Contact Person		Date of Request	(mm/mm/yyyy)
Email		Phone	(123-456-7890)
Program/CIP #
School		Instructor
Course		Phone	(123-456-7890)
Course Weeks/Year		Email
Total Contact Hours		Lab Hours
Lecture Hours
Course Description
Please note the key lecture/lab topics covered each week of the course.

Week	Lecture Topic	Lecture Hours	Lab Assignment/Workbased Placement	Lab Hours
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36

Unique Components: Work-based placements, Leadership Activities, Industry Certifications:

Text(company/copyright year), Software(company and copyright year), Other significant resources: