Forms • Bartlett • CivicEngage

New Instructor

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Name: *

Date of Birth:*

What is a good contact email address?*

Name of program interested in teaching:*

Desired start date:*

Day of the week the class will be held on:*

How often would this class met? (Example: Once a week for 6 weeks, twice a week for 12 weeks, etc.)*

How man sessions in the calendar year would this program be offered?*

Time of the day the class will be held:*

Qualifications/Certificates:*

Are you CPR certified?*

Yes

Description of Class:*

What is the max amount of people that can attend the class?*

How much would a participant be charged to take this class?*

What would be your instructor fee to teach the class?*

* indicates required fields.