CTL SMALL GROUP EVALUATION (SGE) REQUEST FORM

**Please make your small group evaluation requests at least a week in advance.**

STEP 1 - Enter Your Contact Information
First Name :
Last Name:
Phone:
Email:
Dept:

Mail Code:
Affiliation: Faculty Lecturer Graduate Student Other
Do you have a Co-Instructor? Yes No
If yes, please enter the information below:
First Name :
Last Name:
Email:
Dept:

Affiliation: Faculty Lecturer Graduate Student Other
STEP 2 - Enter Your SGE Preferences
When would you like the SGE to take place?
We recommend that an SGE is best performed during the last 20 minutes of class. Let us know if you have a different preference.
First choice date:
 (mm/dd/yyyy)
Class/section start time:
 am pm
   
Class/section end time:
 am pm
       
Second choice date:
 (mm/dd/yyyy)
Class/section start time:
 am pm
   
Class/section end time:
 am pm
       
We try to place you with a consultant from within your broad discipline (Humanities, Social Sciences, Engineering, or Sciences) if possible. We may even have a consultant available from your own department.

Please indicate your preference for a consultant from:
Your own department
Another department

STEP 3 - Enter Your Course Information
Course Title:
Course No.:
Building:
Floor:
Room:
    
       
No. of students in class:
Format of class:

Discussion/Section
Lab
Lecture
Other (please describe below)
Special notes or requests: