Summer Enrichment Youth Course Proposal Form

Proposed Course Information
Course title:
Please write a brief description of the proposed course.
Briefly outline the activities in the course.
If necessary, please list any special equipment (i.e., instructional technology, A/V, easels, lab equipment) or computer lab time you will need. Please be specific with your needs and indicate how often these would be needed.
Room/space requirements:
Student grade level (select one):*

Students entering grades 4-6Students entering grades 7-10
Ideal class size (minimum is 10 students):*
Maximum class size (number of students) preferred:*

Class time (please indicate your first, second and third class time preference):*

Supply List Worksheet
This part of the proposal form must be completed if materials are required. It will help us determine the material fee charge to students for your course. Please note that we try to keep this cost as low as possible. In the event that a course is chosen to be included as part of the program, the instructor is responsible for obtaining supplies for the course(s). We will send you a purchase request form for you to complete and return to us listing actual costs and supplies for your class. Following this, a purchase order made out to the vendor(s) will be provided to you to purchase the supplies.

If item is bought in bulk (i.e. cans of paint), please note this in the chart below.
What is the estimated cost of the materials that need to be purchased for this course? *
How will supplies be purchased?*

Purchase order to vendor (Qualified vendors must accept a SUNY Adirondack purchase order. Please check with your vendors to be sure they do.)Instructor reimbursement

Supply List Worksheet:*

Experience
Have you taught this course in the past?

YesNo
Please describe your education and/or expertise relevant to instructing this course.

List the names, phone numbers and email addresses of three references that are able to express opinions regarding your expertise in this area:

To submit this course proposal, please click the "Submit" button below. After your proposal has been reviewed, the course coordinator will contact you. If you have any questions, please contact our office at conted@sunyacc.edu or (518) 743-2238. Thank you again for your interest in teaching a class with SUNY Adirondack Continuing Education!
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Instructor Information