Community Services Program Proposal Form
City of Winooski Community Services Department
27 West Allen Street, Winooski VT 05404
winooskivt.org
winooskirec.com

Thank you for your interest in offering a program with the Community Services Department. Please complete this proposal and submit with your resume. Your proposal will be reviewed, if determined to meet the needs of our community, you will be contacted and details can be discussed.

Please call or email Parks & Recreation Manager if you have any questions: (802) 777-1621 or afinley@winooskivt.org

**Note: We attempt to of er programs at the lowest possible price as a service to our community. Instructor compensation is one of the factors considered when determining program of offerings. We welcome those who wish to donate their time as a service to our community.

First and Last Name: *
Your answer
Email Address: *
Your answer
Organization (if applicable): *
Your answer
Mailing Address: *
Your answer
Phone Numbers (Mobile, Home, & Work) *
Your answer
Proposed Program Title *
Your answer
Program Description (This will be used in creating a description for print and other advertising.) *
Your answer
Length of Each Class (hours/minutes): *
Your answer
Time of Class: *
Your answer
Indicate Length of Session (1 class, # of weeks): *
Your answer
Number of Days Per Week: *
Preferred Day(s) *
Required
Time of Year: *
Target Audience: *
Age or Grade of Participants: *
Your answer
Minimum Enrollment: *
Your answer
Maximum Enrollment: *
Your answer
Recommended Instructor Compensation ($/per participant): *
Your answer
Waive Fee?
Does​ ​instructor/organization​ ​have​ ​insurance?​ (If yes, please attach a copy.) *
Ideal​ ​type​ ​of​ ​space:​ ​(e.g.:​ ​open​ ​area,​ ​classroom,​ ​etc.) *
Your answer
Materials/supplies:​ ​Are​ ​there​ ​supplies/equipment​ ​the​ ​participant​ ​will​ ​need​ ​to​ ​bring? If yes, what supplies/equipment will be needed? *
Your answer
Instructor​ ​bio​:​ ​(Please​ ​write​ ​a​ ​brief​ ​Bio​ ​that​ ​can​ ​be​ ​posted​ ​on​ ​the​ ​website.) Include link to bio pages where applicable. *
Your answer
Instructor​ ​qualifications​:​ ​(Trainings,​ ​education,​ ​work​ ​experience,​ ​certifications,​ ​etc.) *
Your answer
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