Workshop Proposal Form

 If you would like to offer a Professional Development Workshop, please fill out and submit the following form:

 Workshop Title:  
 Email :                   
 Workshop Date :
 Times : to a.m. p.m.
 Workshop Size :

 (Please state the purpose exactly as you want it to read in the Program schedule)

 Workshop Presenter(s) and Title(s) :
 (Include company if not Palomar employee)

 Workshop Coordinator :
 Ext. Fax :

 Workshop Category:
Student Success Workshops
Student Learning Outcomes
Multicultural Diversity
Professional Enhancement
Technology Topics

 Target Audience:
Faculty
Staff
Other (Specify)

 Instructional materials or supplies needed?
none
Yes, as follows:

 A/V equipment needed?
none
Yes, as follows: