Instructions: This form is to be submitted for requesting a "Community" offering; a non-Banner Student listed, "Special Purpose" course that could be used for a faculty learning community, committee or project where the PipelineMT Group tool is not appropriate. It is recommended that you discuss this request with a Faculty Instructional Technology Center (FITC) staff member prior to submitting this request, to explore if this is the best tool for your purpose. Requires approval by the Director of Academic and Instructional Technology Services. After submission, it may take up to 48 hours for the course to be created.

Date:
Name: (Last, First):
MTSU E-mail:
Faculty/Staff:
Department:
Box #:
Phone # ( Required)
Course Name:
Course ID (If appropriate)	Example: NURS3030

Users to be Added:
Name (Last, First);
MTSU User/Non-MTSU User	MTSU User Non-MTSU User
MTSU Username
Role:
Name (Last, First);
MTSU User/Non-MTSU User	MTSU User Non-MTSU User
MTSU Username
Role:
Name (Last, First);
MTSU User/Non-MTSU User	MTSU User Non-MTSU User
MTSU Username
Role: