First Name:
Last Name:
Address:
City:
Zip:
Phone Numbers:
Home
Work
Fax
Other
Email Address:
Web Address (if any):
PERMISSION TO RELEASE CONTACT INFORMATION
Permission to release home telephone number to students and/or potential students.
Permission to release business number to students and/or potential students.
Permission to create link on community education web page on FRC website with link to your email
address.
Class/Program Title:
Class/Program Description: (Please write a short descriptive paragraph about your class including course content, background or skills
needed. This information will be used to develop a flyer to promote the class.)
Instructional Method(s): lecture lab field on-line blended
Please describe Instructional Method:
Community Education Course Proposal Form
Class/Program Specifics
Start date:
End date:
Number of class meetings:
Day(s) of week:
Length of class meetings:
Time of day:
Minimum # of students:
Maximum # of students:
Course Fee:
Supply Fee:
Location
FRC Campus
Room:
Field
Where:
Other
Where:
Class Requirements
Equipment Requirements
Media Requirements
Supply Needs:
Supplies will be provided by instructor and included in course fee.
Supply list will be provided at registration and students must purchase their own supplies. (Please
attach a supply list with estimated costs.)
Supplies will be provided by instructor, fees collected first day of class.
Instructor/Presenter Background Information: (you may attach a resume if desired)
1. Please describe your experience as it relates to your class/program proposal:
RETURN COMPLETED PROPOSAL TO: Feather River College, Office of Student Services,
570 Golden Eagle Avenue, Quincy CA 95971; (530)283-0202 ext. 273 or 317
2. Describe any other related skills and/or education:
3. Describe your experience in working with the public (include paid and volunteer experience):
Please Provide Two to Three References:
Name:
Phone:
Email:
Name:
Phone:
Email:
Name:
Phone:
Email:
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