COASTAL SENIOR COLLEGE

Affiliated with University College at Rockland

91 Camden Street, Suite 402        Rockland, Maine 04841

This is an abbreviated COURSE PROPOSAL FORM. A printable version is available here. You may need the free Adobe Reader to view and print the form.

Page 1.

1. Course Instructor or Facilitator:
Mailing Address:
Phone:
Email:

2. Course Title: (The catchier the better! Be creative!)

3. Preferred Semester:
Spring
Fall
Winter

4. Preferred Location: Rockland area

Damariscotta Area
Other (Note here):
Note: The schedulers will do their best to accommodate your wishes. However, you may be asked to select another day, time, or location when the final schedules are produced.

5. All classes are held during the day. Thomaston classes are usually on Fridays but an early afternoon slot is also available on other days. Classes in other locations are usually Monday, Tuesday, Wednesday, or Thursday.
Preferred Day:
Preferred Time:

6. If you anticipate any change in starting date, length of class sessions (expected length is 2 hours), a different site location (do you plan field trips?), or number of class sessions other than 8 weeks, please describe here:
7. Class Format: Will your class be expected to take notes, watch slides or videos, break into groups? Please describe the ideal classroom arrangement: podium, chairs in a circle, etc.

Page 2.

8. Minimum class size:
Maximum class size:

9. Instructor or Facilitator: Many of our classes have had multiple speakers or an occasional guest speaker. In either case we expect you to be present during these sessions as “facilitator” for the class. Please list (or attach) all guest speakers, along with their mailing addresses and emails, so they may be invited to the luncheon:

10. Senior College advertises that there will be no term papers, quizzes, or final
exams. However, if you expect students to do weekly or periodic reading,
writing, or other projects, please describe your expectations:

11. Equipment: Please list all requirements for audio-visual materials and equipment, including blackboard or easel, need for room darkening, overhead projector, screen, computer, etc. A portable microphone is available but needs to be requested in advance, as does the computer projector. Also specify the date(s) you will need the equipment..

12. Do you plan to use a text book or other supplies that need to be ordered? (We have a $20.00 limit per student for all materials and supplies.)
YES
NO

(If you checked “YES” please fill out Book/Supplies order form on page 4)

Page 3.

COURSE DESCRIPTION AND BIO

Instructor's Name: (As you wish to see your name in our advertising pieces)
Course Name:
Course Description: (This will be used in our mailings and publicity pieces.) Please give a clear, concise description of course contents, format, and expectations. Know that this may be edited for publication.
Instructor Bio: Share any information you wish about your background or training which would help the curriculum committee know a bit more about you.

Page 4.

COURSE BOOK/SUPPLIES REQUEST

(Use if you checked YES on question 12 on Course Proposal form)

Course Name:
Location:
Instructor:
Email:
Phone:
Maximum number of students:
If you plan to use a text, please list all ordering information: We request that you check either Amazon.com or other web sites for current availability and price. We regret that we are only able to order books which are readily available and can ship within a week. Thank you.
Book:
Publisher:
Author:
ISBN#
Approximate Cost:
Would you like to have us order a copy for you?
Each instructor may use up to $20.00 per student for all supplies, including text and photocopies at .05 each. Keep in mind that a text is not necessary – many instructors find hand-outs work well. We request that you ask UCT to do all necessary copying. Otherwise we may not be able to provide reimbursement.
Other Necessary Supplies: Note that if you purchase materials for which you plan to be reimbursed by Senior College you must include all your original receipts with your bill, which must be submitted on your professional letterhead. Thank you!

(A printable version is available here. You may need the free Adobe Reader to view and print the form.)

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    Coastal Senior College - University College at Rockland - 91 Camden Street, Suite 402 - Rockland, ME 04841       800-286-1594

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