Fillable Mt. San Jacinto College FOCUS Class Proposal Form (Mt. San Jacinto Community College District)

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Mt. San Jacinto College FOCUS Class Proposal Form (Mt. San Jacinto Community College District)

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Mt. San Jacinto College
FOCUS Class Proposal Form
951-487-3711
Submit by: ________________________ Semester: ______________________
Date Submitted: ________________________ Date Received: _____________________
Office use only
Proposed Class Title: ________________________________________________________________
Business Information
(please complete all fields): Instructor Information
_____________________________________________________ _________________________________________________
Business Name (as stated on W-9 or tax ID) Instructor’s Name (if different from business)
______________________________________________________ _________________________________________________
Owner’s Name (or signer of contract) Phone
______________________________________________________ _________________________________________________
Address Email (required)
______________________________________________________ Has s/he taught this class before? Yes No
City, State Zip
______________________________________________________ _________________________________________________
Phone If yes, where?
______________________________________________________ Do you have evaluations you can share? Yes No
Email If yes, please submit with proposal
Please provide contact information for students
____
________________________________________ ________________________________________
Email and/or Phone
Proposed Class Description (In 75 words or less, tell us why someone would want to take your class)
Proposed Class Schedule (Note: Credit classes always have classroom priority. Saturday classes on Menifee and San
Jacinto campuses are the most flexible for scheduling. There are no Friday or Saturday classes during June or July.
Number of weeks: ____________ W TH F SA
Mi
n # of Students: ____________
S
tart Date: ______________
S
tart Time: ______________
Min. Enrollment: ______________
Meeting Days: M T
Max # of Students: ____________
End Date: ______________
End Time: ______________
Max Enrollment: ______________
Total Sessions: _________
Hrs Per Class: _________
Total Class Hrs: ________
Preferred Location of Class (check Academic Calendar for holidays and school closures)
Menifee Campus San Jacinto Campus Temecula Higher Education Center
28327 La Piedra Rd 1499 State Street 43200 Business Park Drive
Menifee, CA 92584 San Jacinto, CA 92583 Temecula, CA 92590
Off Campus Meeting Location
If this class requires students to meet at a location off an MSJC campus, please provide the name and address of location
A Certificate of Insurance is required in the following amounts for off-campus locations:
Commercial general liability insurance coverage:
• $1,000,000 per occurrence (combined single limit for bodily injury and property damage);
• $1,000,000 for personal and advertising injury liability;
• $1,000,000 aggregate on products and completed operations and $2,000,000 for general aggregate.
• List District as an additional insured
Please email to businessservices@msjc.edu
Instructor/Contractor Cost
What fee do you expect for teaching this class? $________________
(MSJC will determine the cost of the class based on your requested fee)
If there are materials, what are the cost? $________________
(
Please provide a detailed list of items provided to students)
Total fees to be paid to instructor/contractor: $________________
Student Supplies/Textbook
Are students required to purchase a textbook for this class? Yes No
If yes, please provide the following:
Textbook Title: __________________________________________ Author: ________________________________
ISBN#: ________________________________________________ Approx. Cost: __________________________
Are there any other supplies students will need for class? If yes, please list:
________________________________________________________________________________________________
IMPORTANT!
By submitting this proposal to the Community Education office, you agree to the following:
• No fees may be charged or collected from student in class. A walk in student must register online at
msjc.edu/FOCUS.
• No services, products or materials may be sold in class.
• Instructors/contractors are not permitted to use this class to promote their personal business.
• A proposal is not a guarantee that the class will be offered. Classes are contingent on sufficient enrollments
Instructors will be reimbursed 100% of
material fees when a list of items has been
provided with the proposal form. Materials
cannot cost more than the class.
Office Use Only:
Total Cost of Class
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Mt. San Jacinto College FOCUS Class Proposal Form (Mt. San Jacinto Community College District)

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Completed 25 July 2020

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