Instructor Course Form

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Classes are not final until approved. The instructor will be notified upon approval.
Feel free to call or email if you have any questions. Contact information: Leza Wood,

Course Title *

Please choose a short but descriptive title for your course

Instructor Full Name *

Type Your Name as you would like it to appear in the catalog. Example: Betty Flintstone, CPC

Instructor Email Address *

Type an email address that you have access to during the day, if possible.

Instructor Full Address *

Street Address, City, State Zip

Instructor Cell Phone

Instructor Home Phone

Instructor Work Phone

Class Start Date *

Type the date you would like your class to start. Please follow the format in the following example.

Example: 09/01/2013

Class End Date *

Type the date you would like your class to end. Please follow the format in the following example.

Example: 09/01/2013

Class Start Time *

Type the time you would like the class to start. Please follow the format in the following example.

Example: 9:00 AM

Class End Time *

Type the time you would like this class to end. Please follow the format in the following example.

Example 4:00 PM

Recurrence Pattern *

Type the recurrence pattern for your class.

For example: every Monday and Wednesday, or One Session

Location *

In Person or Virtual

Course Description *

Please type a description for the class you will be offering. One or two short paragraphs is just the right length. Remember you are trying to entice people to sign up for your class, so make it sound exciting! :)

Notes

Anything else we should know about your class? If this is the first time you are offering this class, or if you are changing books, please use this area to specify the books and/or materials you would like to use. Please give us sourcing information for the materials also.

Instructor Hourly Rate *

Please let us know your required hourly rate for this class

Tuition

If you have an idea about what others are charging for this class, please include the price here. We may need to change it for our purposes, but I appreciate the input if you have it.

Materials / Book Fees

If you know the price of the books and/or materials for your class please include it here. We always estimate an additional 10% for shipping charges.

Hours per Session

# Sessions

Maximum # Students

Instructor Payment Information *

Do you have a business that will invoice us? If you don't have a business, do you have a DBA?

If Invoice, Company Name

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