Date Submitted:
______________
OLLI COURSE PROPOSAL FORM
Course Title: Click here to enter text.
Instructor Name: Click here to enter text. Credentials (ex: PhD): Click here to enter text.
Address: Click here to enter text.
Home Phone Number: Click here to enter text. Cell Phone Number: Click here to enter text.
E-mail Address Click here to enter text.
1. What is your class format? (Check one)
A. ☐Discussion group: (Common interest group with shared responsibility for topic. There may or
may not be readings.)
B. ☐Reading group: (Selected readings with a coordinator and discussion.)
C. ☐Lecture with discussion: (Course leader is responsible for planning and leading the course, and decides on readings
or other materials.)
D. ☐Other: (Please elaborate in your description on the second page.)
2.
Maximum number of participants preferred. You must indicate a number as this will
determine the classroom where your class will be held. Normal limit is 32 to 40 Click here to
enter text.
3.
I prefer to teach in: (Check one) ☐Sioux Falls
4.
Available for which OLLI Term?
☐Fall (Sept – Oct)
☐ Winter (Jan – Feb)
☐Brookings
☐Vermillion
☐Spring (Apr – May)
☐Any Location
☐Any term
5.
Day of the week preferred:
☐M ☐T ☐W
Second day option:
☐M ☐T ☐W
Indicate specific date, if needed: ______________
☐TH
☐TH
6.
Approximate time of day preferred:
2nd option Click here to enter text.
7.
Course length: OLLI terms are about 6-9 weeks in length. Most classes meet once per week.
You may choose the number of weeks you teach your proposed class (Best length for our OLLI
Click here to enter text.
☐F
☐F
☐Sat (Check one)
☐Sat (Check one)
members is 4 weeks or less.)
Please indicate the preferred length of your course in weeks. Click here to enter text.
8.
Indicate the length of the class sessions. ☐60 minutes
9.
Indicate the AV equipment you require to teach your proposed class below:
(If you do not require equipment, please check “none.”)
☐ Desktop Computer
☐ Internet Access
☐ Microphone
☐ Easel
☐ Laser Pointer
☐ Laptop Computer
☐ PowerPoint Remote
☐ DVD Player
☐ Paper & Markers
☐ Document Camera
Other Needs: Click here to enter text.
☐90 minutes
☐ Instructor will bring computer
☐ Whiteboard & Markers
☐ Mac Adapter
☐ Podium
☐ Distance Learning Technology
☐2 hours
☐ LCD Projector
☐ Speakers
☐ Screen or Blank Wall
☐ Overhead Projector
☐ None
10.
Payment Options (check appropriate payment option)
☐ Decline honorarium payment, providing this educational opportunity FREE of charge, as a donation to
OLLI…Thank You!
☐ Decline partial honorarium payment as a donation to OLLI…Thank You! Donation amount: Click here to enter text.
☐ University Employee
Contact OLLI Director, Nancy Wehrkamp at 605-367-5226 to confidentially provide SSN# or AID#.
☐ Guest Lecturer - Completed W-9 is required to be on file (If taught in previous term we have this document on file)
☐ Professional Speaker – Negotiated amount: Click here to enter text. - Completed W-9 is required to be on file
(If presented in previous term we have this document on file)
11.
Describe your course below. We use your description to advertise this course in our OLLI
brochure. Write your description in a manner that will clearly explain the course and entice members
to sign up. Note if field trips, physical activity or special skills are required. ~50 words or less~
Click here to enter text.
12.
Briefly describe your education and experience as you would like them to appear associated
with your name in the course brochure. Include your experience in teaching, facilitation and or
leading discussion groups with older adults. ~20 words or less~
Click here to enter text.
13.
If you are brand new to teaching for OLLI, please list 2 references (name and phone number,
email address) we can contact that can tell us about your teaching experience/ability.
1. Click here to enter text.
2. Click here to enter text.
14.
If a book or books are required for this class, please list the title(s) and author(s)
Click here to enter text.
Text/book is ☐Optional
☐Required Approximate cost of text/book(s) Click here to enter text.
Book(s) can be found at the following locations: Click here to enter text.
15.
Special materials/supplies required for the course (to be purchased by the student)
or additional fee per person (instructor will purchase supplies):
Click here to enter text.
Save this form in your personal computer files and then email to info@olliuc.org along with a
current résumé or CV (if available).
- OR Return this completed form and a current résumé or CV (if available) to the OLLI office:
University Center
Attention: Osher Lifelong Learning Institute
4801 Career Avenue
Sioux Falls, SD 57107
Updated OLLI Course Proposal Form: March, 2015