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Instructor Commitment Form

Instructor Information

Name:
Street:
City:
State:
Zip:
Phone:
Email:
Area of expertise/position/degree:
Instructor(s) Biography:
(50 words or less) This may be an informal bio that communicates your expertise or interest in your topic.

Course Information

  1. Term and Year Offered:
  2. Title of Course or Workshop:
  3. Course or Workshop Description (50 words or less):
  4. Texts/handouts/reference materials?
  5. Are there any additional costs for supplies for each student?:   Yes No
    If there are please indicate a cost: $
    6. Note: Due to copyright laws, copying of published material by the OLLI office is limited.
  6. How many total class sessions do you plan?  
  7. Enter a preferred date, day and time of week for class meeting(s). For those instructors who are teaching more than one consecutive session, please assume that your class will be held on the same day and time of the following week.
    • First Choice
      Date:  Day:  Time: 

    • Second Choice
      Date:    Day:  Time: 

    • Third Choice
      Date:    Day:  Time: 
  8. Days or dates you are unable to be present:
  9. Is there a reason to limit enrollment? If so, please indicate a number:
  10. What instructional or A/V equipment will you need:
    LCD Projector
    Laptop
    DVD Player
    VCR Player
    CD Player
    Record Player
    Flip Chart
    Overhead Projector
    		 Microphone
    Podium
    Slide Projector
    Tape Player
    Television
    Chalk Board
    Internet
    Other (please specify):
  11. Do you plan to collaborate or team-teach with another instructor? Please provide names:
  12. What other special considerations do you suggest? (i.e., movable chairs, tables, etc.)
  13. Do you need a technology assistant to help you operate the A/V equipment during class?
    Yes No
  14. If you are showing a video, will there be discussion time after the video is shown?
    Yes No
  15. Do you have any additional comments, questions or concerns regarding the course?

If you have questions about this form, please call the OLLI office at 304-293-1793.

Office hours are Monday through Friday from 9:00 am until 5:00 pm.

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