Peer Observation Request
Faculty Name:
*
First Name
Last Name
Department:
*
Please Select
Pharmacotherapy
Medicinal Chemistry
Pharmacology and Toxicology
Pharmaceutics & Pharmaceutical Chemistry
None
Faculty Email:
*
example@example.com
Deadline for Receiving Teaching Summary and Peer:
*
-
Month
-
Day
Year
Date
Preferred Reviewer #1 Name
*
Department Preferred Reviewer #1
Please Select
Pharmacotherapy
Medicinal Chemistry
Pharmacology and Toxicology
Pharmaceutics & Pharmaceutical Chemistry
None
Preferred Reviewer #2 Name
Department Preferred Reviewer #2
Please Select
Pharmacotherapy
Medicinal Chemistry
Pharmacology and Toxicology
Pharmaceutics & Pharmaceutical Chemistry
None
Preferred Reviewer #3 Name
Department Preferred Reviewer #3
Please Select
Pharmacotherapy
Medicinal Chemistry
Pharmacology and Toxicology
Pharmaceutics & Pharmaceutical Chemistry
None
Comments about Preferred Reviewers:
If you have comments please add them.
Peer Review Setting:
*
Please Select
ONLINE
IN-CLASSROOM
Course Information
Heading
First Course Name:
*
First Course Number:
*
First Course Room:
Leave in Blank if the lecture happens online
Course Type
Classroom
Zoom
Canvas
Pre-recorded
Add link and instructions in how to access your course (canvas, zoom id/password, Box link)
Lecture #1 Title:
*
Lecture #1 Date:
*
-
Month
-
Day
Year
Date
Lecture #1 Time:
*
Hour Minutes
AM
PM
AM/PM Option
Lecture #1 Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #1 Duration (In Hours)
*
Lecture #2 Title:
Lecture #2 Date:
-
Month
-
Day
Year
Date
Lecture #2 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #2 Duration (In Hours)
Lecture #2 Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #3 Title:
Lecture #3 Date:
-
Month
-
Day
Year
Date
Lecture #3 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #3 Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #3 Duration (In Hours)
Add a Second Course...
Second Course Name:
Second Course Number:
Second Course Room:
Second Course Type
Classroom
Zoom
Canvas
Pre-recorded
Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #1 Title:
Lecture #1 Date:
-
Month
-
Day
Year
Date
Lecture #1 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #1 Duration (In Hours)
Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #2 Title:
Lecture #2 Date:
-
Month
-
Day
Year
Date
Lecture #2 Time:
Hour Minutes
AM
PM
AM/PM Option
Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #2 Duration (In Hours)
Lecture #3 Title:
Lecture #3 Date:
-
Month
-
Day
Year
Date
Lecture #3 Time:
Hour Minutes
AM
PM
AM/PM Option
Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #3 Duration (In Hours)
Add a Third Course...
Third Course Name:
Third Course Number:
Third Course Room:
Third Course Type
Classroom
Zoom
Canvas
Pre-recorded
Add link and instructions in how to access your lecture (canvas, zoom id/password, Box link)
Lecture #1 Title:
Lecture #1 Date:
-
Month
-
Day
Year
Date
Lecture #1 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #1 Duration (In Hours)
Lecture #2 Title:
Lecture #2 Date:
-
Month
-
Day
Year
Date
Lecture #2 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #2 Duration (In Hours)
Lecture #3 Title:
Lecture #3 Date:
-
Month
-
Day
Year
Date
Lecture #3 Time:
Hour Minutes
AM
PM
AM/PM Option
Lecture #3 Duration (In Hours)
PEER OBSERVATION REQUEST SUBMISSION
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