LIFE Class Proposal Form

LIFE Class Proposal Form
Instructor Information:
Instructor First & Last Name*
Academic Credential Acronym (These are to be used if the class you are teaching is related to your credentials - in a relevant field of expertise.) If this does not apply to you or you wish not to include this information, enter N/A.) *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Instructor Bio: (Please note this information will be included in the back of the printed LIFE brochure, along with all other course instructor/coordinator bios.)*

0/20
Additional instructor (If applicable):
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Additional Instructor Bio: (Please note this information will be included in the back of the printed LIFE brochure, along with all other course instructor/coordinator bios.)

0/20
If there are more than 2 instructors, please email Emily Roberts at ES-Roberts@wiu.edu or Sally Adams at SA-Adams@wiu.edu.
Course Title: *
Course Term*
Ex.: Fall or Spring
In what format do you want to teach? *
Course Description (Please provide a 3-4 sentence description about your class. Refer to the attached brochure for examples.) *
Course Date(s) (Provide top 2 days or dates. For Example: a Tuesday morning in April; 3 Thursday nights in October; or September 4 and 11 from 9 - 10 am. ) Course Proposal will not be accepted until two course date preferences are received. *
Will there be any additional per person expenses?*

yesno
If yes, please explain what and the estimated cost.
For example: Food, $10 per person; Booklet, $5 per person; Craft materials, $12 per person
How many sessions do you want your class to be?
How long will each session be?
Time Preference (If none, write no preference.):*
Site Preference (If none, write no preference.):*
Are you willing to take and submit photos of your class' activites?*

YesNo
Maximum Enrollment:*
Be aware that LIFE will no longer be creating waitlists once a course reaches its maximum enrollment. Instead, instructors can consider increasing their course enrollment by just a few, which allows for the cancellations and no shows that often occur
Will you require any of the presentation equipment listed below? (Select all that may apply.):

ComputerProjectorSpeakersMicrophoneOther
Please submit handouts to be duplicated for registrants at least five days prior to the course start date to the Office of Study Abroad and Outreach, located in Horrabin Hall Room 8. They can also be emailed to Emily Roberts (es-roberts@wiu.edu).
Should be Empty:

LIFE Class Proposal Form

Instructor Information:

Additional instructor (If applicable):