UCS Enrichment
Please complete this form to give us a general idea of your proposed class(es) and intent to teach.  Please submit a new form for each proposed class section:
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Email *
Contact Person/Organization: *
Contact Phone Number *
Course/Program Name: *
Description of Program *
Target age of programming: *
Required
Start Date *
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/
DD
/
YYYY
End Date
MM
/
DD
/
YYYY
Number of weeks the class will meet:
Days of week: *
Required
Start Time: *
Time
:
End Time *
Time
:
Proposed Location (Please note:  Use of UCS facilities is limited and not guaranteed.  However, we will do our best to accommodate your request): *
Minimum number of students required to run the class: *
Maximum number of students allowed *
Cost of Class                                                                                                                                                                                                                           *
Material Fee 
Special Instructions or equipment needed:
A copy of your responses will be emailed to the address you provided.
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