Caregiver Emergency Request Form

Caregiver Emergency Request Form

Sociology Department
Please provide information on the class(es)/section(s) that you need support with, and--to the best of your ability--how long you might need support. Your request will be sent immediately to Amy Binder (Sociology Department Chair), who will seek to find someone who can step into your class/section.

If you prefer to share this information by Zoom or phone, please make a note of that, and Amy will contact you asap.
Name*
First and Last Name
Email*
example@example.com - UCSD email preferred
Phone Number
How do you prefer we contact you?*

PhoneEmailZoomAny of the Above
Name of Class and Course Number(s)*
Example: SOCG 200: Intro Methods/Epistemology; SOCI 126: Social Organization of Education
Which of the following are you listed as for the course(s)?*

Faculty/Lecturer/Associate-InInstructional/Teaching Assistant (TA)
Approximately how long will you need coverage for your class/section?*
Your best estimate is fine
Please upload Syllabus here*

Cancelof
Please give as much information as you can on how you have set up your class/section—asynchronous only, synchronous lectures with asynchronous recordings in Kaltura, hybrid…) and any plans you have already made for upcoming classes/sections*
Please give as much information as you can on which lecture/week you are on and which readings need to be covered. **Is there a video that can be shown, or other materials?***
Does Amy have your permission to share your phone number with the substitute instructor/instructional assistant?*

YesNoUndecided
Acknowledgement

I acknowledge that Amy has my permission to add herself and the substitute instructor to my Canvas course(s).
Please verify that you are human*
Should be Empty: