Moodle Instructor Account and Course Request Form

Distance Education

Please complete this form to have an instructor account and/or new course site created for you on HCC’s Moodle server. When your account or site is ready to use you will be notified via email.

User Account Information

First name: *

Middle initial:

Last name: *

Email: *

Course Information

If you are requesting multiple sites, please complete a request form for each course site.

This course is:

Web Enhanced (Supplement for Face-to-Face)

Hybrid

Fully Online Course

Course designator: *

(example: MAT-101)

Course section number(s): *

Semester and Year you will be teaching the course: *

Please include any special instructions:

Use for requesting batch-enrollment of students into site, or name(s) of additional instructor(s), etc.

Date submitted: