Date: 

Quarter:  Fall Winter Spring Summer

Instructor Name:

Address Line 1:

Address Line 2:

City:      State:      Zip Code: 

Home Phone:        Business Phone: 

Fax Number:        E-mail: 

Course Name:    (not more then 24 spaces)

Course Description:

Are there any pre-requisites?  No Yes

Preference of day of week or weekend to be taught:  Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Course Objective:

Course Outline:

• Week 1: 

• Week 2: 

• Week 3: 

• Week 4: 

• Week 5: 

• Week 6: 

Handouts or text required:

Supplies needed:

Supplies participants need to bring from home:

Cost of supplies:

Media equipment needed:

Audience:

Adults:    Children:     Age Limit: 

Type of facility needed:

Location preference:

Maximum number of students you are willing to teach:  

Are you currently teaching this class in the Vancouver/Portland area? If so:

• What organization sponsors your class?
  

• How often is it taught?
  

• Where is it taught?
  

Qualifications to teach this class:

Please include degrees, as appropriate, professional and teaching experience.

Your course proposal will be reviewed and you will be called to set up
an appointment.

Thank you.