Teach Community Education

Community Education Course/Lecture Proposal
Please complete one form for each lecture proposal

Call 717-339-3578 or e-mail dsuhlman@hacc.edu with any questions.

	* Required Field
*Lecture Title:
*Presenter's Name:
Presenter's Title:
*Residential Mailing Address (required to send our honorarium):
*Home Phone:
*Work Phone:
*Email:
*Lecture description:
What is your availability?
Lecture/Course Outline: (Use a simple outline form of the topics and subtopics that will be taught in the lecture session.)
*Will you have duplicating needs?	Yes No
	If yes, approximately how many pages per participant?
Will you be asking us to reimburse you for materials to conduct the lecture?	Yes No
	If yes, please list and estimate the cost or your request:
Audio/Visual Requirements:	Overhead Screen Projector/Screen DVD/Projector/Slide Projector Computer/Projector Other
	Other: Special equipment required is subject to availability.
Comments: