Distance Learning Course Approval Form for eCertification

Select the semester in which the course will initially be delivery via distance:*
Select course type (Online, Hybrid, or 2-Way Video):*
If hybrid, what is the approximate proportion of face-to-face time (e.g., 50% or "N/A"):*
BASIC COURSE INFORMATION
Course prefix:*
Course number:*
Title of course:

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INSTRUCTOR (DEVELOPER) INFORMATION
In the fields below, please enter the information for the individual developing the course for delivery via distance.
Instructor first name:
Instructor last name:
Instructor title:
Instructor phone number:
Instructor email:
DETAILED COURSE INFORMATION
Web address where course can be reviewed:
Intended audience:
Has the course been offered online at least twice? (This is for informational purposes only and is not a requirement.)
- Yes
- No
Is the syllabus set by the institution or may the instructor modify it?
- Set by institution
- May be modified by the instructor
Are learners required to complete a tutorial on the use of the LMS prior to beginning the course?
- Yes
- No
Course description:

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Please list all required textbooks and supplements:
Title:
Author:
Publisher:
ISBN #:
Title:
Author:
Publisher:
ISBN #:
Title:
Author:
Publisher:
ISBN #:

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Provide a list of the course-level objectives (or competencies for competency-based courses) used in this course. The objectives or competencies listed here must match those found in the course.

*Note: It is not possible to complete the course review if measurable learning objectives or competencies are not present. Please consult one of the CIITS Instructional Designers for more information.

After selecting the course objectives/outcomes document, be sure to click the "Submit" button to send it to the CIITS.
File
Max. file size: 50 MB.
What is the source(s) of the course objectives or competencies?
- Created by the Instructor
- Mandated by the Institution
- Other
If "Other" was selected, please explain.
Provide a list of the module/unit-level objectives (or competencies for competency-based courses) used in this course. The objectives or competencies listed here must match those found in the course.

*Note: It is not possible to complete the course review if measurable learning objectives or competencies are not present. Please consult one of the CI²TS Instructional Designers for more information.

After selecting the module/unit objectives/outcomes document, be sure to click the "Submit" button to send it to the CI²TS.
File
Max. file size: 50 MB.
What is the source(s) of the module/unit objectives or competencies?
- Created by the Instructor
- Mandated by the Institution
- Other
If "Other" was selected, please explain.

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Select the elements that will be included in your course.
Discussion/Chat:
- Asynchronous (threaded discussion)
- Additional Information
- Synchronous (live chat)
TECHNICAL REQUIREMENTS

Audio:
Select the audio elements that will be included in your course. If no audio is to be used, go to the next page.
Number of audio segments:
Length of audio segments:
Method of Delivery (Streaming via RealAudio, QuickTime or other; delivered on CD-ROM, etc.)
Additional Information (if necessary)

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TECHNICAL REQUIREMENTS (continued)

Video:

Select the elements that will be included in your course. If no video is to be used, go to the next page.
Number of video segments:
Length of video segments:
Method of Delivery (Streaming via Real Media, QuickTime or other; delivered on CD-ROM, etc.)
Additional Information (if necessary)

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Content Hosting:
Are any course instructions, activities, or instructional materials provided by individual emails or by other tools or platforms outside the primary online classroom?
- Yes
- No
If "Yes," please summarize what they are and how reviewers can access them (or enter "N/A").
COURSE COPYRIGHT AND PERMISSIONS

In any case where the course author(s) contribute copyrightable expression, the course author(s) warrant that they are the only owner(s) of the copyrightable expression and have full power and authority to make this agreement; and that the course materials do not infringe any copyright, violate any property rights, or contain any scandalous, libelous, or unlawful matter.
Name(s) of course copyright holder(s):
Have you confirmed that the course materials that were not developed by the copyright holder are "fair use" or that you are otherwise exempt from liability from infringement?
- Yes
- In process
- No
If not, have you acquired permission to use or link to the materials?
- Yes
- In process
- No
Additional Information / comments:

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PRINCIPLES OF GOOD PRACTICE SELF-STUDY

The Principles of Good Practice for Academic Degree and Certificate Programs and Credit Courses Offered Electronically were developed by the Western Interstate Commission for Higher Education and adopted by the Texas Higher Education Coordinating Board. These Principles provide an outline for consideration when developing, teaching or evaluating the quality of electronic instruction. Therefore, the college requires this self-study as an assurance that all distance courses offered by the college meet these guidelines. (Throughout the following pages, the Principles are in bold.) It is not necessary for you to provide a positive response to each question. However, these questions should indicate course attributes you may want to add, areas that you may wish to improve or further develop, and issues to be addressed during instruction.

Certain assumptions are central to the Principles of Good Practice as well as this self-study:

1. The program or course offered electronically is provided by or through an institution that is accredited by an accrediting agency recognized by the Texas Higher Education Coordinating Board and authorized to operate in the state where the program or course originates.

2. The institution's programs and courses holding specialized accreditation meet the same requirements when offered electronically.

3. The "institution" may be a single institution or a consortium of such institutions.

4. These principles are generally applicable to degree or certificate programs and to courses offered for academic credit.

5. It is the institution's responsibility to review educational programs and courses it provides electronically and certify continued compliance with these principles.

6. Institutions offering programs or for-credit courses are responsible for satisfying all in-state approval and accreditation requirements before students are enrolled.
Confirmation*
- I have read and understand the PRINCIPLES OF GOOD PRACTICE
Please click the check box above to confirm that you read and understand the Principles of Good Practice for Academic Degree and Certificate Programs and Credit Courses Offered Electronically

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4. Qualified faculty provides appropriate oversight of the program or course that is offered electronically.
4a. Faculty member(s) meet SACS requirements.
- Yes
- No
- N/A Hybrid
4b. When teaching the course, the faculty member will be available to support and communicate with the students and oversee student progress and evaluation.
- Yes
- No
4c. Is this course self-paced or is the student’s progress defined by the instructor (for example, are there deadlines for discussion participation, quizzes, tests or assignments)?
- Self-paced
- Deadlines and due dates
4d. Will this course be a part of or in addition to the faculty’s normal teaching load?
- A part of the normal teaching load
- An addition to the normal teaching load

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Thank you for completing the Self-Study and Course Approval Form. Click the "Submit" button to complete the form. You will soon be contacted by one of the instructional designers with the next steps.

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Distance Learning Course Approval Form for eCertification

Self-Study and Course Approval Form

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