Supplemental Instruction (SI) Faculty Request Form

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Please complete the form below to request Supplemental Instruction (SI) for your Fall 2024 course. If you have any questions, you may contact Professor Paula Prouhet (prouhetp@umsl.edu), Faculty Fellow for Student Support Programs in the Center for Teaching and Learning. Thank you!

Instructor's Name: *

Instructor's Email Address: *

Are you requested an SI for a course you are personally teaching or for another instructor? (If another instructor, please list instructor's name)

What is the requested course number and name? (ex. NURSE 3030 Health Assessment Concepts)

List each section of the course you would like SI coverage in. (Please list each section, not "All") *

If you are requesting an SI for multiple sections of the same course, are you open to having one (1) SI who covers multiple sections, or would you prefer a separate SI for each section?

One SI for multiple sections would be sufficient

I would prefer one SI for each section

I do not have a preference

Clear selection

What is the anticipated enrollment in your course?

Has this course been supported by SI in the past?

Yes

Clear selection

How do you plan to use SI support in your course?

How do you think your students would benefit from having a Supplemental Instruction Leader in your course?

Do you know any students who could be possible Supplemental Instruction Leaders for your course? If so, please list their names and email addresses here.

If you do not know individual students to recommend, please provide student names from your gradebook who achieved a B+ or higher.

*Note: The SI Leader must have taken the course before and done well (B+ or higher). We also look for students with leadership potential, maturity, empathy, and interpersonal skills.

(Note: We encourage students of all races, religions, gender identities, sexual orientations, national origins, ages, disability statuses, and veteran statuses to apply.)

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