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School or College:

*Semester:

*Year:

*Location:

On Campus Distance (Please use separate adoption forms for courses that are offered both on campus and online).

*Professor's name:

*Professor's email:

*Course title:

*Course number:

*REENTER Course number:

*Course section:

*Date class begins:

*Date class ends:

*Estimated enrollment:

Check if no text is required.

*Contact person (other than professor):

*Other contact email:

*Telephone number:

Additional information: