts for the instructor

I understand that all College Outreach courses must, at a minimum, break even. I have reviewed the attached budget and approve the expenses and the distribution of the funds if a profit should occur.

Unit Head Signature: Date:

Unit Head Name print):Phone: