Community Education
Non-Credit Course Proposal
Complete this form (one form per course) and mail to the following: Kelley Tilden, Director of Community Education, 1 Massasoit Boulevard, Brockton,
MA 02302, or email ktilden@massasoit.mass.edu or call (508) 588-9100 x1310.
INSTRUCTOR INFORMATION
Can students contact you directly? Yes No
If yes, please check all that apply. Day Phone Evening Phone Email
SCHEDULING INFORMATION
Available to Teach (check all that apply)
Mornings Afternoons Evenings
Days Available to Teach (check all that apply)
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Please tell us if there is an ideal class size and why. Also, tell us if there is a maximum class size and why.
Second Choice Dates (for scheduling flexibility)
Location: Willing to Teach at (please check all that apply)
Brockton Canton Middleborough
Own Facility (requires certificate of liability)
If own facility, please supply business name and address
CLASSROOM NEEDS/EQUIPMENT
Which would you prefer? Desks Tables What type of flooring do you prefer? Carpet Tile
Do you need an open space for movement activities? Yes No Do you need a sink? Yes No
Do you need computers for all students? Yes No Any other special accommodations or needs? Please explain.
Do you need a computer for the instructor? Yes No
Do you need a projector? Yes No
Do you need a CD player? Yes No
Type of computers required? Mac PC
Software needs, please specify _______________________________________
OFFICE USE ONLY
Subject Category for Print Catalog __________ Subject Category for Banner/Online:___________ Number Grade Required? _______________
