ORIGINATOR’S SECTION:
1. College/School:	Desired Term and Year of Implementation (e.g., Fall 2008):
2. Course is to be considered for G.E.? (If yes, also fill out appropriate GE form*)
3. Course will be a variable-topics (generic) course? (“generic” is a placeholder for topics)
4. Course abbreviation and Number:*
5. Title: (Titles using jargon, slang, copyrighted names, trade names, or any non-essential punctuation may not be used.)
6. Abbreviated Title for Banner: (no more than 25 characters, including spaces)
7. Number of Units:

8. Catalog Description: (Not to exceed 80 words; language should conform to catalog copy. Please consult the catalog for models of style and format; include all necessary information regarding consent for enrollment, pre- and/or corequisites, repeated enrollment, crosslisting, as detailed below. Such information does not count toward the 80-word limit.)

9. Why is this course being proposed? Please list the Student Learning Objectives.
10. Mode of Instruction* (See pages 17-23 at http://www.calstate.edu/cim/data-elem-dic/APDB-Transaction-DED-SectionV.pdf for definitions of the Course Classification Numbers) Type of Instruction Number of Credit Units Instructional Mode (Course Classification Number) Lecture Activity Lab
11. Grading Method:*
12. If the (NP) or (CP) grading system was selected, please explain the need for this grade option.
Course Requires Consent for Enrollment?
14. Course Can be Taken for Credit More than Once? If yes, how many times? (including first offering)
15. Is Course Crosslisted: If yes, indicate which course and check “yes” in item #22 below.
16. Prerequisite(s):
17. Corequisite(s):
18. Documentation attached:
19. If this course has been offered as a topic, please enter topic abbreviation, number, and suffix:*
20. How often will this course be offered once established?*
PROGRAM DIRECTOR/CHAIR - COLLEGE CURRICULUM COMMITTEE SECTION: (Mandatory information – all items in this section must be completed.)
21. Does this course fulfill a requirement for any major (i.e., core course or elective for a major, majors in other departments, minors in other departments)? If yes, please specify:
(Enter information here)
22. Does this course impact other discipline(s)? (If there is any uncertainty as to whether a particular discipline is affected, check “yes” and obtain signature) If yes, obtain signature(s). Any objections should be stated in writing and attached to this form. Discipline _________________________________ ______________ Signature Date Discipline _________________________________ _______________ Signature Date

SIGNATURES : (COLLEGE LEVEL) : (UNIVERSITY LEVEL)

1. Originator (please print or type name)	Date	5. UCC Committee Chair	Date

2. Program Director/Chair	Date	6. Vice President for Academic Affairs (or Designee)	Date

3. College Curriculum Committee	Date	7. President (or Designee)	Date

4. College Dean (or Designee)	Date