Horizons Course Proposal , Southeast Missouri State University


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Southeast Missouri State University

Horizons Course Proposal

For your proposal to be considered, please complete all fields of this form. Submit a separate form for each proposal. (* Required Information)

Faculty/Staff Information
First Name* MI Last Name*
Department:*
Mail Stop:*
Office Telephone:*
Home Telephone:*
Fax Telephone:
E-Mail :

T-Shirt Size:
Small Medium Large X-Large XX-Large

Course Information

Course Title:

Half Day Course Full Day Course

Brief Description (3 - 5 sentences):

Field Trips:
Where:      When:
Where:      When:
Where:      When:

Class Materials/Supplies:
Estimated Materials Cost per Student:

Class Size/Student Ages
Horizons classes are typically limited to 15 students ages 9-14 for regular Horizons classes or ages 5-8 for "Little Horizons". Indicate if special limits are needed.

Reason for Request:

Enrollment Limit:
Age Range:

Scheduling:
(Please indicate all times available and preferred times to teach the course.)
Available  To choose more than one option hold down the CTRL key.

Preferred To choose more than one option hold down the CTRL key.

Yes, I can teach additional section(s) of this course. Enrollments for many of the HORIZONS courses have closed quickly and additional sections were needed.

No, I can not teach additional section(s) of this course

Student Assistant Request:
Courses which incorporate laboratory activities and/or field trips may request a student assistant. Typical remuneration is $20 a half day or $100 for a half-day session ( 5 half days ). Faculty are responsible for recruitment of student assistants.

Yes, I will need a student assistant

No, I will not need a student assistant

Student Assistant Name:

Address:

City:

State:

Zip:

T-Shirt Size:
Small      Medium     Large     X-Large     XX - Large

Is the Assistant a Southeast student
Yes, the Assistant is a Southeast Student
No, the Assistant is NOT a Southeast student

Yes, I would be interested in working with children ages 5-8.

Any Additional Comments:

Mailing Address:
Southeast Missouri State University
Office of Extended & Continuing Education
One University Plaza, MS 6850
Cape Girardeau, MO 63701

Fax #: (573) 986-6883 -- open 24 hours

If you have any problems filling out the online registration form, please contact the Office of Extended & Continuing Education at (573) 986-6879 or e-mail kmayfield@semo.edu.

Information for Teachers: Interested in teaching a HORIZONS course? Learn more here.

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