Instructor proposal - adult activities and classes

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Adult instructor and class proposal

Thank you for your interest in leading/teaching a community education activity or class at Anoka-Hennepin Community Education. Complete one form per class proposal.

1.	Instructor or organization name*

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

3.	Email address*

Address*

House number, Street
City
State
ZIP

Phone*
Enter at least 1 response.

Home
Cell
Office

6.	Instructor credentials*

Provide two professional references - name and phone number:

Reference one:
Reference two:

8.	Suggested class title*

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

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

11.	Provide a brief biography of yourself, relating to the class:*

12.	What is the class format (lecture, demonstration, workshop, etc.)?*

13.	Number of sessions*

14.	Time preferred*

15.	Class size limit*

17.	Are you teaching this class as a community service, or what is your desired rate of pay?*

18.	Provide a brief class description (40 words or less):*

19.	What benefit(s) will the students receive from this class (skills learned, projects completed, etc.)?*

20.	Will you need time to set-up prior to the class start time? If yes, please indicate how much time is needed.*

21.	What should a student bring to class, if anything?

22.	Will you provide any materials for students?*
	Will you provide any materials for students?* YesNo

23.	If yes, what are the materials, what is the charge and how much per person?

24.	Do you need any audio/visual equipment?*
	Do you need any audio/visual equipment?* YesNo

25.	If audio/visual equipment is needed, please list:

26.	Will you have handouts? If yes, please have copies to the Community Education office one week prior to class so they can be prepared and ready for your class.*
	Will you have handouts? If yes, please have copies to the Community Education office one week prior to class so they can be prepared and ready for your class.* YesNo