Course Application

Course proposals must be submitted at least three weeks before the proposed start date. After you submit this form, a confirmation email will be sent to you to keep for your records. NOTE: You cannot begin this form and save the data and come back to it later. It must be completed in one sitting.

COURSE INFORMATION

Primary Contact Email(Required)

This contact will receive confirmation of form submission.

Submission Type(Required)

New courses will require a syllabus or course outline to be attached for approval purposes.

New Course

Repeat Course

Course Title(Required)

When was this course last offered?(Required)

list the semester and year, ex Spring 2016

Has the course content changed since the last offering?(Required)

Yes

INSTRUCTOR INFORMATION

Has the instructor previously taught K-12 PD for Boise State University?(Required)

Current status as a Boise State faculty member does not automatically apply to K-12 Professional Development courses. If the instructor for this course has not previously taught a K-12 Professional Development course, please select ‘No’.

Yes

Instructor Name(Required)

First Last

Boise State Employee/Instructor ID

Leave blank if you are unsure.

Instructor's Phone(Required)

Instructor's Email(Required)

Use same email as primary contact email

Use different instructor email

Instructor's Email(Required)

Home Phone(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of School/Organization(Required)

Date of Birth(Required)

mm/dd/yyyy

YYYY

Citizenship Status(Required)

Country of Citizenship(Required)

EDUCATION

Highest Degree Earned(Required)

Area of Study(Required)

Awarding Institution(Required)

Year Awarded(Required)

Areas of Endorsement/Certification(Required)

PROFESSIONAL EXPERIENCE

Please list your work experience in chronological order, starting with your present position.

1. Title or Position(Required)

School/Organization(Required)

Dates of Employment(Required)

2. Title or Position

School/Organization

Dates of Employment

3. Title or Position

School/Organization

Dates of Employment

SECONDARY INSTRUCTOR INFORMATION

Do you have a secondary instructor for this course?(Required)

Yes

Has the secondary instructor previously taught K-12 PD for Boise State University?(Required)

Yes

Secondary Instructor Name(Required)

First Last

Secondary Instructor's Email(Required)

If the secondary instructor has not previously taught a K-12 Professional Development course at Boise State University, they must complete an Instructor Application.

Secondary Instructor's Phone(Required)

Boise State Employee/Instructor ID for Secondary Instructor

Leave blank if you are unsure.

Secondary Instructor's Date of Birth

mm/dd/yyyy

YYYY

COURSE DATES

Start Date of Course(Required)

YYYY

End Date of Course(Required)

YYYY

Date when all coursework must be completed.(Required)

Last date assignments will be accepted to receive a passing grade.

YYYY

Date when registration should be closed.(Required)

The last date students can register for PD credits.

YYYY

Course Type(Required)

Online

In-person

Hybrid (both in-person and online)

Which online platform do you plan to use?(Required)

Canvas

Course provider’s website

Other

Course Location(Required)

The location of the in-person components of the course.

Do you plan to use an existing Boise State Canvas course for the online portion of this class?(Required)

Extended Studies is not responsible for the creation of Canvas courses on behalf of professional development instructors. If using Boise State Canvas, registration must end five days before the start date of the PD course.

Yes

Total number of meetings(Required)

Total number of contact hours(Required)

Your course must have a minimum of 15 contact hours per credit to be considered.

Days and times class will meet(Required)

Ex: MTWThF, 9 am – 1:30 pm

Location(Required)

Number of PD credits(Required)

Boise State PD credits require 15 contact hours per credit, are $60 each, and are Pass/Fail.

Name of school district, organization, or agency providing the course.(Required)

COURSE DESCRIPTION

Course Description(Required)

Educational goals/objectives of this course(Required)

ADDITIONAL INFORMATION

Resources(Required)

Please list any learning resources utilized for this course (training materials, readings/texts, videos, web tools, etc.)

Credit Requirements(Required)

Please list any and all requirements (assignments and assessments, out-of-class work, readings, etc.)

PO OR UNIVERSITY DEPARTMENT PAYMENT

Will credit fees be paid by someone other than the student?(Required)

This may be through a PO, a district invoice or a university department accounting code.

Yes

Will this Payment cover all or only some of the outstanding credit fees for each student, with the remaining balance to be paid by registrants?(Required)

All

Some

How much of each registrant's fees will be paid?(Required)

Is this part of a Grant?(Required)

Yes

If a University Department, please include the account number

Payment Contact Name(Required)

Payment Contact Phone(Required)

Payment Contact Email(Required)

Please note: Invoices will be dispatched via email. It is very important that the email address provided be current and accurately entered.

COURSE PROMOTION

Is this a district-specific offering?(Required)

Yes

Is registration for this course open to the public?(Required)

Yes

Would you like Boise State's K12 PD Program to promote your course?(Required)

Promotion includes emails to K12 educators and a course listing on our website.

Yes

Do students need to enroll in the course using another link or website?(Required)

Yes

Please provide the link to the page(s) that students will need in order to enroll in your course.(Required)

What is the deadline for students to enroll in the course?(Required)

YYYY

Boise State Credits are $60 per credit. Are there any other fees the student will pay? (Ex: course fee, enrollment fee, materials, etc.)(Required)

Yes

How much is the additional fee?(Required)

What does the additional fee cover (ex: enrollment fee, material fee, assessment fee, etc.)?(Required)

SUPPLEMENTAL DOCUMENTS

It is strongly advised that you attach supplemental documentation to this form before submitting (i.e. course syllabus, schedule, instructional materials, etc.). File formats you may upload include PDFs and Word documents. You may upload a total of three documents with this form. If you need to provide more, please email them to k12professionaldevelopment@boisestate.edu.

File 1

Attach first supplemental document. Allowed file extensions include pdf, docx, doc. Max file size is 10MB

Accepted file types: pdf, docx, doc, Max. file size: 10 MB.

File 2

Attach second supplemental document. Allowed file extensions include pdf, docx, doc. Max file size is 10MB

Accepted file types: pdf, docx, doc, Max. file size: 10 MB.

File 3

Attach third supplemental document. Allowed file extensions include pdf, docx, doc. Max file size is 10MB

Accepted file types: pdf, docx, doc, Max. file size: 10 MB.

Before Submitting

If there is an issue with the field when you click submit, you will be redirected to the top of the page. If this happens, your application has not been submitted successfully.

Your information will still be in the fields and any issues will be highlighted in red. A common error is the date format, which needs to be completed with mm/dd/yyyy.

If your application is successfully submitted, you will be directed to a confirmation screen with a blue checkmark. You will also receive a copy of the form in your email.