Community Education Class Instructor Proposal Form

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Please complete this form to teach a class through community education. Thank you!

Which school location(s) do you intend to teach the class through or at? Choose all that apply. *

Cherry

Northeast Range

North Woods

South Ridge

Tower

Required

First Name *

MI *

Last Name *

Email address *

Phone Number *

Email Address *

Street Address *

City *

State *

Zip Code *

Are you a current employee in our school system? *

Yes

Title of the class to be offered:

Please provide a class/program description for our catalog/advertising. *

I will instruct the class on: *

Monday

Tuesday

Wednesday

Thursday

Friday

Other:

Required

I will instruct the class: *

In person

Virtually via Zoom or Google Meets

Both in-person and virtually

Meeting Dates: *

Class Meeting Location (Room or Location

if known):

Meeting Time(s): Include starting and ending times. *

Minimum Participants: *

Maximum Participants: *

Minimum Age Requirement: *

Maximum Age Requirement: *

Registration Deadline: *

YYYY

Instructor Reimbursement Type-Please indicate *

Business/Independent Contractor (Per IRS regulations, please include a business tax ID # on your W-9, not a SS#)

Personal (You will still be asked to complete a W-9 with your SS)

Volunteer or other

Business/Contractor Name

if Applicable

Program/Class Fee Choice *

Flat Fee for all particpating

Individual Participant Fee

Hourly Fee

State fee amount for the choice in the previous question above. *

Material/Supplies will be: *

Purchased by participant (instructor provides list prior to class)

Instructor does the purchasing and provides a detailed invoice/receipt for reimbursement

Cost per participant for supply/materials fee: *

Total cost of class to be advertised/collected (class fee/ + instructor purchased supplies + $6 community education fee): *

Classroom Equipment (select those needed): *

Whiteboard

Tables for instructor

Projector

None needed

Other:

Required

Payment: Payment to the instructor will be made after the successful completion of the district’s required employment forms, criminal background check, and upon the completion of the teaching activity specified above after the coordinator has submitted a payment voucher to the ISD #2142 District Office.

Agreement: I agree to direct the above-mentioned course/program based on the specified information. I understand that should the minimum enrollment for the course/program not be obtained, this agreement is null and void. I will be given the option of (a) directing the activity on a reduced pay basis, or (b) canceling the activity.

YYYY

I agree to the above by typing my name below. *

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