Class Proposal Form"*" indicates required fields First name*Last name*Email* WebsiteAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home phoneCell phoneClass Name*This proposal is for a 5-7 week class 10 week class 1 or 2 day workshop Week-long campIf other, explain belowWhat time are you available to teach?Starting time Hours: Minutes AMPM AM/PMEnding time Hours: Minutes AMPM AM/PMWill you need setup or clean up time No YesIf yes, how long?SetupCleanupTeaching Available Sunday Monday Tuesday Wednesday Thursday Friday SaturdayTeaching Preference Sunday Monday Tuesday Wednesday Thursday Friday SaturdayHow long is your class?Ages Young Child Youth Teen Teen/Adult Adult Only Parent & ChildWhat specific supplies will be needed for your class? How many of each item? List the estimated cost per item. We may have some basic supplies available.Example: Watercolor papaer, student grade quality, 22"x30" - 20 page - .67 per page - $13.40Item & description# of itemsCostTotal Add RemoveDoes your class require certain equipment or facilities?Example: Laptop, projector, instruments, performance space, etc. No YesIf yes, please explain belowWhat date are you able to start teaching? MM slash DD slash YYYY Maximum class size preferenceMinimum students required to open a class is 3 or 4Do students need to bring anything to class? No YesIf yes, student should provide the following:Suggested Pay Rate(if applicable)Please provide the followingCurrent resumeMax. file size: 256 MB.Background check & completed applicationMax. file size: 256 MB.Personal reference #1Max. file size: 256 MB.Personal reference #2Max. file size: 256 MB.Applicable imagesMax. file size: 256 MB.Quality photo headshotMax. file size: 256 MB.5-8 Sentence biographyWhat key techniques / terms can students expect to learn?We will use this information to advertise and promote the class online, Facebook, radio, posters, etc.What product will students walk away with?We will use this information to advertise and promote the class online, Facebook, radio, posters, etc.Step by step, describe your curriculum and / or class activities.EmailThis field is for validation purposes and should be left unchanged.
