Non-Credit Program Proposal Form

PLEASE SEND EMAIL WITH CURRENT RÉSUMÉ ATTACHED TO: knugent@bpcc.edu.

Course Information		Instructor Information
Title of Course:		*Name:
Description of Course:		Address Line 1:
Outline of Course (goals, objectives, topics):		Address Line 2:
Target audience:		City:
Total Clock Hours:		State:
Will CEU’s be awarded?	Yes No	Zip Code:
Maximum number of students:		Home Phone:
Suggested fee for course:		Cell Phone:
Salary Requested:		Work Phone:
Proposed dates and times:		FAX:
Equipment needed for instructor:		*Email:
Preferred location:		Social Security Number:
Textbook:
Supplies needed per person:

* Required Fields