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Instructor Form

Instructor Profile
Instructor's Name:
Address:
City:
State: Zip Code:
May we give your phone/email to prospective students? Yes No
Email:                        (Example: 208-792-2447)
Phone: Secondary Phone:

Instructor Biography for Catalog and References

Instructor Bio                                                                       Use Previous (if within the last two semesters)
Please describe your qualifications the way you want it to appear in our publications.  (We reserve the right to edit.)

 
Professional References                                                     Use Previous (if within the last two semesters)
Please list three contacts who can speak of your ability in the subject area you want to teach.
Name:  
Phone:   (Example: 208-792-2447; Please include area code)
Position:  
Organization:  
Name:  
Phone:   (Example: 208-792-2447; Please include area code)
Position:  
Organization:  
Name:  
Phone:   (Example: 208-792-2447; Please include area code)
Position:  
Organization:  

Course Information
Semester:          Year:
Class Title:    (Example: Intro to Underwater Basket Weaving)
Location: LCSC Campus    Grangeville     Orofino     Clearwater Valley
  Other: (Example: Bryden Canyon Golf Course)
Class Calendar Dates -
Section 1 Dates and Days of Week
Numeric Dates:

       (Example: 3/24, 26)
Days of the Week:   (Example: Mon. & Wed. OR Tues.)
Section 2 Dates and Days of Week
Numeric Dates:

 
Days of the Week:  
Section 3 Dates and Days of Week
Numeric Dates:

 
Days of the Week:  
Section 4 Dates and Days of Week

Numeric Dates:

Days of the Week:

  
Number of Days in class:                        (A 4 week class meeting every Tues. & Thurs. is an 8 day class)
Time Class Starts:     Time Class Ends:    
Time the room needs opened:    
*If additional times are needed please clarify at the end of form.
Class Size:      Minimum       Maximum   
Course Fees:
Base Fee $  (Set by the instructor; Salary is 50% of the base fee)
Misc. Fee $
Please Describe:            
                                          (Example: Supplies, Equipment Rental, etc.)
Are there age restrictions? (If yes, please specify below)                     Yes  No
Are there any special skills or a level of experience suggested/required for this class?
 

Continuing Education Catalog Course Description         Use Previous (if within the last two semesters)
(We reserve the right to edit.)
 
 

Course Supplies and Facilities

--> Additional supply fees will be based on this information
--> Please check below the items needed/required and approximate cost per student
--> Use text boxes to describe details as you see fit
Be sure to specify if you do not need the required equipment.

If you have questions, please contact the Continuing Education Office.
Room Requirements Lab/Computer Needs
 
I need a computer lab:  Yes No If yes, then how many computers?  

Audio/Visual Equipment

No Equipment Needed

LCD Projector

Transparencies

DVD Player/TV

Opaque Projector

Laptop Computer

VCR/TV


Use this space to specify all room requirements or no room requirements at all.
(sinks, desks, rectangular tables, etc)
You can also use this space for any miscellaneous room requests
 
Textbooks and Handouts Textbook                                                                                                                         No Textbooks
 
Textbook required $  per student for the text
I would like CE to purchase I will supply the text book
Textbook Name:
Publisher:
Edition:
ISBN:


Handouts & Photocopies                                                                                            No Materials

  Number of Handouts at $ per student for the handout
I will supply photocopies at $ per person.

Continuing Ed will make copies at 5 cents per page
     (Instructor must provide the materials 10 days prior to class start date).

Transportation                                                                                                              No Transportation

I need transportation for the following day/dates:

I agree to take the 15 passenger van driving test

 
Miscellaneous Please list or clarify any information not covered by options on the form:
TEACHING FOR OTHER LC VALLEY ORGANIZATIONS
I understand that I am free to teach for other LC Valley organizations (i.e., YWCA, WWCC, Lewiston Parks & Recreation, etc.), and I agree to not offer the same class I am teaching for LCSC CECE during this catalog term.





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