Name *

First

Last

Phone *

Email *

Email

Confirm Email

Course Information

Semester *FallSpringSummer

Course Name *

Course Description *

Location *

Begin Date *

Day(s) of the Week *

• Mon.
• Tues.
• Wed.
• Thurs.
• Fri.
• Sat.
• Sun.

Begin Time *

End Time *

Number of Meetings *

End Date *

Max Enrollment *

Cost of Materials-To be Paid to the Instructor

Guest Speakers/Agencies

Will you have a guest speaker or agency? *

• Yes
• No

Guest Speaker Name

First

Last

Contribution to the Class

Phone

Email

Email

Confirm Email

Agency

Contribution to the Class

Contact Name

First

Last

Phone

Email

Email

Confirm Email

Instructional Supplies-These items will be calculated into the course fee.

Do you require instructional supplies? *

• Yes
• No

Vendor

Phone

Website

Item Description

Item #

Quantity

Unit Cost

Vendor 2

Phone

Website

Item Description

Item #

Quantity

Unit Cost

Vendor 3

Phone

Website

Item Description

Item #

Quantity

Unit Cost

Sponsorships

Do you have sponsorship(s)? *

• Yes
• No

Sponsor Company

Contact Person

First

Last

Phone

Email

Email

Confirm Email

Description of Sponsorship

Amount Pledged

Sponsor Company 2

Contact Person

First

Last

Phone

Email

Email

Confirm Email

Description of Sponsorship

Amount Pledged

Submit