Continuing Education Proposal Form

CONTINUING EDUCATION
NON-CREDIT PROGRAM PROPOSAL FORM

Instructor Information:

Instructor Name:

Address Line 1:

City:

State:

Zip:

Address Line 2:

Phone:

Email:

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Course Information:

Course Title:

Course Description:

Course Outline:

Target Audience:

Minimum Age Requirement?

Total Course Hours:

Will CEUs be awarded?

Maximum Number of Students:

When would you like to offer this class?

If your course meets the criteria for current industry demands, we will contact you to obtain specific date you are available to teach based upon your preference indicated above.

Will you need any special equipment?

Will you be using a textbook?

Name of Textbook:

Publisher:

Edition or Date:

ISBN Number

Are any specific supplies needed per person?