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New Contract Instructor Application
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This form has been modified since it was saved. Please review all fields before submitting.
Steps
1.
Step One
(current)
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This section is incomplete
2.
Background, Experience & Programming
This section is complete
This section is incomplete
3.
Information Available to the Public
This section is complete
This section is incomplete
Step One
Instructor Name
Business / Organization Name
Legal Name for Payroll:
Address
City
State
Zip Code
Home Phone
*
Work Phone
Mobile Phone
*
Fax
Email Address
*
Birth Date
*
Birth Date
Gender
Male
Female
Other
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Background, Experience & Programming
Please describe your background and experience:
Proposed course and / or subject matter:
Proposed age range for class participants:
List 3 program outcomes (i.e., As a result of this class, participants will be able to...):
Why should the Town of Danville offer your class?
List other locations/agencies where you have taught or are already teaching the proposed class:
Provide 3 references with phone numbers:
Have you submitted a Course Proposal in addition to this application?
Yes
No
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Information Available to the Public
PUBLIC BIOGRAPHY: If you are accepted as an Instructor with the Town of Danville, what would you like your public biography to say about you.
*
What pieces of information would you want available to the public?
Home Phone
Cell Phone
Work Phone
Email
Photo
A Program Coordinator will contact you to arrange an interview after receiving your Application and Course Proposal. Please be prepared to provide a course outline, sample materials, information about your organization, etc.
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