OLLI West Class Proposal Form 1. Please enter your contact information. First Name: Last Name: Home Phone: (
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Cell phone:
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Email Address: Please use this format: emailaddress@xyz.com Address 1: Address 2: City: State/Province: Postal Code:
2. Have you facilitated a DU OLLI class previously? Select all that apply. I have not previously facilitated a DU OLLI class. Yes, at OLLI West Yes, at OLLI Central Yes, at OLLI South 3. Name of proposed class: 4. Class description for the catalog:
5. What type of class will this be? Select all that apply. Lecture Discussion Presentation Reading Video Tours Hands-On Activities (includes writing) Other 6. Provide your bio for the catalog.
7. Will there be one or more co-facilitators? If yes, please provide the name(s) and email(s) of the additional facilitator(s) in the 'Co-facilitator(s) Information' field. Yes Co-facilitator(s) Information: No
8. Is there a materials fee? If yes, state the amount in the 'Amount' field and complete the next question. Amount: Yes No
9. If you responded ‘yes’ to the materials fee, please advise what it is for. Select all that apply. Textbook Materials that have been copied and will be provided to members Entrance fees (for example, to a museum) Other 10. Number of class sessions: 1 2 3 4 5 6 7 8 11. Minimum number of students required: At least 10 At least 15 Other 12. Maximum number of students required: 15 or less 25 or less 35 or less 50 or less Unlimited
13. Are there any weeks you CANNOT facilitate classes during the 2016 – 2017 year? No Yes (list dates in Comments) Other Comments
14. Is there a day of the week you CANNOT facilitate classes? Please check any days of the week you will NOT be able to facilitate classes. No limitations to the day of the week Monday Tuesday Wednesday Thursday Friday Comments
15. Are you able to facilitate in the morning (9:30 – 11:30)? Yes No Other
16. Are you able to facilitate in the afternoon (1:00 – 3:00)? Yes No Other 17. Will you be using your own laptop or tablet? If yes, please note in the comment section if it has VGA or HDMI connectivity so we can provide a compatible projector for your equipment. (Note: If, when your classroom is scheduled, you will be facilitating at JUC, information will be provided so you can contact Doug, ollidoug@icloud.com, to discuss your equipment needs and specifications.)
Yes No Comment:
18. What equipment and supplies do you require OLLI to supply for your class? Check all that apply. White board Flip charts Pointer CD player Projector/screen Laptop WiFi access DVD player Podium microphone Portable microphone Tables (vs an auditorium style set up) No supplies/equipment needed Other
19. Do you require AV training prior to the start of your class? (Note: It is your responsibility to know how to operate the equipment you will use for your class.) Yes No Comment:
20. If you plan to use Portfolio for your class, do you require training on its development and use? (Portfolio is a program that allows individuals to create, and maintain, internet web pages. You can use this tool to provide information to your students such as the syllabus, articles, slides, etc.) Yes No Comment: