Course Information: New       Repeat

Course Title:

Course Description:

Instructor Data: Please send email with a current resume attached to lifelong@sonoma.edu

Name of instructor:

Home Address: Address, City, State and Zip

Home phone:   Work Phone:

email:       Fax:

Academic Degree(s):

Teaching Experience:

Brief narrative biography of instructor(s) for catalog:

Scheduling Information:

Proposed Session: Mon     Tue      Wed      Thurs

Check Time: 10-11:45am      1-2:45pm

Number of meetings: 8

Enrollment Limit:

Photocopying:

Please bring your non-copyrighted materials or send them to the attention of Faculty Support Coordinator at least one week prior to the date this material is needed. Specify the title of the class and any pertinent photocopying instructions and we will have the work processed and ready for pickup prior to your first class meeting.

I would like Extended Education to duplicate my non-copyrighted materials. The number of copies per student is:

I will have my non-copyrighted materials duplicated off campus and will submit an invoice with original receipts immediately after the last class sesssion for reimbursement. The number of copies per student is:

My materials packet includes copyrighted materials. The number of copies
per student is . The will be submitted to Extended Education 90 days before the class begins and will be available for purchase in the SSU Bookstore.

My materials packet consists of materials written by me under my own copyright. A statement granting permission for copying will be clearly written on the materials. The number of coies per student is

Audio Visual Aids Request (e.g. VCR, overhead projector, cd/cassette player, flipchart, etc.)

Equipment may be reserved at the time you submit your proposal. If you want to make additional requests, please call the Faculty Support Coordinator at least two days before the class meets at 664-2394 and specify the dates and times you wish to reserve material. Additional equipment is available on a first-come first-served basis.

Type of Equipment:

Dates and times needed:

Other: