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2. Program Name or Seminar Topic:*
4. Contact Name:*
5. Title:*
7. Business Name (if applicable):
9. Cell Phone:
10. Office Phone:
12. Email Address:
14. Street Address
16. Please select one:*

    1. I am offering my services free of charge (as a volunteer instructor).
    2. I am requesting payment for my services as a contract instructor.**
17. **Contract Instructor Terms:

    If you request payment for your services, you will be required to enter into a contract agreement with the City of McKinney.

    Background checks and / or drug tests may be required for all City of McKinney instructors.

19. Qualifications, Certifications, Licenses, etc.*

    Please describe your qualifications for conducting the program you are proposing and list any relevant certifications, licenses, education, experience, etc.

    A copy of current qualifications, certifications, licenses, etc. must be submitted in-person to the SRC.

21. Describe the program or seminar you are proposing:*
23. When would you be available to conduct the proposed program?*

    Check all that apply

    1. Mondays: Anytime
    2. Mondays: Mornings
    3. Mondays: Afternoons
    4. Mondays: Evenings
    5. Tuesdays: Anytime
    6. Tuesdays: Mornings
    7. Tuesdays: Afternoons

    1. Tuesdays: Evenings
    2. Wednesdays: Anytime
    3. Wednesdays: Mornings
    4. Wednesdays: Afternoons
    5. Wednesdays: Evenings
    6. Thursdays: Any time
    7. Thursdays: Mornings

    1. Thursdays: Afternoons
    2. Thursdays: Evenings
    3. Fridays: Any time
    4. Fridays: Mornings
    5. Fridays: Afternoons
    6. Saturdays: Any time
    7. Saturdays: Mornings
25. Professional References (please provide at least two):
27. Name:*
28. Phone Number:*
30. Name:*
31. Phone Number:*
33. Name:
34. Phone Number:
36. Thank you for your interest in providing services at the SRC!*

    Your proposal will be reviewed for future consideration. This inquiry form does not guarantee the selection or booking of services.

    1. I acknowledge that I will provide proper documentation of my qualifications upon request and that submitting this proposal form does not guarantee that my program will be selected.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field