ESU #3 Online Module Proposal Form
The ESU #3 Professional Learning Department has been exploring on-demand learning opportunities for districts in the form of online training modules. These modules provide a safe learning space for teachers and/or students to learn new content at their own pace. If you are interested in ESU #3 providing these opportunities to your district, please fill out this questionnaire.

To see examples of previously created content, please visit http://learnonline.esu3.org
First Name *
Your answer
Last Name *
Your answer
E-Mail Address *
Your answer
District *
Your answer
Project Name *
Your answer
Learning Objectives *
Identify the learning objective of this module, thinking of ABCD (Audience, Behavior, Condition, Degree) Example Objective: Teachers new to the district will learn our district's policy on mandatory reporting using the reporting form provided in a timely manner.
Your answer
Key Take Aways *
What are the key points you want each person who goes through this module to take away with them?
Your answer
Intended Audience *
Who is your intended audience for this course?
Facilitation *
Best practice for modules would be to use a module in a blended setting, where the module accompanies face to face discussion to deepen understanding of content. Does this module require support for implementation?
Solution *
What problem does putting this content into a module solve? (Ex. "More time for discussion on content in staff meetings," or "This module allows teachers to revisit content as needed.")
Your answer
Assessment *
Do you want to include an assessment component in this module?
Content *
Who will provide the content for the course? (Choose all that apply)
Required
Delivery *
Each module created will need a place to be housed online. How will your content be delivered?
Regional/District *
Can this module be shared regionally or used solely in your district?
Timeframe *
What part of the year do you want to deliver this content to your staff/students? The timeframe is dependent on the number of requests.
Your answer
Additional Information *
What additional information would you like us to know. Ex. District Goals, New Curriculum Series, District Policies, strategy implementation, etc.
Your answer
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