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2. Name (First, Last)
3. Phone Number
4. Email
6. Address1
8. Address2
10. City
11. State
12. Zip
14. Education/Degree (select all that apply)

    1. Self-taught
    2. BA
    3. MA
    4. BFA
    5. Teacher Certification
    6. Other Training
16. Describe "Teacher Certification" or "Other Training"
18. Select all interest areas you are able to teach. (select all that apply)

    1. Crafts
    2. Dance
    3. Music
    4. Painting
    5. Needle Arts
    6. Theater
    7. Ceramics/Pottery
    8. Multi-media Arts

    1. Athletics
    2. Outdoor Recreation
    3. Nature Education
    4. Enrichment
    5. Culinary
    6. Gardening
    7. Games
    8. Literature

    1. Presentations
    2. Technology
    3. Health & Wellness
    4. Fitness
    5. Therapeutic Recreation
    6. Support Group
    7. Other
20. If "Other", please describe.
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22. 1. Receive an email copy of this form.
23. Email address

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24. Submit

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