COURSE PROPOSAL
ACADEMY

INSTRUCTOR:   Last Name

First Name

PREFERRED SESSION(S):     Please circle ALL appropriate information.

_____ Session A (June 18 - 22) GRADES 5,6
_____ Session B (June 25 - 29) GRADES 5,6
_____ Session C (June 25 - 29) GRADES 7,8
PREFERRED PERIOD(S):

____Class Period 1 (8:15-9:15am)
____Class Period 2 (9:30-10:30am)
____Class Period 3 (10:45-11:45am) 
____Class Period 4 (1:00-2:00pm)
ALTERNATE PERIOD(S):
MEDIA EQUIPMENT NEEDED:
SPECIAL ROOM NEEDS:
DO STUDENTS REQUIRE SPECIAL MATERIALS?_______ WHAT ARE THEY?
ARE THERE ANY SPECIAL SKILLS OR A LEVEL OF EXPERIENCE REQUIRED FOR THIS CLASS?_______ EXPLAIN:
COURSE TITLE (snappy titles, list a few choices)
COURSE DESCRIPTIONS (Please write a fabulous course descrition describing your class that will entice students to sign up for it. Every description should be creative, accurate and include solid course information. 50 words or less):
DESCRIBE THE OBJECTIVES OF THIS COURSE AND THE HANDS-ON ACTIVITIES YOU WILL USE TO REACH THEM.
INSTRUCTOR INFORMATION ACADEMY

ALL INSTRUCTORS:

1.  Name:     

 Social Security #
2. Street Address:

City:                                                    State:                            Zip:

3. Day Phone: Evening Phone: Email address:

4. School or Business:

Position:
5. Please write a short biography (25 words or less) to be used with our course descriptions. Please include teaching experience, degrees earned, accomplishments and awardsl.
 

NEW INSTRUCTORS ONLY:

PLEASE COMPLETE THE SECTION BELOW AND INCLUDE A CURRENT RESUME WITH THIS APPLICATION. Indicate the names of two people who can speak to your ability in the subject area you wish to teach.

Name, Address, Phone:

Name, Address, Phone:

Name, Address, Phone:

RETURN INSTRUCTOR INFORMATION FORMS BY FEBRUARY 26, 2007 TO: ACADEMY 2007, SOU Extended Campus Youth Programs, 1250 Siskiyou Boulevard, Ashland, Oregon 97520 (541) 552-6916