Course Access / Media Request Form

Use this form only if you are not registered for the distance course for which you are requesting access. If you are registered for a distance course and need access, see Course Access. Refer to the rate chart for the fees associated with course access requests.

All data on this form is subject to verification before requests are fulfilled. If you are ordering CDs/DVDs, please allow at least 1 business day for your request to be processed after payment is received. Call 303-492-6331 (option 1) if you have any questions.

Term Information

Semester: * select...FallSpringSummer

Year: *

Your Information

Last Name: *

First Name: *

Student ID (if applicable; last four digits): *

Phone (of primary contact): *

Email: *

Status: *

Current CU Student

CU Alumnus

Corporate Organization

Course Information

Course Number: *

Course Title: *

Type of Access You are Requesting: *

Full course on the Internet

Full course on CD

Specific Lecture(s) on CD

Lectures Date(s):

Delivery Information

Delivery Preference: *

Pick up at the CAETE Office

Ship to the address below

Shipping address is only required if you are requesting CDs/DVDs to be shipped to you. A shipping and handling fee will be charged. There are no shipping charges for corporations/organizations. We do not ship outside the continental United States.

Company Name (if applicable): *

Dept./M.S./Org:

Street Address:

City / State / Zip:

Total Costs

Cost for Course Access: *

Cost for Shipping: *

Total Costs: *

Payment Information

Payment Method : *

Check

Visa

MasterCard

Discover

Company PO

Payment must be received in the CAETE office before the request will be processed. Call our office at 303-492-6331 with credit card information or fax to 303-492-5987. Checks should be made payable to the University of Colorado, and mailed to CAETE, University of Colorado, 435 UCB, Boulder, CO 80309-0435.

Name on Credit Card:

Expiration Date (mm/yy):

Company PO#:

I agree to pay all applicable charges and to abide by the copyright agreement.: *

Yes

No (this request will not be processed)

Copyright Agreement

By submitting this form you agree to adhere to this copyright agreement. All material is granted to the user under a limited license for sole use of the recipient. All material is copyrighted by the University of Colorado, and any reproduction, broadcast, or resale is strictly prohibited.

I Agree: *

yes

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Math Question: * 1 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.