HQT Set Up Form

To be used for setting up HQT CP courses, HQT CP Tutoring, and HQT CP Access taught by CWCS employees. Not required for Elluminate HQT CP Courses, Learning Center HQT CP courses, or HQT courses taught by business vendors (for business vendors, use a PO). ESes must submit the form as an attachment to cwcs@connectingwaters.org

HQT Summer School Funding Semester: First Second Third

Course Information:

Title: Grade Level Range:

Class Street Address:

Class City: County:

Course Type (select one): Reading/Writing Life Skills History

Political Process Mathematics Science Special Interest

Instructor: Instructor’s Phone: Instructor’s Email: (if contact info already in FRED from other courses, may leave phone and email blank)

Knowledge (select one): (if already in FRED from other courses, may leave blank)

Volunteer experience in subject/work experience in subject <5 yrs

Work exp. 5 – 10 yrs in subject/Professional exp <10 yrs in subject/Teaching or training exp <10 yrs in subject

Prof exp.10+ yrs in subject/Teaching or training 10+ yrs in subject/Specialized training or recognized expert in subject

Training Level (select one): (if already in FRED from other courses, may leave blank)

No experience/<5 yrs experience

5 – 10 yrs experience

10+ yrs w/credential/degree or equivalent

Credential (select one):

Yes

No

Start Date: Last date to sign up: End Date:

Start time: Stop Time: Day(s) of the Week:

Minimum Class Size: Maximum Class Size: Number of Classes:

Materials used:

Facilities Name/address/phone

Proposed Per Student Per Class Rate (Daily Rate)/ Per Course Fee:

Any Extra Notes to be added: