NORTHERN VIRGINIA COMMUNITY COLLEGE Community Education Course Proposal Form

Thank you for your interest in teaching a non-credit course for the Workforce Development Division. Please complete and return this form, with your course outline, for consideration.

Proposed Course Title: Instructor's Name: Address: City:    State:    Zip: Home Phone: Work Phone: Email:

COURSE DESCRIPTION: Please provide a description of the proposed course as you would want it to appear in the brochure. We reserve the right to edit and revise the description for publication.

COURSE PREREQUISITES: Please list any specific skills or knowledge (if any) students should have prior to enrolling in your proposed course.

INSTRUCTIONAL OBJECTIVES: List what is to be taught or what activities are to be provided. Be specific and include all topics.

LEARNING OUTCOMES: The instructional objectives listed above should lead to intended student learning outcomes. Please list how you expect a student will develop (personally, socially, or professionally) or what activity you expect a student to be able to accomplish as a result of completion of the instructional objectives.

REQUESTED TEACHING SCHEDULE:

Preferred time of day:  Morning    Afternoon    Evening Preferred day or days of the week: Please check semester availability:  Spring (Jan. – May)    Summer (June – Aug.)    Fall (Sept. – Dec.) Number of class meetings: Number per week: Number of hours per class meeting: Total class hours: Maximum number of students you can accommodate in the course: Will a textbook be used?  Yes    No   Is it required or optional?  Required    Optional   Name and ISBN of textbook: Will handouts be used?*  Yes    No   * (All handouts must be approved by this office prior to your first class) Will the instructor or NOVA make copies of the handouts for the students?*  NVCC    Instructor   * (If you want NOVA to provide copying services, you must provide a clean master) Will any special facilities be needed (such as tables instead of tablet armchairs), easels, running water, etc.?  Yes    No   Will audio and/or visual equipment be needed? Please specify.

INSTRUCTOR DESCRIPTION: Prospective students often inquire about the background of instructors, including their skills, work and teaching experience. Please attach a brief (60 words or less) description which we might read over the phone. Also, please indicate how you would like your name to appear in the printed Schedule of Classes (e.g. Robert Z. Smith, business consultant; Susan A. Jones, CPA; Larry Brown, MBA).

Please provide us with the name, address, and telephone number of two references who are familiar with your teaching.

Please paste your resume, in TEXT format, into the box below, so we may assess your qualifications to teach the proposed course.