EmailMeForm
Flex Workshop Request
Mesa College
Flex Workshop Request Form
Complete and submit form at least 5 working days prior to the event
Only one event per form.
Presenter/Facilitator Name(s)
*
Requester email
*
Department
*
Phone
Event Title:
*
Event Location
Confirm event location through the
campus events form.
If the event is using the LOFT call 619-388-5000 or
email
to reserve space. Note if event is off-campus.
Zoom Link/Login Information
Workshop Capacity
*
# Flex Hours
*
Start Date
*
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
End Date
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Workshop Proposal
Project Type- Select all that apply
*
Course instruction and evaluation (1)
Staff development, in service training and instructional improvement (2)
Program and course curriculum or learning resource development and evaluation (3)
Student personnel service (4)
Learning resource service (5)
Related activities, such as student advising, orientation, matriculation services, and student, faculty, and staff diversity (6)
Department or division meetings, conference workshops and institutional research (7)
Other duties as assigned by the District (8)
The necessary supporting activities for the above (9)
Address these three items:
-Describe the event.
-Explain how this activity is tied to what was selected under 'Project Type' above.
-Explain how it will improve instruction.
*
Additional Instructions (cost to participate, accommodations, repeated dates, etc.)
Signature
Clear
draw
