Academy's Workshop/Course Proposal

Name First Last
Credentials
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email
Phone - (###) - ### ####
Please attach a resume with information pertaining only to your proposal topic. This information will be used to develop a short profile of your credentials to be used for marketing purposes and to share your credentials on website.
Please attach a jpeg of the instructor, which will be used for marketing purposes.
Workshops/Courses

Workshops are one-time events 1.5 hours in length and are meant to introduce a topic to participants. Workshops may be scheduled to begin on September 10, 2013 or thereafter.

Courses are held 3-4 times and are designed to explore a subject more thoroughly than a workshop or develop an introductory skill that can then be built upon by the participant. A course might be held e.g. Tues. and Thurs. from 9-11am for two weeks or Tues. from 9-11am only for 4 weeks. Courses may be scheduled starting on October 1, 2013 or thereafter.
Workshop/Course Title
Workshop/Course Description: 3-4 sentences
Please list 2-3 Learning Objectives.
Objective 1
Objective 2
Objective 3
Please list any technology needs you may have
Please indicate a date and an alternative within the following framework.

Fall 2013 ...... September 10 - November 22, 2013

Workshops and Course start times are between 9:00 - 5:30pm on Tuesday, Wednesday, and Thursday. The Academy only has programming on days the University is in Session.
1st Choice: Date(s)
1st Choice Time (Beginning) : HH MM AM/PM
1st Choice Time (Ending) : HH MM AM/PM
2nd Choice: Date(s)
2nd Choice Time (Beginning) : HH MM AM/PM
2nd Choice Time (Ending) : HH MM AM/PM
After Supply Expenses, there will be a 60/40 payment split: 60% to Instructor(s) & 40% to the Academy.
Make check payable to or indicate the percent wanted if splitting the payment between payment choices.

Please check your choices. myself SCE Scholarship Fund Academy of Lifelong Learning
Percentage, if splitting
Thank you for your offer of assistance! Please leave any questions or comments below or call 217-581-5114. Completed form due by 4pm, March 20, 2013.

Academy's Workshop/Course Proposal

Academy's Workshop/Course Proposal

Please indicate a date and an alternative within the following framework. Fall 2013 ...... September 10 - November 22, 2013 Workshops and Course start times are between 9:00 - 5:30pm on Tuesday, Wednesday, and Thursday. The Academy only has programming on days the University is in Session.

After Supply Expenses, there will be a 60/40 payment split: 60% to Instructor(s) & 40% to the Academy.

Please indicate a date and an alternative within the following framework.

Fall 2013 ...... September 10 - November 22, 2013

Workshops and Course start times are between 9:00 - 5:30pm on Tuesday, Wednesday, and Thursday. The Academy only has programming on days the University is in Session.