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LSCS-3 Class Application Form

Please complete this form if you are an instructor interested in establishing a class of students so that this e-textbook may be incorporated into your course(s). Once submitted, a member of our team will respond within 48 hours with additional instructions.

Thank you so much for your time and interest in Laboratory Safety for Chemistry Students (Third Edition)!
1.Please provide your name.(Required.)
2.Please provide the name of your institution.(Required.)
3.Please provide an institutional email address associated with an ACS ID, which you'll be using to access the e-textbook.
(If you have not yet created an ACS ID, please do so first using this link.)(Required.)
4.Please provide the name of the course you are instructing that will be associated with this cohort.(Required.)
5.Please provide an estimated number of students who will be joining the cohort and accessing the e-textbook.(Required.)
6.When do you expect your course to be ready to share with your students? (Add an expected date, e.g., 'August 18th,' 'End of June.')(Required.)
7.How would you prefer to manage the course assessments (quizzes, tracking, etc.)? (Select one)(Required.)
8.If you selected to have a course in ACS Moodle, what is your preferred name for the course we will be creating for you? (Please keep it around 3 to 6 words, e.g., 'John Brown General Chemistry' or 'Campbell University CHEM 2020 Course.'
9.If you selected “Institution’s LMS,” which Learning Management System are you using? We’ll send you a link to download the appropriate files for importing into your LMS.
10.At the end of the semester, would you be willing to distribute a brief ACS survey to your students so we may learn about their experience with the e-textbook? Students who complete this survey will receive a $10.00 Amazon gift card.
11.At the end of the semester, would you be willing to complete a short survey about your experience with the e-textbook? As a token of gratitude, you will receive a $20.00 Amazon gift card upon completing this survey.
12.Are you a currently a member of any of the following ACS communities/associations? Please check all that apply
13.If you are not a member, would you be interested in receiving more information about member benefits?
14.Does the ACS have your permission to use the provided contact information for future correspondences regarding chemical safety resources or programs?