KITTERY ADULT AND COMMUNITY EDUCATION

Cindy Furbish Telephone:(207)439-5896
Traip Academy Fax:(207)439-3789
12 Williams Avenue
Kittery, ME 03904 Hours: 11-3 pm / 6-9 pm, Mon.-Thrs.

Instructor/Course Information Sheet

If you are interested in teaching a course for Kittery Adult Ed. please fill out the attached form. Note: it is extremely important that all fields are filled in. If you have any questions or concerns do not hesitate to contact us. If convenient, please email form back to .

Instructor Information

Name: Type your name here D.O.B. Type Date of Birth

Address: Type your address here

What is the best telephone number to reach you at during the day: phone number

E-mail:

Are you an Independent Contractor:

Are you a member of Maine State Retirement:

Please give a brief Bio. on yourself (approx. 35 words): Please type your text in this area.

Course Information

Course Title: Course Title Start Date: Start Date & Day: Mon., Tue., or Thurs. Day

*Please indicate 1st choice & 2nd Choice. We will do our best to accommodate your request. We are open 3 nights a week from 5:30-9 p.m. We will also offer some Saturday dates from 10-2 pm (call for dates).

# of Weeks: Time: # of Students: (min) (max)

Your requested pr/hr Fee: Material Fee:

Additional Room Needs: Please type in any additional room needs

Will you be providing a Material List:

Are you flexible in reference to the above requests:

We will do press releases and publicize your course in our brochure to solicit enrollment. Please give a brief Course Description that may entice students (2 or 3 sentences): Please type your text in this area.

Feel free to attach a JPEG image of your work/craft.