WORD Clock Hour Proposal Originator's Name * Local Council Address * Phone Email * Program Title Start Date End Date Start Time End Time Total Instructional hours (excluding breaks & meals) Number of clock hours requested Target Audience Location Number of participants Tell us a little about the presenter. Presenter/instructor(s) Address Day Phone Current position Program Description Presenter Qualifications/Vita Information WHO WILL BE RESPONSIBLE FOR THE CLOCK HOUR FORMS? This includes distributing the forms to participants, collecting checks and completed forms at the conclusion of the workshop, and returning all materials: Name Email
