Course Proposal Form

Date:*

Facilitator(s):*

Co-facilitator:

Not required.

UND Student Leader(s);

Not required.

Are you UND faculty or staff?

Yes
No

Are you UND alumni?

Yes
No

Are you a tribal member?

Yes
No

Course title:*

Brief description:*

Type of course:

Event (one time only 1-2 hours)
Course (3-4 hours)
Seminar Series (6-8 hours in class + reflection)
Citizens in Action Academy
Camp

Preferred day and time:

Tuesday 3 - 5 pm
Wednesday 9 - 11 am
Thursday 4:30 - 6:30 pm

Ideal Class Capacity:*

If Other, please specify class size:

Do you have a preferred location?

Yes
No

If yes, please provide building name, room number, and contact info. Lifelong learning will be responsible for securing event location for class time(s).

Location:

Please list any additional materials needed?

Is there a field experience component to the class?*

Additional Information or Questions:

Presenter & Bio:

Contact:

Contact Office Phone:

Contact Cell Phone:

Contact Email:

Course Proposal Form

Course Proposal Form

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