Class Proposal and Information Form

Name of proposed class:*

Make it catchy but accurate. Add the word DRAFT if you know you want to facilitate the class but don't yet have all the information ready. When you complete the form it will save automatically and send you an email link so you can edit the form at a later time. Be sure to go all the way to the end of the form and use the SUBMIT button to save your draft.

To move from one entry field to the next, it is best to use the mouse and click into the entry field.

To navigate between pages, use the BACK and NEXT buttons at the bottom of the page.
Click the SUBMIT FORM button when you have completed the form to your satisfaction.
You will receive a confirmation email after submission with a PDF attachment that you can download and/or print.
Inputs with a red * indicate a response is REQUIRED.
Before you start, please have your short bio, class description and co-facilitator contact information and bio ready to upload to this form.
Refer to Appendices A, B and C on the Facilitator Information page of the OLLI South website for sample bios, course descriptions and syllabi.

Date*

MonthDayYear

Facilitator/Instructor Information

Name*

First NameLast NameSuffix

Have you facilitated a DU OLLI class previously? Select all that apply.*

I have not previously facilitated a DU OLLI classYes, I have facilitated at WestYes, I have facilitated at CentralYes, I have facilitated at South

If yes you have facilitated before, are you a

Master FacilitatorSenior FacilitatorDiamond FacilitatorNot applicable

E-mail*

example format: youremail@xyz.com

Confirm E-mail*

example format: youremail@xyz.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Please enter your preferred phone contact number, either Home or Cell*

Alternate phone (optional)

Third Phone Number

Are you currently an OLLI member?*

YesNo

Have you been contacted by a member of the OLLI South Curriculum Committee regarding facilitation of a class?*

YesNo

If yes, who contacted you?

Type the name of the OLLI member

Provide your bio as it relates to the proposed class for the catalog:*

This field has a 60 word limit per facilitator0/60

Will there be one or more co-facilitators?*

YesNo

Name of co-facilitator

First NameLast Name

Email of co-facilitator

example@example.com

Provide your co-facilitator's bio as it relates to the proposed class for the catalog:*

This field has a 60 word limit per facilitator0/60

Class/Presentation Information

Class title to be printed in the catalog:

Enter the name of your class as you want it to appear in the catalog

Which Category best describes your proposed class? Select only one.*

Class description:*

This information will be used in the catalog. Please see Appendices A,B, and C on the website for samples.

What type of class will this be? Check all that apply:*

If there are tours or field trips associated with your class, please indicate below what those will be:

If there is a class fee, how much will it be?

If guests are allowed, what is the guest fee?

Will you be using a book, pamphlet or handouts?*

Yes, a book is requiredYes, a book is required to be purchased by OLLIYes, a book is recommended onlyYes, I will be emailing handoutsNo, nothing is required

Name of published work:

Will there be a materials fee?*

YesNo

Fee Amount?

Reason for fee? Select all that apply:

Book or other publicationEntrance fees (i.e. museum entrance fees)Other

Upload your syllabus here, if you have it ready and save yourself a second step

Browse Files

It is not necessary to have your syllabus ready during the course proposal process

If you prefer, type in your syllabus here:

OLLI South Class Proposal Form