Student Request for a Course Evaluation 2

This is a request for a course evaluation. This evaluation is kept completely confidential. The new evaluation forms created in Fall 2010 are only accessible to those with the password.

Student Name * First Last
Student E-mail *

Please enter your e-mail address carefully. The instructor needs this to fill out your evaluation. You will be notified at this e-mail when the instructor has completed the evaluation.
Instructor Name * First Last
Instructor E-mail *

PLEASE ENTER THIS INFORMATION VERY CAREFULLY. IF THE E-MAIL ADDRESS IS INCORRECT THE PROFESSOR WILL NOT RECEIVE THE REQUEST.
If you have had the instructor for more than one course, please use the space below to indicate BOTH courses.
Course name/Number (i.e. CHEM 223) *
Semester Course was Taken (i.e. Fall 2010) *
Course name/Number (i.e. CHEM 223)
Semester Course was Taken (i.e. Fall 2010)
Field of Interest (Mark all that apply)
Medicine (MD) Osteopathy (DO) Dentistry Optometry Podiatry Veterinary Medicine

Student Request for a Course Evaluation 2

Student Request for a Course Evaluation 2

If you have had the instructor for more than one course, please use the space below to indicate BOTH courses.