Instructor Name:
  Business/Organization Name:
City    State   Zip
E-mail Address                          Birth Date (MM/DD/YYYY)

Please describe your background and experience:
Proposed course and/or subject matter:
Proposed age range for class participants:
List 3 program outcomes (i.e., As a result of this class, participants will be able to...):
  Why should the Town of Danville offer your class?:
  List other locations/agencies where you have taught or are already teaching the proposed class:
  Provide 3 references with phone numbers:
  Have you submitted a Course Proposal in addition to this application?
  A Program Coordinator will contact you to arrange an interview after receiving your Application and Course Proposal. Please be prepared to provide a course outline, sample materials, information about your organization, etc.