EmailMe Form - ISD 728 Community Education Course Proposal Form

Suggested Class Title: *

Targeted Age Level(s): *

Instructor Name: *

First Last

Business/Vendor name (if applicable):

Cell Phone:

### - ### - ####

Work Phone:

### - ### - ####

Email: *

Address *

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

Course Outline/Major Topic Areas/How will the tiime be spent? *

Suggested Course Description for Marketing: *

Have you taught this course before: *

Yes

No

If yes, when and where?

Days/Time available to teach course: *

# Sessions suggested for course:

Amount of time suggested per session:

Minimum/Maximum # of students:

Type of room or setup needed:

Materials-Equipment-Teaching Aids required:

Estimated supply costs:

$ Dollars . Cents

Additional Comments/Information:

Instructor Bio Information (include education, training, certifications, etc. as they relate to proposed course):