Name:
Phone:
Email:
Address:
Course title:
Description/syllabus of proposed course:
Suggested enrollment limit:
Will you create a handout for students? Living U will make copies for your students, up to 3 pages per class. YesNo
Proposed number of sessions: OneTwoThree
Proposed length of session(s): One hourOne and a half hoursTwo hours
Days of the week you are available: MondayTuesdayWednesdayThursdayFriday
Preferred date/day/time:
What class elements will your course include? Please check all that apply. LectureDiscussionPowerPoint presentationDVD
What equipment needs do you have? Please check all that apply. Screen and projectorMusic played through sound systemLaser pointerLarge tablet and markersPodiumBlank paper or note cards for studentsPiano
Will you need easels? NoYes
How many easels do you need?
Will you need display tables? NoYes
How many display tables do you need?
Please provide a brief biography for promotional purposes:
We appreciate that Living U teachers volunteer their time and share their knowledge with those in our local community. To show our thanks, we'd like to provide you with a $50 honorarium gift. How would you like this check to be addressed? Please address it to the name and address I've listed above.Please make this donation in my name to the Living Branches Foundation.No thank you — I do not wish to accept an honorarium at this time.
