Lower Division Observation Request Form

Lower Division Observation Request Form
Name of Student:*

First NameLast Name
Today's Date:*

MonthDayYear
Date
Contact Phone:*

Area CodePhone Number
Contact Email (TBC):*
example@example.com
Course Number:*
Course Name:*
Professor Name:*
Professor Email*
example@example.com
Total Number of Observations Required for the Course:*
Time Limit: 30 Minutes (Max):
Grades Requested (select all that apply):*

K3K4K51st2nd3rd4th5th6th
Subject Requested for Observations:
Mark the boxes below to indicate your hours of availability:
Monday

8:30-9:00 am9:00-9:30 am9:30-10:00 am10:00-10:30 am10:30-11:00 am1:00-1:30 pm1:30-2:00 pm2:00-2:30 pm
Tuesday

8:30-9:00 am9:00-9:30 am9:30-10:00 am10:00-10:30 am10:30-11:00 am1:00-1:30 pm1:30-2:00 pm2:00-2:30 pm
Wednesday

8:30-9:00 am9:00-9:30 am9:30-10:00 am10:00-10:30 am10:30-11:00 am1:00-1:30 pm1:30-2:00 pm2:00-2:30 pm
Thursday

8:30-9:00 am9:00-9:30 am9:30-10:00 am10:00-10:30 am10:30-11:00 am1:00-1:30 pm1:30-2:00 pm2:00-2:30 pm
*Observations can be scheduled September 1st through November 30th in the fall.

*Observations can be scheduled February 1st through April 30th in the Spring.

LD OBSERVATION CONTACT: Jennifer Sweat, jsweat@tcajax.org or 904-596-2471
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