Date: 202X/MM/DD
To the Director of Keio Research Center for Foreign Language Education

Moodle Application Form

To open a Moodle course, please fill in this Application Form and send it to the Director of Keio Research Center for Foreign Language Education at moodle＠ml.keio.jp
All faculty staff and instructors at Keio schools are eligible to apply to open moodle courses.

　Applicant（Course Instructor）
Full name		
Keio ID number		
Affiliation(Department) Campus
		
Position (Job title)		
Tel. Extension		
E-mail		
Other Contacts		

Summary of the Course
instructor account name		
Course name
		
Approximate Number of users		
Any users out of Keio? If yes, specify the organization and purpose.		
Remarks