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First Name *

Last Name *

Position *

Please Select Adjunct Faculty Clinical Faculty Professional Track or Instructor/Lecturer Tenured/Tenure-track Faculty Graduate Teaching Assistant/Graduate Instructional Assistant Other

If position is "Other," please specify.

College/School *

Please Select Arnold School of Public Health College of Arts and Sciences College of Education Molinaroli College of Engineering and Computing College of Hospitality, Retail, and Sport Management College of Information and Communications College of Nursing College of Pharmacy College of Social Work Darla Moore School of Business Honors College Joseph F. Rice School of Law Palmetto College – Columbia Palmetto College – USC Lancaster Palmetto College – USC Salkehatchie Palmetto College – USC Sumter Palmetto College – USC Union School of Music University 101 Programs University Libraries Other

If College/School is "Other," please specify.

Department *

Email *

Phone *

Course Number and Title *

Course Status *

Please Select New Face to Face Course New Online Course New Blended/Hybrid Course Existing Face to Face Course Existing Online Course Existing Blended/Hybrid Course Other

If Course Status is "Other," please specify.

Reason for Consultation Request *

Have you previously worked with a CTE Instructional Designer? *

Please Select Yes No