Instructor proposal - youth activities and classes

1.	Instructor or organization name:*

2.	If organization/vendor, please list the instructor name:*

3.	Email address:*

4.	Address:*
	Number, Street   City   State   ZIP

5.	Phone* Enter at least 1 response.
	Home   Cell   Office

6.	Instructor credentials*

7.	Has the instructor taught this class before?*
	Has the instructor taught this class before?* YesNo

8.	If the instructor has taught the class before - when and where?*

9.	Class type:*
	Class type:* Arts, crafts, food Health and safety Dance, music, theater, fine arts Language, history, culture Sports Educational, academic Science, technology, engineering, math Youth service Recreation

10.	Grade level:* Select at least 1 and no more than 10.
	Preschool    Kindergarten    Grade 1    Grade 2    Grade 3    Grade 4    Grade 5    Grade 6    Grade 7    Grade 8    Other, please specify

11.	Preferred time:* Select at least 1 and no more than 4.
	After school  Evening  Weekend  Non-school day

12.	Preferred season:* Select at least 1 and no more than 4.
	Fall (Sept. - Nov.)  Winter (Dec. - Feb.)  Spring (Mar. - May)  Summer (Jun. - Aug.)

13.	Class length/time:*

14.	Number of sessions per week:* Check one.

15.	Total number of weeks:*

16.	Space/equipment needs: Select at least 0 and no more than 9.
	Classroom  Gym  Field  Computer lab  Desks   Tables  Sink  Equipment   Other, please specify

17.	Class objective:*

18.	Suggested class size:*
	Minimum   Maximum

19.	Suggested class title:*

20.	Class description:*

21.	Additional comments: