Name:

Address:

City/State:    Zip Code:

Home Phone:  Work Phone:

Cell phone: Fax:

Email Address:

List specific college education and training or experience that you have had that is related to the course you are proposing:

Current Employer:

Occupation:   How long?

Employer Address:

Employer Phone:

List references that have knowledge of you as an instructor/teacher:

Name: Position:

Address:

Work phone: Alternate Phone:

Name: Position:

Address:

Work phone: Alternate Phone:

Proposed Course Title: If you are proposing to teach more than one class, please submit a separate application for each class.

Description of class to be used in catalog:

Is this class for adults (18+)? PLEASE CHOOSE YES NO If no, please list appropriate ages:

When do you prefer to teach the class (Day, Evening, or After School (for youth)?

Where do you prefer to teach the class? (Listed locations do not include after school youth classes) Select location Alamo Heights H.S. Churchill H.S. Community Learning Center Johnson H.S. MacArthur H.S. Reagan H.S. Other

Address of other location

Room/Equipment needs:

How many class meetings are necessary?

From: AM PM   To: AM PM

Will there be a supply fee payable to the instructor?

If yes, what is the fee?

What materials will students need to provide?

Will handouts be needed? YES NO Number of pages per student

Book Title:

Author: Publisher:

ISBN: Price:

If you have a resume, please mail to:

NEISD Community Education
8750 Tesoro Dr. San Antonio, TX 78217
Adult Classes: Carrie Smith, Coordinator (210)657-8866, Ext 235 or csmith4@neisd.net
Youth Classes: Waverly Jones, Coordinator (210)657-8866, Ext 273 or wjones@neisd.net