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NEW COURSE PROPOSAL – please complete entire form (attach additional documents
or sheets if needed)
Please submit form(s) by Tuesday, May 10th, 2016
Instructor’s Profile:
Instructor Name: __________________________________________________________
Address:_______________________________________________________
City:____________________
State:______________
Zip Code: ___________
Telephone:
(cell)
______________
(home) ____________
(work)_________________
E-mail address: _____________________________________
Website:_________________________________
You can provide students my

Email Address 

Phone Number
Social Security # or Tax I.D. #: _________________________________________________
Occupation:__________________________
Salary Expectation: ________________
Provide 2 References (either a supervisor or someone who has taken a class from you):
1. Name:
Email:
2. Name:
Email:
Relationship:
Phone:
Relationship:
Phone:
Note: We are required to have a copy of your general resume on file. Please submit it with this application.
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Class Profile (Please submit one form for each class you would like to teach):
Fall 2016
Note: The following course should be for the month of Sept. 01 to Dec.10th. Do not schedule classes 9/5/16,
11/11/16-11/13/16, 11/24/16-11/27/16, and avoid Sundays (unless class is held offsite).
Name of class:
Proposed date(s) and time(s):
If your proposed date(s) &/or time(s) are not available, please list other options (your availability) here:
Preferred location(s) (i.e. Oceanside campus, San Elijo Campus or other location):
 Oceanside
 San Elijo
 Other ______________________________________
Classroom request or requirements (including room equipment needed):
Standard classroom (comes with instructor computer, overhead projector)
Tables (not tablet armchairs)
Sink
Computer lab
Other ____________________________________________________________
______________________________________________________________________
Amount of time for setup:
[ ]none
[ ]15 min
[ ]30 min
[ ]Other __________
Amount of time for clean up: [ ]none
[ ]15 min
[ ]30 min
[ ]Other _____________
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Minimum number of students: ______________
I am willing to work with students under 18:
Maximum number of students:____________
Yes
No
If “Yes,” the youngest age I am willing to work with is: _______________
Does the child need to be accompanied by a parent/guardian?
Yes
No
Proposed fee to student: $_______________________
Materials fees (Paid by students directly to instructor, write “none” if no material fee is needed. Please list item(s)
and the cost of each material - note what material fees cover. Attach or email a separate copy of materials if you
need more space. Material fees can only reflect the actual retail cost of item(s) provided): $_______________
Materials (What materials must the student have and bring to class? Please attach a separate sheet if you need more
space. This item(s) will either be included in our bulletin/catalog or emailed to students):
Note: We are required to have a reference copy of the curriculum and materials for each of our Community Education
classes. If your course is approved, you will be required to provide our office with a copy of all curriculum and materials
you will be providing to the students. You may attach your curriculum plans with this proposal or send it to me upon
your course proposal being selected).
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Outline of information to be covered (Course content):
Student Learning Outcomes (Class/Seminar objectives, what do you want the student to learn?):
Methods of Instruction (How will this course be taught? i.e. lecture, hands-on, etc.):
Demand: (Why do you think there is a need in the community for this type of class?)
Experience (Have you taught this subject before? Where? What were the results?):
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Competition: (Have you seen this type of course offered at other places? Where and by whom?)
Promotional paragraph suitable for publication (please keep it short but appealing):
MINIMUM REQUIREMENTS
Community Education Class. A Community Education class is a class which meets the following minimum
requirements:
1. Is designed for the physical, mental, moral, economic, career or civic development of persons enrolled therein.
2. Provides subject matter content, resource materials, and teaching methods which MiraCosta College deems
appropriate for the enrolled students.
3. Is open to all members of the community.
4. Is not intended for the promotion of the instructor and/or his/her business interests.
5. Must potentially attract enough participants that the tuition charged will cover all costs associated with offering
the class.