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Non-Credit Workshop Proposal Form

If you are interested in teaching a workshop at Clinton Community College, please fill out the following form. Please complete all fields and do not leave any blanks. If something doesn't apply to your workshop proposal, simply mark it "N/A". Incomplete proposals may not be reviewed or may be returned for information, at the Coordinator's discretion, which can cause delays in the process. A response to your proposal will be EMAILED to the email address provided within approximately 2 weeks of your proposal review. Please email proposals to Ashley Cousens at ashley.cousens@clinton.edu. Feel free to call our office at any time with questions about this process at 562-4145.


Name *


Phone Number *


Alternate Phone Number *


Email *


Student Contact Preference *


Address *


Do you teach this course or a similar course anywhere else?
 Yes
 No


If yes, where and what do you charge per student?


Workshop Title *


Description *


Total Hours of Course *


Workshop Dates (please include days of the week) *


Start/End Time *


Student Capacity (maximum) *


Type of classroom (i.e. computer lab, outdoors, art room, etc.) *


Instructor Needs (i.e. smartboard, projector, etc.) *


Student Materials (please list SPECIFICALLY) what students will need for class. Please note if they must PURCHASE materials and where they can find them) *


Student Textbook (please provide textbook ISBN number, description and where it can be purchased) *


CCWD Involvement (will you need help from our office for copies, certificates, etc? List these needs here.) *


Other Information (please list anything else we may need to know about your workshop here) *