Community Education Class Proposal

Name:

Email:(required)

Phone:

Address:

City:

State:

ZIP:

What is the best way to contact you?

When is the best day/time to contact you?

Class title:

Describe the class you are proposing:

Describe the benefit the student will receive from your class:

Instructor's qualifications and experience:

Have you taught this class previously?

What enrollment did you have?

Please explain why you feel the program was successful:

Room requirements (tables, chairs, desks, sinks...):

Additional equipment needed (computers, internet access, projector, VCR, overhead):

Materials to be supplied by student:

Instructor and supply fees (what you expect to be paid per hour):

Other information you would like to share about your proposed class: