Name:
*
First Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Phone Number:
*
Please enter a valid phone number.
Format: 000-000-0000.
Date of Birth:
*
-
-
What online or social media presence do you have?
Website
Facebook
Instagram
X/Twitter
YouTube
Other
Website URL:
*
Facebook URL:
*
X/Twitter:
*
Instagram:
*
YouTube URL:
*
Relevant Teaching Experience:
*
Include work experience, training, certifications, etc.
Biographical Information:
*
Include education and background relevant to the topic(s) you teach.
Current or Former NSHE Instructor/Employee:
*
Yes
No
Which area do you want to teach?
Professional Development/Career/Entrepreneurial Courses
Adult Personal Enrichment Courses
EPIC Encore, Courses for Students 60+
Safety Center
Course Title:
*
Full title of Course, ex: "Introduction to Biology"
Have you spoken with a staff person about this course?
*
No
Yes, who did you speak to?
Total Course Hours:
Days of Week and Time Available to Teach:
Course Description:
*
Upload Example of Work:
Browse Files
Drag and drop files here
Choose a file
If your proposed class is an art, craft or photography course, please upload a photo of the work you've done in this subject:
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Upload Example of Work Status:
List Three Ways a Student Would Benefit from this Course:
*
Who is the Targeted Audience for Your Class?
Additional Student Costs:
A reasonable materials fee may be requested (fees must be kept to a minimum and must accurately reflect the tangible cost to the instructor) and must be approved by EPIC. Please describe what student materials are required.
Supplies:
List items that students must purchase in advance.
Preferred Location:
I have my own location
I want EPIC to find a location for me
Facilities Information:
Tables, desks, A/V, etc.
Max. Number of Students:
Course Outline:
List topics that will be covered in each class period and a brief description that may include subtopics.
How will you promote your class?
Please verify that you are human:
*
Sender Name:
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