Continuing Education Course Proposal Form

Name*

First Last

Title (if applicable)

Company (if applicable)

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Alternate Phone

Email*

Course Title*

Are there other instructors or staff involved in course delivery?

If so, please provide details below

Are you offering this course anywhere else?*

Yes
No

If Yes, Where and When?

Course Description*

(Limit 100 Words). What makes this course unique over other similar courses? What can a student expect to learn?

List five specific learning outcomes/major topics to be covered.*

What should students be able to do by the end of the class?

List methods of presentation*

Lectures, demonstrations, field trips, exercises, films, discussions, etc.

What supplies or textbook need to be purchased by you or the students?*

If textbook is required please provide the title, author and ISBN number, plus approximate cost of the book.

What is the approximate cost of these materials?*

This does not include registration fee.

What do students need to bring to the first class?*

Suggested vendors or sources of supplies or textbook*

Name and Location

Will students need previous knowledge or skills in the subject?*

If so, what skills?

Intended Audience*

Describe the target audience of this course. Kids? Adults? General Public? Professionals?

What day(s) would you prefer to teach?*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

How many total instructional hours?*

How many class sessions per week?*

How many weeks?*

Meeting time*

Daytime
Evening
Saturday
Sunday

Do you prefer an intensive or workshop format?*

For example: 2 weekends, 5 days in a row, one day 9 to 5? Describe.

Minimum number of students?*

Maximum number of students?*

Course Budget

Expected compensation per hour*

Continuing Education only pays for classroom time, not for preparation or follow-up.

Number of photocopies per student*

Other course expenses*

Please itemize instructional materials, other costs such as travel, food, project materials, ect.

Other salaries

Please explain

Budget Total*

Special locations, room arrangements or equipment needed*

Suggested marketing/promotion ideas or materials*

Instructor's biography, resume and related experience

Biography*

(limit to 100 words) Include relevant experience, teaching experience, academic degrees. This information will be published online and in printed schedules. Why would a student want to take your class?

Attach your resume*

Accepted file types: pdf, doc, docx, Max. file size: 8 MB.

Education

Provide full information on your education and training.

Institution/College*

City and State*

Dates*

Degree*

Major*

Please provide three professional references for us to contact

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Relationship

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Relationship

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Relationship

I certify that the information on this and any attached form is true and completed to the best of my knowledge.

Signature*

Date*