Course Proposal Form – Mt. Airy Learning Tree

First Name:

Last Name:

Preferred Pronouns:

He/Him/His She/Her/Hers They/Them/Theirs

Address:

This is where we will send the check at the end of the term.

Address, Line 2:

City:

State:

Zip Code:

Email Address:

Provide an email you check REGULARLY.

Daytime Phone:

(include area code)

Evening Phone (if different):

(include area code)

May we provide students with your telephone number(s) and/or email should they have questions?

Yes No

Which number(s)/email can we provide students? Check all that apply.

Day Evening Email

If you have a website, please enter the URL here. Otherwise, leave blank.

Course Name:

Write a specific 50-100 word course description. Refer to the class capsules in the catalog for examples.

Put yourself in the student's shoes. What will students get out of the course? Why should they take this class?

Provide a biographic statement about yourself, your experience and why you are qualified to teach this class.

If you have specific day(s) or time(s) in mind, please list them here. We anticipate classes will resume in the FALL of 2021.

How long would each class be? One hour, two? Longer?

How many weeks would it take to teach the course?

Suggested course fee:

Our fees tend to end in 4s or 9s.

If you are providing materials, what is the fee per person?

Please provide the cost per student for materials. Do not include this cost in the course fee.

What is the MAXIMUM number of students you can have in the class?

MALT has a minimum of 4-5 students for the class to run

Do you have any special classroom needs? (Internet, LCD projector, etc.) OR if you have your own space, please indicate here (and provide address).

Let us know if you would like to teach ONLINE via Zoom or IN PERSON.

I will need to use one of MALT's Zoom accounts

I have my own Zoom account

This can only be taught in person

If you have your own Zoom account, you will be responsible for creating the Zoom link, sharing that with your students, and with the MALT office.

You may also submit a photo of yourself (a headshot or teaching) for us to use online and in our print catalog. Photos should be at least 1000 px x 1000 px to be used in print.

Photo for possible inclusion in the catalog.