Himdag Committee Review Question Title * 1. Himdag Committe Chair or representative Name Question Title * 2. Date of Review Date / Time Date Question Title * 3. Which Type of Curriculum New Program New Course Program Modification Course Modification Question Title * 4. Title of Curriculum Request Question Title * 5. Results of Review Curriculum was approved with no recommendations. Curriculum was approved with recommendations that were reviewed and approved by the curriculum developer(s). (Please submit clean copy of curriculum without track changes) Curriculum was denied by the Himdag committee. (Answer question 6) Other (please specify) Question Title * 6. If curriculum was denied by Himdag committee, please provide reason? Question Title * 7. Himdag Committee consensus results. 1 2 3 4 5 6 7 8 9 10 11 12 Number of members who voted "Yes" Number of members who voted "Yes" 1 Number of members who voted "Yes" 2 Number of members who voted "Yes" 3 Number of members who voted "Yes" 4 Number of members who voted "Yes" 5 Number of members who voted "Yes" 6 Number of members who voted "Yes" 7 Number of members who voted "Yes" 8 Number of members who voted "Yes" 9 Number of members who voted "Yes" 10 Number of members who voted "Yes" 11 Number of members who voted "Yes" 12 Number of members who voted "No" Number of members who voted "No" 1 Number of members who voted "No" 2 Number of members who voted "No" 3 Number of members who voted "No" 4 Number of members who voted "No" 5 Number of members who voted "No" 6 Number of members who voted "No" 7 Number of members who voted "No" 8 Number of members who voted "No" 9 Number of members who voted "No" 10 Number of members who voted "No" 11 Number of members who voted "No" 12 Number of members who "abstained" Number of members who "abstained" 1 Number of members who "abstained" 2 Number of members who "abstained" 3 Number of members who "abstained" 4 Number of members who "abstained" 5 Number of members who "abstained" 6 Number of members who "abstained" 7 Number of members who "abstained" 8 Number of members who "abstained" 9 Number of members who "abstained" 10 Number of members who "abstained" 11 Number of members who "abstained" 12 Question Title * 8. Upload clean copy of curriculum PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Upload clean copy of curriculum Done