RENAISSANCE ACADEMY OF FGCU PRESENTATION PROPOSAL FORM
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Last Name:
First Name:
Title:
Florida Address:
Address Line 2:
City/State/Zip:
Telephone/Fax:
(Select One)
Term:
(
)
-
(
Full Time
)
Jan – May
Ms.
Dr.
-
Alt. Telephone:
(
)
-
Alt. Fax:
(
)
-
Oct - May
Please consider teaching in at least two of our terms. Please mark your selections:
Summer 16 (Jun-Aug)
Locations:
Mrs.
Alt Address:
Alt Address 2:
City/State/Zip:
Email:
Residency:
Mr.
Fall 16 (Sept - Nov)
Winter/Spring 17 (Jan-May)
Please consider offering your course in at least two of our locations. Please mark your selections.
Naples Center (downtown)
The Brooks (Estero)
Atrium Exec Center (Ft Myers)
Marco Island
Moorings Park (Naples)
Estero Country Club
Bentley Village (Naples)
The Terraces (Bonita Springs)
Herald Court Centre (Punta Gorda)
The Club at Grandézza (Estero)
The Club at The Strand (Naples)
The Club at The Strand (Naples)
FGCU Main Campus
Presentation Category:
Presentation Title:
Number of Sessions:
Session Length:
One
Two
1 hour
Three
1.5 hours
Preferred Start Date:
/
/
Preferred Start Time:
Morning
Four
2 hours
Other
Preferred Days:
Afternoon
Other
Monday
Evening
Max # of Students (if any):
Tuesday
Wed
Thurs
Friday
Other
Dates Which I am Definitely Unavailable:
AV or Other Requests (projector, lectern, microphone, etc):
Requested Room Setup (theatre style, podium, circle of chairs):
Description of Presentation for Publishing in the Catalog (75 words or less):
Biography for Publishing in Catalog (30 words or less):
Anyone you would suggest we contact regarding the possibility of teaching a Renaissance Academy class?
Name:
Tel: (
)
-
Email:
FOR OFFICIAL USE ONLY:
DOW:
LOC:
DATES:
CAT:
NOTES:
TIME:
FEE:
Please contact John J. Guerra at 239-287-5196 or jguerra@fgcu.edu with any questions regarding this form.
Revised: 12/12/14