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Kids' College Instructor Form Deadline: February 28, 2009

Instructor Profile
Instructor's Name:   
Address:
City:
State: Zip Code:
May we give your phone/email to parents of possible students? Yes No
Email:   (Example: djsnyder@lcsc.edu)                   
Phone:     (Example: 208-792-2447) Secondary Phone:

Instructor Biography for Catalog and References

Instructor Bio                                                     Use Previous (if within the last year)
Please describe your qualifications the way you want it to appear in our publications.  (We reserve the right to edit.)

 
Professional References                                    Use Previous (If within the last year)
Please list three contacts who can speak of your ability in the subject area you want to teach.
Name:
Phone: (Example: 208-792-2447; Please include area code)
Position:
Organization:
Name:
Phone: (Example: 208-792-2447; Please include area code)
Position:
Organization:
Name:
Phone: (Example: 208-792-2447; Please include area code)
Position:
Organization:

Course Information
Semester:          Year:
Class Title:    (Example: Intro to Underwater Basket Weaving)
Location: LCSC Campus
  Other: (Example: Bryden Canyon Golf Course)
Please choose desired session and class time from the following chart:

Session
(Mon-Thurs)

Morning

Afternoon

Session I
(Mon-Thurs)
June 22-25

8:30am–10:15am 10:30am-12:15pm 1:15pm-3:00pm
 3:15pm-5:00pm

Session II
(Mon-Thurs)
July 6-9

 8:30am–10:15am 10:30am-12:15pm
 1:15pm-3:00pm 3:15pm-5:00pm

Session III
(Mon-Thurs)
July 20-23

 8:30am–10:15am
10:30am-12:15pm 1:15pm-3:00pm 3:15pm-5:00pm

Session IV
(Mon-Thurs)
August 3-6

 8:30am–10:15am
10:30am-12:15pm 1:15pm-3:00pm
 3:15pm-5:00pm
 

Half Day Camp

Session I
(Mon-Thurs)
June 22-25

 8:00am–12:00pm
 1:00pm-5:00pm

Session II
(Mon-Thurs)
July 6-9

 8:00am–12:00pm
1:00pm-5:00pm

Session III
(Mon-Thurs)
July 20-23

 8:00am–12:00pm
 1:00pm-5:00pm

Session IV
(Mon-Thurs)
August 3-6

 8:00am–12:00pm
 1:00pm-5:00pm
Please select ages allowed to register for this class:

6-8 years

8-9 years

 9-10 years

10-11 years

 11-12 years
    I would like to be assigned a student volunteer/teacher's aide
Course Fees:
Misc. Fee $ Please Describe:
                                          (Example: Supplies, Equipment Rental, etc.)
Are there any special skills or a level of experience suggested/required for this class?
 

Kids' College Catalog Course Description                        Use Previous (if within the last year)
(We reserve the right to edit.)
 
TEACHING FOR OTHER LC VALLEY ORGANIZATIONS
I understand that I am free to teach for other LC Valley organizations (i.e., YWCA, WWCC, Lewiston Parks & Recreation, etc.), and I agree to not offer the same class while I am teaching for a given Kids' College session.

Course Supplies and Facilities

--> Additional supply fees will be based on this information
--> Please check below the items needed/required and approximate cost per student
--> Use text boxes to describe details as you see fit
Be sure to specify if you do not need the required equipment.

If you have questions, please contact the Continuing Education Office.
Room Requirements Lab/Computer Needs
 
I need a computer lab:  Yes No If yes, then how many computers? 
Software needed for class   


Audio/Visual Equipment
                                                                   No Equipment Needed

LCD Projector

Transparencies

DVD Player/TV

Opaque Projector

Laptop Computer

VCR/TV


         No Room Requirements
Use this space to specify all room requirements
(specify room bldg./number, sinks, desks, rectangular tables, etc.).
You can also use this space for any miscellaneous room requests
 
Textbooks and Handouts Textbook                                                    No Textbooks Needed
 
Textbook required $  per student for the text
I would like CE to purchase I will supply the text book
Textbook Name:
Publisher:
Edition:
ISBN:


Handouts & Photocopies                           No Handouts or Photocopies

  Number of Handouts at $ per student for the handout
I will supply photocopies at $ per person.

Continuing Ed will make copies at 5 cents per page
     (Instructor must provide the materials 10 days prior to class start date).

Transportation                                               No Transportation

I need transportation for my class on the following day/dates:

I agree to take the 15-passenger van driving test
Additional comments:
 

 
Miscellaneous Please list or clarify any information not covered by options on the form:

Background Check Permission
 I have not previously had a criminal background check. You have my consent to consent to conduct a criminal background check. (A separate authorization form will be provided to you.)

I have previously had a criminal background check. You have my permission to contact my employer to verify that I have passed a criminal background screening.

Please type in your supervisor's name, e-mail address, and phone number in the box below.

 
I confirm this form is complete with all information necessary for my class.





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