Date: 2026/MM/DD
To the Director of Keio Research Center for Foreign Language Education

Moodle course Creator Application

To create Moodle courses, please fill in this application form and send it to the Director of the Keio Research Center for Foreign Language Education at moodle-group＠keio.jp. All faculty, staff, and instructors at Keio schools are eligible to apply to create Moodle courses. 

　Applicant（Course Instructor）
Full name		
Keio ID number		
Affiliation (Department) Campus
		
Position (Job title)		
Tel. Extension		
E-mail		
Other Contacts		
※	If this is your first time, you first need to create your user account.

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