(Continuing and Global Education Use Only)
(Office Use Only)
 Fall  Summer  Spring Year_ ________________
 Extension  Non-Credit  Both  CEUs
EXTENSION COURSE
PROPOSAL FORM*
Class No._ ___________________ _____________________
Extension
*For academic credit courses,
subject and catalog number must be
listed in the current General Catalog.
Course Information

Academic Credit Course
Non-Credit Course
_______________________
Subject
(e.g. ACCT)

Class Section _ ______________________________________
Subject__________________ Catalog No._________________
Course ID________________ Event ID____________________
Tuition Fee:
(Complete front and back of form—
incomplete forms will be returned)

Non-Credit
Salary:
 $75  $________  Non-Credit__________
 Per Salary Scale  ______________
 Other_ ___________________________________
NOTE: The Division of Continuing and Global Education is self-supporting.
An operating budget will be constructed for the course or program.
Both
________________________________________________________________________ ______________
Catalog No. _
Course Title (please complete additional information regarding the course on reverse side)
(e.g. 144)
Class Dates_________________________________________________
Begin
Units
__________________________________________________
End
Lecture ____________________ _______________________ ____________________________ _________________________
LAB/ACT____________________ Time
_______________________ ____________________________ _________________________ Time
Enrollment: Min.______________
Days of the Week
Days of the Week
Max._______________
Preferred Bldg./Room No.
Preferred Bldg./Room No.
Assigned Bldg./Room No.
Assigned Bldg./Room No.
Classnotes:  15 (Web-Enhanced)  17 (Web-Based)
Other__________________
Restricted Enrollment: (Instructor or Department consent required for students to enroll).  No  Yes. If yes, permission numbers will be sent to:
 Instructor
 Dept. Admin. Asst.
 Program Coordinator
 Dept. Chair
 other_________________ (check all that apply)



Mixed Grading (both letter grade and CR/NC)
Grading Options (for topic courses only*):
Letter Grade
Credit / No Credit Grade
*Participants in non-credit courses receive either a CP (Completed Program) or NCP (Not Completed Program).
CEUs Requested: Contact Hours ___________
Will this class be team taught?

Instructor Information
No

 BBS  CPAAC  BRN  CRC  Fresno State
Yes [If yes, please attach additional form with “instructor information” section completed for other instructor(s)]
Instructor's Name: ______________________________________________________________________________________________________________
Last
First
Middle Initial (Needed for Payroll Purposes)
Highest Degree Held_______________________________________________ E-mail Address_______________________________________________
Home Address_________________________________________________________________________________________________________________
Street
City
State
Zip Code
Fresno State ID_________________________________________________Telephone_______________________________________________________
(Office)
(Off-Campus Phone)
Campus Department _____________________________________________Mail Stop______________________________________________________
Yes. If yes, you may not be currently eligible to teach this
class. Please contact the Faculty Affairs Office for clarification.
Yes, contact Faculty Affairs.
Financial Eligibility: Will this assignment put you over the 125% workload limit?  No
Are you on the Faculty Early Retirement Program (FERP)?
 No 

For instructors who are not currently Fresno State employees/faculty:
Is this your first time signing up with California State University, Fresno Payroll Services?
 , we will inform you of the next steps
 No, list date of last appointment_________________________
FOR OFFICIAL USE ONLY FOR ACADEMIC CREDIT – TO BE COMPLETED BY DEPARTMENT STAFF Signature _____________ Extn ___________
Instructor Rank: (please check one)

Lecturer D

Lecturer C
 Professor 
 Lecturer B Associate Professor

Lecturer A 

Assistant Professor

Lecturer L
Volunteer (volunteer form attached)

Teaching Associate
Instructor’s Signature_____________________________________________________________________ Date __________________________________
Approved by Department Chairperson________________________________________________________ Date __________________________________
Approved by School Dean _________________________________________________________________ Date __________________________________
Authorized by____________________________________________________________________________ Date __________________________________
Authorized Signature, Continuing and Global Education
9/14
Continued on reverse side
IF THIS PAGE IS NOT COMPLETE THE APPLICATION WILL BE RETURNED.
(Attach separate sheet if necessary.)
Target Audience: Please describe the intended audience for your course and any specific organizations, associations, professions, etc., useful
in marketing your course.
________________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Course Objectives/Student Learning Outcomes:_____________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Course Description: (150 words maximum) ___________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Instructor Description (40 words maximum) as it would appear in CGE promotional materials: ___________________________________
______________________________________________________________________________________________________________
Notes To Instructors:
• Course fees for academic credit courses:
1. If the instructor salary is paid by Continuing and Global Education (CGE) based upon the California State University Extension Salary
Schedule, the course fee is set in accordance with the University policy. (A pay scale can be obtained through CGE.)
2. If course expenses, including instructor’s salary, are paid by the requesting agency or organization, participants are charged a per unit fee.
• California State University, Fresno faculty are restricted on the amount of time they may devote to, and the salary which they may earn by, outside
employment. This information should provide the needed accountability in this area, as well as to insure that all extension courses are regulated through
the CGE.
• If you anticipate instructional expenses beyond regular salary, authorized travel, or routine publicity, prior approval must be obtained from the Associate
Vice President or Associate Dean of CGE.
• Grading System for Non-credit Courses:
Students can earn the grade of Completed Program (CP) if they attend and complete the course at the specified days and times. The grade of Not
Completed Program (NCP) will be given to a student who does not attend or who does not complete the course.
• The fees collected for CEUs will be retained solely by Continuing and Global Education.