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Walla Walla Community College - Extended Learning DepartmentWinter 2015 Course Proposal Winter Quarter January 8th-March 20th
Session One: 01/08/15-02/15/15 Session Two: 02/16/15-03/20/15Jodi Worden, Extended Learning Coordinator 527-4561 [email protected] Luci Berg, Extended Learning Program Assistant 527-4331 [email protected]
Please fill out completely and accurately. This information will be used to assist us in assessing your expertise, interests, and suitability for teaching opportunities. We use this information to
ensure accuracy when creating your class marketing materials.
INSTRUCTOR DETAILS
Full Name:
Mailing Address:
Telephone No: Cell phone No.
Email Address:
Important: A payroll packet will be sent to you if you are a new employee. This packet will need to be completed and returned to our office no later than Friday, October 31st along with A) a current Driver’s License and Social Security Card or B) Current Passport.
If you wish to teach as a volunteer you will not need to complete the payroll packet. We will have a different form for you.
Instructor Proposal Application P a g e | 1
Previous Instructor: New Instructor: Social Security #:
Instructor Bio (If you're a current instructor, this isn't needed)
Quest: Community Eduation: Kids College: Please choose a program:
Extended Learning Department Course Proposal Jodi Worden, Program Coordinator - 509-527-4561 or [email protected]
Luci Berg, Program Assistant - 509-527-4331 or [email protected]
COURSE DETAILS
Course Title: (This will be printed on the flyer)
Preferred Dates of Class: (Pick length of class and preferred dates that fall in the quarter dates)
Hours Preferred: On WWCC Campus: Total Classroom Hrs:
Maximum Enrollment #: Highest # of Students you would prefer in your class
Required Texts: (Must list Title, Author, ISBN # and publisher if you have a required text for your class)
Materials Required? Yes No Cost to WWCC (estimate) _____________
Instructional Needs: (Photocopying/Transportation for students/Possible Reimbursements/Instructor other than yourself, etc.)
Course Description: (This will be on the flyer....make it fun....sell your class but keep it short so it fits! *550 characters max*)
Instructor Proposal Application P a g e | 2
Session One-5 weeks: 09/29/14-11/03/14
(Please include a list)
Session Two-5 weeks: 11/4/14-12/12/14Custom Date (one day class or less then 5 week class)
Hours Preferred: Off WWCC Campus: Classroom Preference?
Hours you will physically be with your students
Full Quarter Class: 9/29/14-12/12/14
BY MY SIGNATURE BELOW OR BY THE ELECTRONIC SUBMISSION OF THIS DOCUMENT, I certify that to the best of my knowledge there are no misrepresentations or falsifications in my answers to the questions above. I am aware that any misstatement disclosed through investigation will constitute grounds for disqualification and/or dismissal.
DATE: SIGNATURE:
Return Completed Materials to:
MAIL: Office of Extended Learning
ATTN: Luci Berg
EMAIL: [email protected]
Walla Walla Community College 500 Tausick Way Walla Walla, WA 99362
Instructor Proposal Application P a g e | 3
Course Details (We will use this to answer student questions instead of calling you all the time so share the details! )
Extended Learning Department Course Proposal Jodi Worden, Program Coordinator - 509-527-4561 or [email protected]
Luci Berg, Program Assistant - 509-527-4331 or [email protected]
Click Yellow button to email form to Luci
