Living U Course Proposal Form

Name: *

Email: *

Phone: *

Street Address *

City *

State *

Zip Code *

Course title: *

Description/syllabus of proposed course: *

Class size:As many as would like to attendI would like to limit the number of students

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

Preferred date/day/time: *

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 have 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.

Living U Course Proposal Form

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