Management of Change Form

All fields are required unless otherwise specified!

Full Name:

Institution or Company:

City:

State:

Email:
Ex: employee@company.com

Affiliation with Materials:
College Instructor/ Adjunct
College Administrator
Industry

Course to be Changed/ Improved: Select one... Instrumentation Introduction to Process Technology Safety, Health, and Environment Process Technology I - Equipment Process Technology II -Systems Process Technology III - Operations Quality

Course Version:
Classroom-Based Instructor Manual
Classroom-Based Student Workbook
Web-Based Content Modules
Web-Based Facilitator Guide

Lesson Plan or Module Number:

Page Number (if applicable): this field is not required.

Proposed Change/ Improvement:
Omission
Revision/Correction
Addition

Describe the proposed change/ improvement – Examples include addition of topics or objectives for a course, correction of factual error, addition of content for a specific section, suggested revision of classroom or lab activity, or supplemental materials. Supplemental materials for distribution to other instructors/adjuncts should be faxed or emailed to the Center.

Is the consideration of the change/improvement suggested above urgent?
Yes; the matter is urgent.
No; the matter is not urgent.