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First Name

Last Name

Email

School, Graduation Year, Major (if known)

General topic for course you are suggesting

More information about what you would want to learn in the course. If you can, please describe how the class would relate to wellness, citizenship, service, and dialogue.

Do you have a specific faculty member in mind who you would like as the instructor for the course?

Yes
No

If you answered "Yes" above, please provide the first and last name of the faculty member, the department they teach in, and if you know it, their email address.