Mini-course sign-up form

Chugach Optional 2011
Minicourse Instructor Sign-up Form

Name of instructor______________________________

Phone_____________      E-mail__________________

MINICOURSE NAME/TOPIC __________________________
(If you need help finding a topic, note so here)

MINICOURSE LOCATION: On-site       Off-site: ____________
(A school chaperone will accompany all off-site courses)    (note location here)

MINICOURSE DESCRIPTION: (use back of form as necessary) _____________________________________________________________________________________________________________________________________________
_______________________________________________

SPECIAL MATERIALS OR REQUIREMENTS, if any:
______________________________________________________________________________________________
_______________________________________________

Do you need help finding an assistant?             Yes    No

If not, note your assistant's name ________________________

If you want the Chugach community to cover any expenses, estimate costs here: _______________________________________

Minimum number of students in course          _________
Maximum number of students in course                   _________

Ideal age group/grade levels                              _________

Ø  Courses for primary kids (K-2nd grade) need to make room for snack breaks and recess at the usual times.
Ø  If you have questions, concerns, night terrors, whatever, just contact Dawnell Smith at ChugachMinicourses@gmail.com or 243-5887.