<p> PORTLAND STATE UNIVERSITY CONTINUING EDUCATION/GRADUATE SCHOOL OF EDUCATION</p><p>COOPERATIVE COURSE INFORMATION SHEET Continuing Education/Graduate School of Education (CE/ED) provides quarter credit and noncredit educational experiences for educators and human service practitioners. Proposals for educational offerings are welcome from qualified individuals. For your course to be considered, you must submit the following:  Information Sheet (logistics) Submit for all courses, new or repeat.  Course Proposal /Syllabus (content) – Submit for all new courses.  Instructor Résumé/vitae (for new instructors) Submit if current resume on file has not been updated for two years. No proposal will be formally considered until information is submitted in full. Forms available on our website at: www.ceed.pdx.edu/forms_co-op.shtml. Questions? Call 1-800-547-8887 x 8279 or local 503-725-8279</p><p>Courses that are not going to be advertised through CE/ED should be submitted for approval 6 weeks prior to the start of the class. Deadline date information for courses (advertised or non-advertised) is on our website at www.ceed.pdx.edu/forms/deadlinedates.pdf. Return form(s) to: Portland State University CE/ED PO Box 751 Or FAX to 503-725-5599 Portland OR 97207-0751</p><p>Date of Submission: Term Offered: Course Information</p><p>Proposed Title: ARTSplash (Words such as Institute, School, Specialization, Program, Center cannot be used in the title.)</p><p>Is this a REPEAT course? YES Is this a NEW course? If NEW, please include Course Proposal and Current Resume/Vitae. </p><p>Proposed Academic Department: GSE Proposed Number of Quarter Credits: 3</p><p>Noncredit: Undergrad Credit: Undergrad/Grad Credit: Grad Credit: 3 Contact Hours: 32</p><p>Grading Option For Undergrad Credit (circle one): A-F Only P/NP Optional P/NP ONLY --(for practicum or Graduate Credit (circle one): A-F Only P/NP Optional* P/NP ONLY student teaching only)</p><p>*For a graduate course, it is preferable that students take the course for a letter grade. It may be difficult to transfer P/NP courses to a graduate program at a later date.</p><p>Logistics Location Site (Building/Room): Cramer Hall, Rms. 221, 224 and 01</p><p>Address: Portland State University Street/PO Box P O Box 751 City Portland State OR. Zip Code 97207 Days/Dates: See attached Specific Times: Fri. 4-8pm </p><p>Agency Instruction Fee: $ PSU Credit ($50 per credit) $ Total $ CEU/Clock Hours: Other Fees: (travel, materials fee, room/board, airfare: (paid to agency) $ </p><p>Online Classes: Delivery method: fully online partially online Computer requirements for this course: (if other than standard web or internet access) </p><p>Course pre-requisite? No Yes Prerequisite Course Enrollment (# of students expected) 20 Course Enrollment Limit: Instructor Information</p><p>Instructor(s) (last, first, middle initial): Joseph Mark Wubbold Highest Degree: Masters</p><p>Social Security Number: 552-33-3977 PSU ID Number: 938251015</p><p>Work Phone: 5-2933 Home Phone: 503-287-9261</p><p>Address: [ ] New address? Street/PO Box City State Zip Code </p><p>Email address: Fax number: </p><p>Instructor Grading All grades are posted on the PSU web. Please include Grading Instructor’s (Full) Name: Joseph Mark Wubbold date of birth: 1/29/1960 (mo/day/yr), and PSU ID number: 938251015 for access to the faculty web site. </p><p>Agency Check One: Cooperative: Sponsored: X *Open Enrollment *(If open enrollment, will you need: Textbooks Hand Outs Duplicated AV Equipment Other </p><p>Cooperating or Sponsoring Agency Portland Public Schools</p><p>Contact/Representative Jeffrey Gilpin Agency Federal Tax ID # </p><p>Contact Day Phone (503) 916-5404 ext. 1029 Agency Fax No (503) 916-5541</p><p>Address Street/PO Box Portland Public Schools 501 North Dixon Street Portland, Oregon, 97227-1807</p><p>Agency email [email protected] Agency Website http://www.pps.k12.or.us/</p><p>Agency Agreement Signer (Name) Jeffrey Gilpin</p><p>For class registration call: Mark Wubbold Phone: 5-2933</p><p>Web: www.artsplash.pdx.edu Email: [email protected]</p><p>Registration information (Please note: Due to school closures during summer and other breaks, we request that instructors indicate a home or personal address to which we should send the registration packets. We can mail packets to any address that is fully staffed during the entire year.) Person to whom registration packets should be sent : Mark Wubbold Address Street/PO Box 5707 NE 32nd Ave. City Portland State OR. Zip Code 97211</p><p>Course Promotion Continuing Education will promote a sponsored or cooperative credit course in the CE/ED catalog (at no cost), if the course is approved prior to the deadline for copy. Do you want this course promoted in the CE/ED Catalog? NO CE/ED Website? NO All promotional materials must be reviewed by CE/ED. Please refer to Guidelines for Flyers for CE/ED Courses which is on our website at www.ceed.pdx.edu/forms_co-op.shtml</p><p>Office use only INSTRUCTOR: Adjunct Rating: ______Active/Inactive/Active-no packet (circle one) Category ______Fee/tuition ______Three year approval status ______Term ______(Summer: week______) Index code ______Program name: ______CEU ______WA Clock Hr______Cert of Completion______Detail (Revenue) code - CR______NC______SU ______</p>