Elder College Instructor Applicaton Form

Thank you for your interest in Peninsula Elder College! This form will help you present your idea to the Elder College Advisory Committee. Please fill this form in as completely as possible. You can submit this form via e-mail, fax or by dropping it off to the Panorama Recreation Centre reception. This form will be submitted to the Advisory Committee. You will receive a response within 3 weeks.

We plan our programs well in advance. Please see below for the application submission deadlines.

May 1 for programs occurring September through December.
September 1 for programs occurring January through June.
February 1 for programs occurring July through August.

Please submit 1 application per program session as indicated above. Please keep the confirmation email response for your records.

Required fields are denoted with *

Contact Information:

Name*

Street Address*

City*

Email*

Home Phone*

Work Phone

Postal Code*

Qualifications & History:

Please type N/A if information has previously been submitted.

Please list all relevant qualifications and certifications useful for instructing your specific idea, workshop, class or program: *note: teaching certificate not required.*

Briefly describe the history of your program. If this is a first time program, briefly tell us why you feel you are qualified to instruct your topic of knowledge.*

Please provide up to two relevant references if possible.

Reference #1 Name*

Reference #1 Phone #

Reference #2 Name:

Reference #2 Phone #

Program Information:

Submit a separate form for each unique class or program ie. if you teach Bridge and Poker, or if you teach the same program on different days and times each week.

Program Title*

Program description for the brochure: (in 50 words or less try to promote this program, course or workshop)*

Please let us know the preferred dates and times you can instruct. This will help the Committee find appropriate facilities available that works for your schedule! Sometimes we will ask for alternative dates/times if there is not space available.Instructional text goes here

Day(s) of week

Start Time

End Time

Start Date (Session #1)

End Date (Session #1)

Start Date (Session #2)

End Date (Session #2)

Set-up Information

How much set-up and take down time do you require for each class?

Please list additional equipment and/or set-up needs (e.g. TV/VCR, DVD, Flip Chart, Table/chairs, or portable screen). On most occasions Panorama Recreation staff will set up any general equipment for you such tables, chairs, TV, overhead or flip charts before each class.

Does your program or class require participants to pay an extra material fee? If so, please indicate what supplies are needed and what the cost is for the item(s).

Please indicate how many registrants you are comfortable with while you are instructing.

Minimum # of registrants in your class:*

Maximum # of registrants in your class:*

Comments/ Special Instructions

Important Note

According to CRD policy, all volunteers are required to provide proof of a recent (within 1 year) Criminal Record Check prior to the start of the program. Criminal Record Checks can be obtained from your local Police Department at no cost to you. Volunteer Application Letters are available through Panorama Recreation Reception. Please wait until your application has been approved by the Elder College Advisory Committee before completing a Criminal Record Check.

I understand that this is required:*

Yes
No

Type the code from the image

Questions?

If you have any questions please Email.

You can also contact:

Community Recreation Coordinator
Email
Tel: 250.655.2178
Fax: 250.656.3360

Panorama Recreation

Panorama Recreation

Elder College Instructor Applicaton Form

Contact Information:

Qualifications & History:

Program Information:

Set-up Information

Important Note

Questions?

Job Opportunities

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