CE Course Proposal Form
Name:
*
Title (if applicable):
Company (if applicable):
Address:
City:
State:
Zip Code:
Email Address
example@example.com
Website:
Home Phone:
-
Area Code
Phone Number
Cell Phone:
-
Area Code
Phone Number
Business Phone:
-
Area Code
Phone Number
Program Type:
Personal Enrichment
Professional Development
Leisure Learning
Other
Course Title:
Course Description:
Course Format (check all that apply, at least 1 is required):
*
Lecture
Discussion
Hands- on
Other
Target Group:
Prerequisites (E.G. – music reading ability; basic computer skills; knowing certain dance steps, etc.)
What special experience or education qualifies you to teach the course you are proposing?
Total Number of Course Hours:
Hours per Session:
Sessions per Week:
Total Number of Weeks:
Preferred Days: (Please check all that apply)
M
T
W
TR
F
Sat
Preferred Times:
Preferred Class Location (check all that apply):
Wharton
Sugar Land
Richmond
Other
Textbook Required:
Yes
No
Textbook Title:
Textbook Author:
Textbook ISBN#:
Textbook Publisher:
Do you anticipate that handouts will be needed?
Yes
No
Not Sure
If so, please indicate the expected total number of pages per student:
List other materials that are necessary, including an accurate cost amount for those materials:
Recommended class size for the students to have a good experience:
Room requirements: Indicate any special classroom set-up needed. Our classrooms are all different,table and chairs, tablets, arm chairs or lecture. For classes with special needs the tables can be moved or removed.
Multimedia requests: Computer(s), projector, internet, etc.
Learning Objectives: List at least five course completion outcomes. (What will the student know, be able to explain, be able to apply in their lives, be able to analyze, be able to create, or be able to evaluate?)
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