Continuing Education Unit Proposal Form

North Dakota State University
Distance & Continuing Education

Date:

Request for: Workshop or Conference

Location:

Start Date:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2004 2005 2006 2007 2008 2009 2010	Start Time:	a.m. p.m.
End Date:	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2004 2005 2006 2007 2008 2009 2010	End Time:	a.m. p.m.

Workshop/Conference Title:

Type of CEU's: General ND Social Worker NBCC Other, please specify:

Number of CEU's: * The registration fee for recording the CEU is $10.00 (per person) per offering.

* A Continuing Education Unit (CEU) is used for activities which do not qualify for college credit. The CEU may be used for the measurement, recording, transfer and recognition of participation by adults in non credit activities. A CEU is defined as "ten contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction and qualified instruction."

Number of times activity will meet:

Number of organized contact hours per session:

Total Teaching Hours = ( Number of times activity will meet ) x ( Number of organized contact hours per session )
Total Teaching Hours will be automatically calculated.

List specific objective(s) for the activity:

Attach copy of an outline, a syllabus, a conference program or workshop details.

List evaluative procedures to be employed:

Required textbook(s):
(If no required textbook(s), enter None.)

Should the University order textbooks for the instructor? Yes No

If "No," where can students purchase textbooks?
If "Yes," where can thy be sent? (address):
(If no purchase textbook(s) or address, enter None.)

Teacher/Activity Coordinator name, include background and experience:
(If no Teacher/Activity Coordinator, enter None.)

Guest Lecturer name(s), include background and experience:
(If no Guest lecturer, enter None.)

Note: If guest lecturers are to be paid by NDSU, attach a list of names, mailing addresses and social security numbers.

If a group, organization, or person requested this activity, please list the organization and/or name of person:
(If no group, organization or person requesting activity, enter None.)

Have arrangements been made for a teaching site? Yes No

If "Yes," the activity will be held:

City or Campus:
Building:
Room:

If "No," should NDSU make physical arrangements? Yes No, the undersigned will do it later.

Would you like the CEU offering listed on the NDSU-DCE web site? Yes No

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