Town of Fountain Hills Instructor Activity Proposal

Please include a description of your class as you want it advertised.

All instructors are required to go through a background screening.

Contact Information

Business/Organization *

Contact Person *

Mailing Address *

City *

State *

Zip *

Mobile Phone *

Email Address *

Website *

Upload your W-9

Instructor Qualifications

List Instructor qualifications and applicable certifications. *

Upload copies of your certifications

Activity Overview

Space Requirements:

Class/Activty Name

Course Length (How many days per week and how many weeks)

Class Fee (Be sure to keep in mind the 70/30 split when determining your fee)

Materials Fee

What day of the week do you want to teach?

Start Time

End Time

Age Group

Minimum

Maximum

Location of Class: What type of space do you need for your class?

General Description of Activity *

List Program Outcomes: As a result of this class, participants will learn . . . *

Class/Activty Name

Course Length (How many days per week and how many weeks)

Class Fee (Be sure to keep in mind the 70/30 split when determining your fee)

Materials Fee

What day of the week do you want to teach?

Start Time

End Time

Age Group

Minimum

Maximum

Location of Class: What type of space do you need for your class?

General Description of Activity *

List Program Outcomes: As a result of this class, participants will learn . . . *

Class/Activty Name

Course Length (How many days per week and how many weeks)

Class Fee (Be sure to keep in mind the 70/30 split when determining your fee)

Materials Fee

What day of the week do you want to teach?

Start Time

End Time

Age Group

Minimum

Maximum

Location of Class: What type of space do you need for your class?

General Description of Activity *

List Program Outcomes: As a result of this class, participants will learn . . . *

References

Business/Organization Name

Years with the Business

Contact Name

Contact Phone

Contact Email

Please attach any letters of reference

Business/Organization Name

Years with the Business

Contact Name

Contact Phone

Contact Email

Please attach any letters of reference

Business/Organization Name

Years with the Business

Contact Name

Contact Phone

Contact Email

Please attach any letters of reference

Signature and Certification

By signing below, I agree to provide the services that are requested in this form.

Name (Printed) *

Date *

Signature *

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