Instructor Application

Name

E-mail

Mailing Address

City

State

Zip Code

Phone Number

Alternate Phone Number

Your bio

120 words or less, in the third person, tell about how long you been involved in this field, your education, or experience that applies to your class and other pertinent information about yourself.

Why do you want to volunteer to instruct at Mari's Place?

Describe what you would like to teach

Define beginning level and final level of abilities of students in your classes and how you would move them along that scale.

List all Certifications or Licenses that you hold related to courses you want to teach

List the Title, Issue Date, Expiration Date, and a Brief Description - If none, leave blank

List your experience related to the courses you want to teach.

List Date, Course Title, and Location for each class. If none, leave blank

List references related to the courses you want to teach.

List Name, Position, Organization, and Phone for each. If none, leave blank.

List any additional Certifications or Licenses that you hold.

List Title, Issue Date, Expiration Date, and Brief Description for each. If none, leave blank

List any additional Work Experience beginning with the most recent

list Position, Employer, Dates

Emergency Contacts (who we should contact in case something happens to you).

Please list at least one contact

Comments