Non-credit Course Proposal Instructors must submit a separate form for each class you wish to teach. Complete all items on this applications and attach your resume and course syllabus. You may also print the form and mail it in. Instructor first name: Instructor middle initial: Instructor last name: Professional designations/credentials: Address: Phone number: Alternate phone number: Email address: May we give your contact information to prospective students? Yes No Choose all that apply: Phone number Alternate phone number Email address Proposed class title: Proposed beginning date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026 Proposed end date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202420252026 Proposed meeting days: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Proposed beginning time: Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Proposed end time: Hour Hour123456789101112 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Class size minimum: Class size maximum: Will handouts be provided for participants? Yes No What type of handout material will be provided? Will you need Continuing Education to copy and assemble handout material? Yes No Provide links to your handout materials, if available. Are there any special skills or a level of experience required for this class? Yes No Describe the skills or experience students will be required to have. Will the students need to bring any items? Yes No Describe the items students will need to provide for the class. What is the minimum age requirement for this class? What room set up will you need? Classroom Empty with chairs Empty room or studio Other Describe the room and setup you will need. What audio/visual needs will you have? TV DVD CD player Screen Overhead projector Slide projector Data projector Laptop Chalkboard and chalk Whiteboard and markers Other Please describe your additional A/V needs. Class description: In 50 words or less, please describe your class in the way you want it to appear in our publications. Instructor bio: Please describe your qualifications in the way you want it to appear in publications. References Reference 1: Provide your first reference's name, company/title, and phone number. Reference 2: Include your reference's name, company/title, and phone number. It is the policy of the UL Lafayette Continuing Education Department that there shall be no active solicitation in the classroom; specifically, no selling of any personal books, workbooks, pamphlets, CD-ROMs, disks, and/or private/professional services. I agree to the UL Lafayette Continuing Education solicitation policy.
