Instructor Assignment Change Request
Submit a request to change the assigned instructor for a course. Please complete all required fields to ensure timely processing.
Course Name
*
Course Code
*
Department
*
Please Select
Mathematics
Computer Science
Physics
Chemistry
Biology
Other
Current Instructor Name
*
First Name
Last Name
Proposed New Instructor Name
*
First Name
Last Name
Requester's Name
*
First Name
Last Name
Requester's Email
*
example@example.com
Reason for Assignment Change
*
Effective Date of Change
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Supporting Documents (if any)
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of
Approval Status
*
Pending
Approved
Rejected
Comments from Approver
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