Information needed to request your developmental shell following completion of the Etudes NG Workshop

Your First Name: ____________

Your Last Name: ______________

Your Email Address: (be sure it's typed correctly) ________________

Your Institution: ______________

Last FIVE digits of your SSN: (needed to create unique userid's) _______________

Site Information

Subject Abbreviation: (i.e. MATH, ENGL, etc. LACCD colleges, see abbrev.) _______

Course Number: (i.e. 101, 1A, etc.) ____________

Check type of site:

Course Site

Project Site

Note: Course sites are for classes where you will have registered students; project sites are for projects such as sabbaticals or research, for departmental collaboration, etc.

Eligibility/UserID Verification

Specify when you completed ETUDES-NG training: (dates/term) ________

Do you have other ETUDES-NG sites on our servers? No Yes

If you have a login to the ETUDES-NG servers, what is your userid?

Note: Please allow five days for the installation of development sites, minus weekends and holidays. You will