Name of Presenter: (First name, Last name) *

E-mail: *


Address: *

City, State, Zip: *
Select State or Province Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Daytime Phone: *

Cell Phone:

Are you a new OLLI instructor? (first time teaching through OLLI)? *
Yes
No

Biographical information or expertise: *(required for new instructors)
If you are a new OLLI instructor or have updates, please attach or type biographical information and/or basis of expertise relevant to this course.
PDF, DOC, RTF, or TXT files accepted

Resume Synopsis: * (required for new instructors)
A synopsis of your resume in three typed lines is required for the catalog (not more than 30 words).

Title of proposed course: * (Creative titles are encouraged)


Is this a new course (first time offered through OLLI)? *
Yes
No

Which OLLI location is this course to be offered through? *
Please choose... Grand Forks - UND Bismarck - BSC

Course Description: *
Please describe your course in a way that is appealing to your audience, is concise (150 or fewer words), and explains the benefits participants will receive by attending. Include the objectives of the course with enough details to stimulate members' interest in taking your course. This information is used in marketing materials.

Course Syllabus : *
Please attach a draft Course Syllabus. If your course is accepted, a final syllabus will be required at least 4 days prior to the Open House for the semester your course will be offered.
PDF, DOC, RTF, or TXT files accepted

Class Type (check one or more and enter time percentage indicated): *
Lecture - %
Group Discussion - %
Appreciation / Lab - %

Classroom setup:
Classroom Conference square

We are currently accepting proposals for the fall semester. Please indicate your preferred class times:

Class Day and Time - 1st Preference: *
Select... Monday Tuesday Wednesday Thursday Select... 9 am - 11 am 10:00 am - 12:00 pm 1 pm - 3 pm 5:30 pm - 7:30 pm

Class Day and Time - 2nd Preference: *
Select... Monday Tuesday Wednesday Thursday Select... 9 am - 11 am 10:00 am - 12:00 pm 1 pm - 3 pm 5:30 pm - 7:30 pm

Class Day and Time - 3rd Preference: *
Select... Monday Tuesday Wednesday Thursday Select... 9 am - 11 am 10:00 am - 12:00 pm 1 pm - 3 pm 5:30 pm - 7:30 pm

Additional comments or requests about class dates or times:


Preferred number of participants (classes require a minimum of 10 participants): *

Reading List:
Author's Full Name:
Title:
Publisher & ISBN :
Price:
Approx. Number of Pages to be copied:

Audiovisual Requirements: *
None Needed / I will provide my own

I request OLLI to provide the following: (choose all that apply)
LCD Projector with Screen
TV/VCR
TV/DVD
Presenter Laptop
Overhead Projector
Slide Projector
Internet Connection
Flip Chart
Other Audiovisual Requirements:

Other Important Information or Comments about the course: