HBCU Course Revision Form

DRAFT

Historically Black Colleges and Universities –
Undergraduate Program
Course Revision Form

OMB Clearance Number: TBD
Public Burden: Submission of the requested information is voluntary. Reporting burden for this
collection of information is estimated to average 20 minutes, including the time for reviewing
instructions. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden, to Suzanne Plimpton, Reports
Clearance Officer for OMB Collection 3145-0204 (HBCU-UP), National Science Foundation,
4201 Wilson Blvd., Suite 295, Arlington, VA 22230.

Grantee Institution:

Date:

Description of Revised Courses Funded by HBCU-UP
The National Science Foundation (NSF) requests information on courses developed or revised using HBCUUP funds that meet the following criterion established by the American Competitiveness Council (ACC):
Courses that “integrate the use of instruments, methods, and procedures that are commonly used
in academic, industry, and government laboratories.”
As a grantee of the HBCU-UP Program, please provide the following information:
1. As part of your HBCU-UP project, have you revised or developed a course or courses to “integrate the
use of instruments, methods, and procedures that are commonly used in academic, industry, and
government laboratories?” (please circle)
Yes

No

2. If you answered “yes” above, please fill out the table—and submit a syllabus—for each course that was
revised or created fitting the description above.
For each course listed, please indicate whether the revision or development of the course involved the
integration of innovative technology into the course (example: virtual or simulated labs or digital portfolios
NOT instructional aids such as Blackboard or Power Point).
Course Name:

# Credit Hours:

Example: COLLEGE ALGEBRA

3

Field (Physics, Biology, Chemistry, etc):

MATHEMATICS

Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

MyMathLab
Course Name:

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

If additional space is required, please use reverse side.

Name of person completing form: ______________________________ Title: _____________________

Email address: _____________________________________________ Telephone: ________________

Course Name:

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

# Credit Hours:

Field (Physics, Biology, Chemistry, etc):

Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Course Name:
Syllabus is attached: (circle one) Yes
No
If syllabus is not attached, please explain why:
Course incorporates technology: (circle one)
If yes, please describe:

Yes

No

Thank You!