header

 

Blackboard Assistance Request Form

Please Provide The Following Information:

* Indicates Required field

*First Name:  

*Last Name:  

*Choose One:

Faculty
Staff
  Student

Phone:

*E-mail:  

*Course ID:   (e.g., T-101-149, MC-27-490)
Enter ALL for login related issues.

*Course Name:  
Enter ALL for login related issues.

*Area/Type of Problem:  

*Please describe the problem you are experiencing

 

Where did you experience this problem?  

If you were at a Computer Lab or selected Other, please specify where?

 

What Operating System were you using?  

What type of Internet connection were you using?

Who is your Internet Service Provider?

What Internet Browser do you use?

Additional Comments:

 

Edited by M.Clauburg | Graphics Credits | Last Updated April 09, 2008 | ©2005, 2006 Philadelphia University