Special Classroom Request Form

This form is intended for faculty members to request special classroom assignments for a given session. It must be emailed to Kelly Hart, Assistant Registrar, at hartk@trinitydc.edu to be considered during the scheduling process. You will receive an email acknowledging the receipt of your forms; receiving this acknowledgement does not guarantee fulfillment of the request. Forms cannot be submitted on behalf of “TBA” instructors unless the course has a standard syllabus which necessitates SMARTroom technology or the use of a computer lab. In that case, the form should be completed and submitted by the program chair. A separate form must be submitted for each course and/or section. Late requests may not be considered.

All information is required. Incomplete forms will be returned.

Course #:		Section:	Instructor:
Year:	Semester/Term:	Weekly Monthly Day Term 1 Term 2 Semester		Day & Time:

Instructor will need to:	% of class meetings used:
	0%	25%	50%	75%	100%
Show videos on VCR
Show DVDs
Display Power Point presentations
Display Slides or Transparencies
Access the Internet
Have each student at a computer

Please briefly describe the pedagogical need for the request(s) above:

Are there any other specific requests for this course? (i.e. Is seminar-style seating preferred?)

Please make all special requests here so that they may be considered at the time of scheduling.

Date Received: ____________________