AE New Course Submission Form

AE New Course Submission Form

This form is for non-Community College Providers only. To save your progress and return to the form later, click the "Save" button at the bottom of the form. Please contact your Regional Support Specialist with any questions you have.
Provider Name*
5-digit Provider ID*
This can be found on the "Program Information" page in the Administration section of DAISI.
This form is for non-community-college providers only. Please fill out a PDF version of the New AE Course Submission Form (11-C1) and attach it to your ICCIS submission.
Course Title/Name*
If you are submitting multiple courses at different EFL's or instructional categories, separate titles with a comma
Course Number/Code*
If you are submitting multiple courses at different EFL's or instructional categories, separate codes with a comma
Instructional Category (select all that apply):*

ABEASEHSCRESLVOC
CIP Code*
Refer to Appendix C of the AE Provider Manual for valid CIP Codes
Population the course is expected to serve:*
(e.g., low-level ESL students, ASE Levels 5 and 6, etc.)
Enter a brief course description. If you selected more than one instructional category, explain how the course will be differentiated to suit the needs of all learners in the class.*
This course is... (select all that apply)

Job Skills IncorporatedCitizenshipMath Only
Enrollment Type(s)*

Fixed EnrollmentOpen Enrollment
Intensity/Duration

Each class will be blank* hours per week forblank* weeks.

Note: If this is a variable credit course, enter the maximum number of hours/weeks.
Course Repeats:*
Must be less than or equal to 3.
Minimum Units of Instruction (Read Only)
Minimum UI is always 0.5.
Maximum Units of Instruction (Read Only)
This field is pre-calculated based on your response to Intensity/Duration and Course Repeats.
Will any class sections of this course be offered in a hybrid or at-a-distance format?*

YesNo
Which ICCB-approved distance-learning curriculum (Class Software Model) will you use?*
If you plan to use more than one, choose the curriculum you will be using most often.
% of class time using curriculum (Hybrid only; enter a range if this will vary from class to class):
Do not include the % sign
Which proxy hour tracking model will you use?*

Clock Time ModelLearner Mastery ModelTeacher Verification Model
Provide a brief description of how you will use the model indicated above to track proxy hours.*
Does this course meet web-accessible standards/ADA -compliance?*

YesNo
See ADA guidance on web accessibility here.
Explain how this course is ADA-compliant.*
Syllabus

Upload a PDF version of the syllabus for this course. The syllabus must include:
1. a brief description of the course
2. specific objectives of the course
3. a topical outline
4. a method for evaluating student progress
5. (if applicable) IELCE Competencies.
Upload the syllabus:*

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Submitted by:*

First NameLast Name
Title:*
Email*
example@example.com
Signature*

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AE New Course Submission Form

This form is for non-community-college providers only. Please fill out a PDF version of the New AE Course Submission Form (11-C1) and attach it to your ICCIS submission.

Intensity/Duration

See ADA guidance on web accessibility here.

Syllabus