Adult Education Instructor and Course Information
 We greatly appreciate the time you are taking to complete this form.  We will only ask you to complete this form once (unless your information has changed).  Thank you for helping us to ensure we have the most accurate and up to date information on file.
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First Name *
Last Name *
Mailing Address - Street name and number *
City *
State *
Zip code *
Preferred phone number *
Please include area code
Preferred email address *
Please list an email account that you will check on a consistent basis.
In case of emergency, who should we contact? *
Please be sure to list the name and phone number below.
Please provide a brief bio of yourself in the space below. Be sure to highlight your experience as it relates to the course you would like to teach. *
We would like to share information about each instructor with prospective students.  This will be shown on our website and in our catalog.
Proposed course title *
Please understand this title may need to be edited
Proposed course description *
Be descriptive and be sure to indicate if there are any prerequisites for this course
Length of course *
Please indicate the preferred length of your course
Please indicate the length of each session *
Ex. 1 hour, 1 hr 30 min., etc.
Hrs
:
Min
:
Sec
What day of the week would you like to offer your course? *
Please choose your preferred day. (If your course will meet more than 1 day per week, please choose the additional days)
Required
Space needs *
What is the ideal set up for your course?  Please check all that apply.
What type of supplies do you need for your class? *
We will purchase supplies for you.  We will NOT reimburse without prior approval.
Will you be receiving an Instructor Fee? *
If yes, what amount are you seeking (per hour, per person or total)?
Would you like to teach more than one course? *
If so, you will be directed to another page to provide additional information.
What is the minimum number of students needed to have an effective session? *
What is the maximum number of students allowed to have an effective session? *
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