Course Title:

Instructor Name (first and last):

Street Address: City, State, Zip:

Phone Number:

Fax Number:        *E-mail address:

Subtitle:

*Course Description and Outline (700 character limit) :
Please enter the course description and Outline

*Qualifications (a brief description of your experience in this subject, including any professional certifications attained (700 character limit)):
Please list your qualifications

Have you ever taught this course before? if so, where?

What audience (e.g., women, businessmen, professionals, elders, etc.) do you feel would be interested in this course?

Maximum Number of Students:

Number of meetings:

Preferred day/evening for class: second choice:

Preferred date(s) and time(s)

Recommended length of course in terms of hours and weeks (e.g., some of our patterns are 1 1/2 hours per week for 6 weeks, 2 hours per week for 8 weeks, 7 hours for on-day workshop, seminar, etc.)

What supplies, if any will be required by the students and what is the estimated cost of supplies to students?
List Supplies needed

What equipment, materials or services do you expect NECC to supply for your use in teaching this course? List equipment and materials needed
Will your course require special classroom facilities, e.g., tables, art room, sink, gym, lounge area, etc? List facilitites needed
Which campus would you prefer? Main NECC campus, Methuen, Andover, Lawrence, OTHER if "OTHER",
specify:
Additional information or clarifications you'd like to add:
List additional information