Moodle Request Form

Instructor Information
Name*
Email Address*
Telephone Extension*

Course Information
Course Title*
Course Code*	(e.g. ICM801)
Content	If content from a previous class/semester's coursesite is needed for this coursesite, please specify the course name and semester (i.e., Fall 2006) where that content can be found. Enter 'none' if there is no content.
Needed Assistance*
	I don't need any assistance at this time. I will create and edit my own content. I need assistance changing/modifying my course content. For example: uploading PowerPoint files, entering test questions, adding a graphic. I would like an instructional designer to review my existing coursesite and assist me with improving it. For example, creating more engaging learning activities, adding more opportunities for feedback, reorganizing the content. I need assistance creating a new coursesite.
Comments and Special Instructions Use the comments section below to list additional instructors, or provide any other special instructions for this coursesite. Please indicate a preferred start date and end date.



Please submit your request at least 5 working days prior to the start of your session. For questions about completing this form, please contact: Ms. Melaine D’Cruze Assistant Manager, eLearning Phone: 3634 7611 - 14, Ext 3912 Email: melaine.dcruze@aku.edu Open Learning Aga Khan University-Institute for Educational Development IED-PDC 1-5/B-VII, Federal B Area Karimabad, P.O. Box 13688 Karachi, 75950 Tel: + 92 - 21 - 3634 7611 - 4 Ext. 3912 Fax: + 92 - 21 - 3634 7616 Email: ied.openlearning@aku.edu