NORTHLAND CAREER CENTER
COMMUNITY EDUCATION CLASS PROPOSAL
Instructor Information |
Instructor’s Name _______________________________________________________ Date __________________________
Address ______________________________________________________________________________________________
Street CIty/State Zip
Phone: (____)___________________________ Email: ________________________________________________________
Have you ever been convicted of a felony: ____ Yes ____ No
If yes, please explain:
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_____________________________________________________________________________________________________
Are you currently employed by Platte County R-3 Schools? ____ Yes _____No
Briefly describe your experience and/or educational background relevant to the course(s):
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Briefly describe your teaching experience: ___________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
References:
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Name & Phone number
____________________________________________________________________________________
Name & Phone number
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Name & Phone number
Prohibition Against Discrimination, Harassment, and Retaliation
The Platte County R-3 School District Board of Education is committed to maintaining a workplace and educational environment that is free from discrimination and harassment in admission or access to, or treatment or employment in, its programs, services, activities and facilities, and provides equal access to the Boy Scouts and other designated youth groups. In accordance with law, the district strictly prohibits discrimination and harassment against employees, students or others on the basis of race, color, religion, sex, national origin, ancestry, disability, age, genetic information or any other characteristic protected by law.
The Platte County R-3 School District is an equal opportunity employer.
Compliance Officer: Dr. Rob Gardner, Assistant Superintendent of Personnel & Operations 998 Platte Falls Rd, Platte City, MO 64079 Phone: 816-858-5420, Fax: 816-858-5593 Email: gardnerr@platteco.k12.mo.us
Course Proposal |
Instructors Name: ______________________________________________________________ Date __________________
Suggested title: (interesting and to the point!):
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Summary of the proposed course: (if needed attach extra page)
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What is the expected outcome or objective for students? (ex: student will complete project/learn to speak language)
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Suggested for: ________ Fall (Sept - Dec) _________ Winter/Spring (Jan-May)
Course hours (proposed):
Number of sessions: _________________ Hours per session: _________________ Total hours: _____________________
Day(s) of week: _______________________________________________ Time of course: _________________________
Maximum number of students for course: ________
Supplies needed for course
Will this class require a Textbook? Yes_____ No _____
Title _________________________________________________________________________________________________
ISBN#_________________________________________________________ Retail $ ________________________________
Will this class require students to pay for Material or Supplies? Yes ________ No _________
Material Fee Amount: $_________ For:_______________________________
In fairness to the student Material fees should be kept as minimal as possible.
To ensure a suitable classroom is assigned and for scheduling, please list media services and room requirements needed for your class. For example--(Projector, VCR, Blackboard, specific software, computer, tables, open space, mats, etc.)
Media Services: _______________________________________________________________________________________
Room Requirements: ___________________________________________________________________________________
Please return to: NCC Community Ed, Kathleen Henke
1801 Branch St., Platte City, MO. 64079
Phone: 816-858-5505 Email: henkek@platteco.k12.mo.us