College for Seniors Course Proposal Form              

Please fill out the form below and press submit

NEW Course:  Please answer all Questions.
REPEAT Course: 
You may omit #9-11

First Time Instructors:  Include a summary of your experience pertinent to course being proposed, or a resume. 


1. Name of Course        
2. Instructor(s):
3. Mailing Address
4. Telephone Number
5. E-mail address:

6. May we list your e-mail address in the catalog?  Yes  No

7. Additional instructors:

8. Is this a new course or a repeat course? ( if a repeat, you may omit #9-11)

9. Instructor bio for catalog:
      (30 words or less)

10. Course Description:
     (no more than 60 words)

11.  Course outline: (provide an outline for each class meeting including trips, guest lecturers, film, etc)

12. Are you willing to teach more than one section of this course in the same term? Yes  No

13. Requested term:     Summer     Fall     Winter     Spring

14. Course Length:     4 weeks     8 weeks     Other - explain

15. Maximum student limit (enter 0 if no limit):

16.  I am available to teach (check ALL that apply:

    Mon Tues Wed Thur Fri Sat
    9:00 - 11:00 AM
    11:30 - 1:30 PM
    2:00 - 4:00 PM
    5:30 - 7:30 PM
    Any time, any day

    Other:
    Preferred days/times:

         Studio classes may be 2+1/2 to 3 hrs.;  Wellness classes may be 1+1/2 hrs.

17. Format:

  Learning Circle

(trained facilitator leads discussion on themes/topics drawing primarily from participants’ experiences,  knowledge, interests and concerns)

  Lecture - Discussion

(information presented by teacher; participants may ask questions/react)

  Seminar

(instructor led; participants required individually/in groups to research/present findings)

  Wellness Class

features appropriate exercise/fitness activities)

  Skill Building

(hands-on approach to acquire certain skills)

18. Equipment Required (check as many of the following as you will need): 
        None Required
 
       Player / Recorder      Projector      Miscellaneous
  cassette player  Elmo (opaque projector) flip chart
  cassette recorder LCD and computer   lectern
  CD player  LCD projector  (have own laptop) microphone/s
  DVD player slide projector  portable white board
  VCR and TV transparency projector other:

19. Handouts:  I will need (total number of pages per person) for course (enter 0 if no copies needed)

20. Textbook: none needed    recommended    required (should not be over $30)

    Title:
    ISBN:
    Price:

21. Any additional fees or materials which the student must purchase?  Yes No. 

If Yes, estimated cost per student is and please provide a materials list (especially for arts and crafts courses)

22. Under which of the following categories do you want your course listed in the catalog (select one only)

  Arts/Crafts History Philosophy/Religion Women's Studies
  Computing  Language & Literature Psychology  
  Contemporary Issues  Music/Dance Science/Math  
  Finance / Business / Law Personal Development  Wellness Unsure

23. [For repeat course proposals only]  When was this class last taught?  


Copyright © 2006 North Carolina Center for Creative Retirement.  All rights reserved.
Revised: August 28, 2009 .