SMITHTOWN CENTRAL SCHOOL DISTRICT
INTEREST APPLICATION for ADULT CONTINUING EDUCATION
Complete and mail to:
Smithtown Adult Continuing Education
PO Box 906
Smithtown, NY 11787
(631) 382-2090
Name__________________________________________Date__________________________
Address______________________________________________________________________
_____________________________________________________________________________
Phone (home)________________(business)_________________(cell)__________________
E-Mail________________________________________________________________________
What course(s) are you qualified to teach to adults?
_____________________________________________________________________________
_____________________________________________________________________________
Describe any experience you have had working with adults.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Describe employment or volunteer experience pertinent to the course described above.
______________________________________________________________________
_____________________________________________________________________________
References: (Please include address and phone number for each.)
1.___________________________________________________________________________
2.___________________________________________________________________________
3.___________________________________________________________________________
Present Employment: (Please include address and phone number)
_____________________________________________________________________________
Instructors are not permitted to use their courses for personal gain or to solicit clients or customers.
On back, please outline your class/workshop/ seminar proposal to include description of offering, materials needed (if any), time frame, and number of sessions.
Thank you.
