Institutional Capability Review Application

Your submission of this form over the internet is a preliminary application that will enable the Project Director to determine whether it is appropriate for your institution to pursue an Institutional Capability Review at this time.  You will receive a response to your submission from the Project Director.

Institution Name:
Person in Charge of Distance Learning:  
Name/Title:
Address:
Phone Number:
Fax Number:
E-mail Address:
Primary Contact Person for Review (if different from above):  
Name/Title:
Address:
Phone Number:
Fax Number:
E-mail Address:
Degree/Certificate programs offered by distance education (half or more of program):  
Program Title: Degree(s): Unit of institution offering program (if applicable): Program Director/Head:
When did the institution begin offering distance education?
Approximately how many courses does the institution offer at a distance?
Please list all units of the institution that offer distance education:
Is oversight of distance education at your institution centralized or decentralized ? (check one)
If centralized, list individual/office responsible for oversight of distance education:
If decentralized, is there any mechanism for assuring quality and consistency in distance education programs across the institution? Yes No
If yes, please describe briefly:
Delivery systems used for distance education at your institution:
Online (Web-based)
Live Videoconferencing
Other (please describe):
Please describe briefly the institution's future plans for distance education:
Name: Date:

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