Supplemental Instruction Request Form

To set up Supplimental Instruction (SI) please fill out the following form:

If you see this don't fill out this input box.

Name of faculty member *

Faculty email address *

Faculty phone number *

Course name *

Course code *

Name of recommended SI student leader

Email address for recommended SI student leader

Anticipated start date for SI sessions

In order for SI sessions to progress most effectively, please be aware of the following:

Weekly meetings have been scheduled between faculty and SI leader

SI leader has been added to Canvas

SI leader has access to all class textbooks and necessary materials

Check all boxes that have been completed.