Please fill out this course proposal form and submit. The following information will be needed 30 days prior to the event. Course title Date(s) of course Name of location Street address City State --Select an option-- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Fed St of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota No Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa Armed Forces Americas Armed Forces Canada Armed Forces Europe Armed Forces Middle East Armed Forces Pacific Zip code Agenda Include times, breaks, breakout sessions and meals. 1000 characters remaining. Instructor(s) Provide name(s) of each instructor(s). See instructions below. Please note: each instructor will need to provide a current vita or resume. It may be emailed to CodyBrewington@MissouriState.edu or mailed to Missouri State University, Noncredit Programs, Attn: Cody Brewington, 901 South National, Springfield, MO 65897. 1000 characters remaining. Planning Committee Provide names and titles of all individuals involved in planning, if applicable. 1000 characters remaining. Attendance How will the workshop be monitored to ensure participants will sign-in, attend the sessions and return the correct paperwork? Attendance sheets and evaluations can be provided by Noncredit Programs. 1000 characters remaining. Target Audience Provide a list of professions that would be interested in attending and an estimate of how many participants may enroll in the course. 1000 characters remaining. Brief Course Description / Learning Objectives Please provide a brief course description and learning objectives. 1000 characters remaining. Number of continuing education hours you are requesting, if applicable: Choose which CEUs your organization would like to apply for from this list: The Missouri Bar – CLEs • Attorneys / Prosecutors The MO Chapter of the National Association of Social Workers • Social Workers The Missouri Society of Professional Engineers • Engineers Missouri Peace Officers Standards and Training • Law Enforcement The Missouri Department of Natural Resources • Water Operators Missouri State University continuing education units (CEUs) • All Professionals MO Board of Certified Accountants Continuing Professional Ed • Accountants Will sign-in sheets or evaluations from MSU be needed for your course? Yes No Requested by Date Human verification Submit
