Independent Instructor Application

City of Inglewood

Thank you for your interest in becoming an Independent Contract Instructor for the City of Inglewood - Parks, Recreation and Community Services Department. Please complete the application in its entirety. Your submission will be acknowledged upon receipt.
Independent Contract Instructor Application
Instructor's Name: *

First Name Last Name
Business Name:
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone Number: *
Email Address: *
Class Title: *
Class Description: *
Goals and Objectives: *
Participant Age Requirements: *
Proposed Fee Per Class/Session: *
In addition to the proposed class fee, will you be charging any other fees such as supply, material and/or uniform? *

Yes No
If yes, what is the cost and what is provided for the fee?:
Facility Requirements: *
Be sure to include all facility requirements related to the class.
Desired Location: *

Ashwood Park Darby Park Edward Vincent, Jr. Park Lockhaven Community Center Rogers Park Senior Center Siminski Park Veteran's Memorial Building
Class Duration - Total Number of Weeks: *
Include the total number of weeks classes will be held. If classes are held in sessions, include the number of weeks in each session. If you plan to offer monthly classes, please insert "on-going monthly classes".
Class Duration - Hours Per Week: *
Include the total number of hours per week classes will be held. Be specific in providing the hours per day.
Meeting Days: *

Monday Tuesday Wednesday Thursday Friday Saturday
Meeting Times: *
Minimum Number of Students Per Class: *
Maximum Number of Students Per Class: *
Instructor/Student Ratio: *
Special Class Requirements: *
Related Work Experience: *
Are you CPR certified? *
If yes, when do your CPR certifications expire?
Please input the exact date.
Training/Certifications Pertaining to Proposed Class: *
File Upload - Class Proposal *

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Each prospective instructor is required to provide three (3) professional references. The City may contact these individuals as part of the selection process. A professional reference may NOT include family, friends or class participants.
Reference: *

First Name Last Name
Phone Number: *
Reference: *

First Name Last Name
Phone Number: *
Reference: *

First Name Last Name
Phone Number: *
I certify that all the statements and information on this application are true and complete to the best of my knowledge. I herby authorize the City of Inglewood to verify any information contained in this application. I understand that false or incomplete statements may be cause for disqualification.
Signature *

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City of Inglewood

Independent Contract Instructor Application