Instructor Intake Form Instructor Intake Form Instructor and Class Intake FormPlease enable JavaScript in your browser to complete this form.INSTRUCTOR INFOInstructor Name *FirstLastAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *This email will be your main contact for students and for notification of class sign-ups.Phone *Instructor BioCOURSE INFORMATIONCourse Name *Course Description *Charge for the Class *Level (Beginner, Intermediate, Advanced, etc.) *Location (Building name and which classroom, i.e. upstairs classroom, kitchen)MATERIALSMaterial List (optional)Amount To Be Charged for Materials on day of class(optional)REQUESTED SCHEDULEList dates, start times, how many days for the class, how many hours per class., etc. *Upload Image of yourself (portrait style) Click or drag a file to this area to upload. Upload Image of what you will create in class (or example of your artwork) Click or drag a file to this area to upload. Upload Image of what you will create in class (or example of your artwork) Click or drag a file to this area to upload. Upload Image of what you will create in class (or example of your artwork) Click or drag a file to this area to upload. WaiverAgreement *I have read & fully understand all the Instructor Guidelines and Requirements and agree to the above waiver.CommentSubmit