Personal and Professional Enrichment Classes - Instructor Proposal

Complete one proposal form for each class.  Please email course outline to either dana.j.chacon@svcc.edu or brenda.helms@svcc.edu.  In the subject line please include the name of the course. 

1. 1. First Name
   2. Last Name
   3. Sauk ID @99887766
   4. Address
   5. City
   6. St
   7. Zip
   8. Home Phone
   9. Work Phone
   10. Cell Phone
   11. Email Address
   12. How do you want to teach the class? Check one or both.

       1. Online
       2. On-Campus
   13. If you want to teach online what online format or program will you be using?
   14. Title of Course
   15. Course Description
   16. If you want to teach the course off-campus, please include the name & address of location
   17. What is the minimum age of a student can be to enroll into this class?
   18. What is the maximum number of students for this class?
   19. What is the minimum number of students for this class?
   20. Select the day you prefer to teach. MondayTuesdayWednesdayThursdayFridaySaturday
   21. How many weeks will your class meet?
   22. Preferred Date - 1st Choice
   23. Preferred Date - 2nd Choice
   24. Proposed Time - 1st Choice
   25. Proposed Time - 2nd Choice
   26. Textbook, if required Title, Author, Copyright Date, Edition, Publisher, ISBN#)
   27. Supplies students need to bring

Please mail, email or drop off handouts that you need copied for class at least one week before the start date. 

1. Equipment - Please select what your will need in your classroom

   1. Overhead Projector
   2. Computer
   3. Flip Chart
   4. Video/TV
   5. Computer Projector
2. Other Equipment
3. Special Concerns or Comments