Activity Proposal Form

El Camino College
Professional Development & Learning

Please complete this form if you are planning an activity and wish to offer it for flex credit.

For more information regarding Professional Development Categories and Approved Flex Credit Activities, please visit:
http://www.elcamino.edu/about/depts/prodev/docs/PD-Categories-and-Approved-Flex-Activities-v3.pdf

Activity Title:*

Description:*

Flex Category:*

Faculty/instructional improvement Student improvement Institutional improvement Other duties as assigned by the district

ECC Title 5 Category*

Course instruction and evaluation Staff development, in-service training, and instructional improvement Program and course curriculum or learning resource development and evaluation Student personnel services Learning resource services Student advising, guidance, orientation, student, faculty diversity Departmental or division meetings, conferences and workshops, and institutional research

Will the primary focus of this activity provide opportunities to learn about racism, anti-racism, racial equity gaps, or other areas related to racial equity?*

Yes No

Will this activity provide opportunities to learn about distance education?*

Yes No

Activity Date:*

Is this a re-ocurring activity?*

Yes No

Please add all additional dates:

Start Time:*

:

End Time:*

:

Location:*

Online On-Campus Location

Online*

Please provide online link information.

On-Campus Location:*

Please provide room number and/or area.

When would you like to close registration?*

Example: 1 Week before, 1 hour before, none, etc.

Contact Person:*

First Name

Last Name

Email:*

Phone/Extension:*

Presenter Name:*

First Name

Last Name

Presenter Type:*

Full Time Faculty Adjunct Faculty

Other:

Will there be more than one presenter?*

Yes No

Other Presenters)*

Please list any other presenters.

Who is your intended audience for this workshop/activity?*

Faculty Classified Staff Managers/Supervisors All (Faculty, Classified Staff, Managers/Supervisors) Specific Group

Please list the specific group or people:*

What is the maximum attendees for your event?*

Will there be a lunch break?*

Yes, a non-working lunch break Yes, a working lunch break No

How long will your non-working lunch break last?*

Additional Information:

Please feel free to provide any additional information regarding your activity.