Instructor Application Continuing Education (Non-Credit) Edinboro University Instructor Information
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Instructor Application Continuing Education (Non-Credit) Edinboro University Year______ One of the 14 Universities in Pennsylvania’s State System of Higher Education Instructor Information (Please attach a copy of your instructor bio as you would want it to appear in print) Name____________________________________________________________________________________________________________ Address_________________________________________________City___________________State_______Zip_____________________ Daytime Telephone____________________________________________ Alternate Telephone_____________________________________ Are you currently employed by the Commonwealth of Pennsylvania? ___ Yes ___ No Are you an EUP Faculty Member? ___ Yes ___ No Have you taught this course (or a similar one) before? ___ Yes ___ No If yes, please list where, when, and the contact person______________________________________________________________________ Proposed Course Information Course Title_______________________________________________________________________________________________________ Course Description (for promotional purposes)____________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Class Location: ____ The Porreco College – Erie ____ Edinboro University Main Campus ____ Other, please list_______________________________ Course outline: attach a sheet that lists what subjects/topics will be covered in each class session. Are there any prerequisites for this course _____Yes _____ No If yes, please list the prerequisites:______________________________________________________________________________________ Who is this course designed to reach and who would benefit from it?__________________________________________________________ Please check below how many sessions you will need to cover the course content: __ One-day workshop __ Two-day workshop __ One week __Two weeks __Three weeks __Four weeks __Five weeks __Six weeks __Seven weeks __Eight weeks __Nine weeks __Ten weeks __Other (please specify):_____________________________________________________________________________________________ Please check below the time frame you prefer for each class: __One-hour session __One & one-half-hour session __Two-hour session __Three-hour session __Six-hour session __Other (please specify):_________________________________________________________ Please complete information on other sideď‚® _________________________________________________________________________________________________________________ Proposed course information (continued) What time of day/night do you want to offer your course? (Example: 6:00pm-7:00pm):_________________________________________ Please check the day(s) you want to offer your course: __Monday __Tuesday __Wednesday __Thursday __Friday __Saturday What is the maximum number of students you can effectively manage in your course?____________________________________________ Will you have any material that needs to be duplicated? (If yes, these must be submitted at least three weeks before the class begins) Yes_____ No_____ Will you need any audio/visual equipment? (If yes, list equipment needed, and for which class sessions you will need it on a separate sheet) Yes_____ No_____ Will supplies need to be purchased for this course? (If yes, list what supplies, the cost, and where they will be purchased on a separate sheet) Yes_____ No______ Will the students be required to purchase a textbook? (List required texts only. Specify the complete title, author(s), publisher, vendor, ISBN number, and approximate cost on a separate sheet) Yes_____ No______ Will you require any special classroom set up or facilities? (If yes, please indicate on a separate sheet) Yes_____ No______ Will you require use of a computer lab? Yes_____ No_____ _________________________________________________________________________________________________________________ For office use only (do not write below this line) Course title___________________________________________________ Course accepted: Yes_____ No_________ Course location________________________________________________ Number of sections_____________________________________________ Year____________________________________________ Course date(s)_________________________________________________ Instructor rate_____________________________________ Course day(s)_________________________________________________ Course confirmed (date/initials)_______________________ Course time(s)_________________________________________________ Course description for brochure__________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Instructor description for brochure (50 words or less)______________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Return Application to: Beth A. Zewe – Department of Continuing Education Edinboro University Room 112 Wiley Arts & Science Center 200 Cooper Circle Edinboro, PA 16444 Phone: 814-732-1420 FAX: 814-732-2534 zewe@edinboro.edu
