Interest FormPlease enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastCredentials/Qualifications *Email *Cell Phone *Secondary PhoneResume or CV * Click or drag files to this area to upload. You can upload up to 2 files. Please upload a current Curriculum Vitae or Professional ResumeCourse InformationSuggested Course Title *Provisional Course Description *Provisional Course Learning ObjectivesWhile we will need all of the information asked here on the form, if you don't have it now, it can be submitted later.Who is Your Target Audience? *Estimated Number of Course Hours *Course Materials Click or drag files to this area to upload. You can upload up to 3 files. Please upload your course materials here, if you have any at this time. This might include a PowerPoint, handouts, etc. If you do not have materials at this time, you may submit them later.Photo Upload Click or drag a file to this area to upload. Please upload a quality photo, preferably "head shot" for use on our Instructors page of the website. If you do not have one now, you may submit it later.Additional CommentsIf you'd like, please give any additional comments regarding yourself or your proposed course.CommentSubmit