City of Irvine Website - Contract Class Proposal

P E R S O N A L I N F O R M A T I O N

NAME*

BUSINESS NAME

ADDRESS*

CITY

ZIP

DAY/WORK PHONE*

OKAY TO RELEASE DAY/WORK PHONE TO THE PUBLIC?

Yes No

HOME PHONE*

OKAY TO RELEASE HOME PHONE TO THE PUBLIC?

Yes No

FAX NUMBER*

OKAY TO RELEASE FAX NUMBER TO THE PUBLIC?

Yes No

E-MAIL ADDRESS*

OKAY TO RELEASE E-MAIL ADDRESS TO THE PUBLIC?

Yes No

P R O F E S S I O N A L R E F E R E N C E S

1. REFERENCE NAME*

PHONE*

RELATIONSHIP

2. REFERENCE NAME*

PHONE*

RELATIONSHIP

PLEASE LIST LOCATIONS (CITIES, COLLEGES, ETC.) WHERE YOU HAVE PRESENTED AND/OR TAUGHT THIS PROGRAM.

C L A S S I N F O R M A T I O N

SUGGESTED CLASS TITLE

DESCRIPTION OF YOUR CLASS (25-40 WORDS)

LIST THREE (3) REASONS WHY STUDENTS WOULD ENROLL IN YOUR PROGRAM.

WHAT TYPE OF FACILITY WILL YOU NEED? (check all that apply)

BALLROOM
CRAFT ROOM
FIELD
GYM

KITCHEN
MULTIPURPOSE ROOM
OTHER

DO YOU HAVE A FACILITY IN MIND?

Yes No

NAME OF FACILITY

OTHER FACILITY

PLEASE SPECIFY ANY ADDITIONAL REQUIREMENTS.

PLEASE SPECIFY SET-UP REQUIREMENTS.

PLEASE SPECIFY ANY SPECIFIC EQUIPMENT NEEDED.

PREFERRED DAY(S) OF THE CLASS

MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

SUNDAY
MONDAY THRU FRIDAY
MONDAY / WEDNESDAY
MONDAY / WEDNESDAY / FRIDAY
TUESDAY / THURSDAY
OTHER

PREFERRED TIME(S) OF DAY/EVENING TO OFFER THE CLASS

TIME PER MEETING

NUMBER OF WEEKS

LENGTH OF SET-UP TIME NEEDED

LENGTH OF CLEAN UP TIME NEEDED

TYPE OF SET-UP

BANQUET
CLASSROOM
THEATER

NONE
OTHER

STUDENT AGE

NUMBER OF PARTICIPANTS

MINIMUM MAXIMUM

MINIMUM

MAXIMUM

COST PER PERSON (BASED ON 50% SPLIT)

ADDITIONAL MATERIAL FEE TO ASSESS STUDENTS?

MATERIAL FEE INCLUDED IN COST?

Yes No

HAVE YOU MET WITH OR CONTACTED OTHER CITY EMPLOYEES?

Yes No

A G R E E M E N T : R E A D C A R E F U L L Y B E F O R E S E N D I N G

The City's Class and Brochure Coordinators reserve the right to edit text descriptions and titles as necessary. This document is not binding and is subject to revisions.

I certify that all statements made above are true and complete. I am aware that the City will contact the references provided above. I fully understand that this proposal does not constitute an expressed or implied contract or employment.

Please enter the word above in the text box below.

The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.