<p>RENAISSANCE ACADEMY OF FGCU PRESENTATION PROPOSAL FORM Use TAB key to move forward thru the fields. Use SHIFT-TAB to move back thru the fields. Use mouse to select checkboxes.</p><p>Last Name: First Name: Title: Mr. Mrs. Ms. Dr. Florida Address: Alt Address: Address Line 2: Alt Address 2: City/State/Zip: City/State/Zip: Telephone/Fax: ( ) - ( ) - Alt. Telephone: ( ) - Email: Alt. Fax: ( ) - Residency: Full Time Jan – May Oct - May (Select One)</p><p>Term: Please consider teaching in at least two of our terms. Please mark your selections:</p><p>Fall 17 (Sept - Nov) Winter/Spring 18 (Jan - May) Summer 18 (May - August)</p><p>Locations: Please consider offering your course in at least two of our locations. Please mark your selections. Naples Center (downtown) Atrium Exec Center (S Ft Myers) Herald Court Centre (Punta Gorda) The Arlington (SE Naples) Bentley Village (N Naples) Brooks Commons Club (Bonita Springs) FGCU Main Campus (S Ft Myers) Moorings Park (S Naples) The Terraces (Bonita Springs) </p><p>Presentation Category: </p><p>Presentation Title: </p><p>Number of Sessions: One Two Three Four Other </p><p>Session Length: 1 hour 1.5 hours 2 hours Other Max # of Students (if any): </p><p>Preferred Start Date: / / Preferred Days: Monday Tuesday Wed Thurs Friday </p><p>Preferred Start Time: Morning Afternoon Evening Other </p><p>Dates Which I am Definitely Unavailable: AV or Other Requests (projector, lectern, microphone, etc): </p><p>Requested Room Setup (theatre style, podium, circle of chairs): </p><p>Description of Presentation for Publishing in the Catalog (75 words or less): </p><p>Biography for Publishing in Catalog (30 words or less): </p><p>Anyone you would suggest we contact regarding the possibility of teaching a Renaissance Academy class?</p><p>Name: Tel: ( ) - Email: </p><p>FOR OFFICIAL USE ONLY: DOW: TIME: LOC: DATES: CAT: FEE: </p><p>Please contact John Guerra at 239-287-5196 or [email protected] with any questions regarding this form. Revised: 5/15/17 NOTES: </p><p>Please contact John Guerra at 239-287-5196 or [email protected] with any questions regarding this form. Revised: 5/15/17</p>