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Instructor/Contractor Information

Name*
Email Address*
Phone Number *
Address*
City*
State*
ZIP Code*
Are you established as a business?*
1. Yes
1. No
Business Name
A City of Issaquah business license is required. Do you have a City business license?*
1. Yes
1. No, but I am willing to get one if contracted.
License Number
Does your business carry liability insurance?*
1. Yes
1. No
How much liability insurance do you carry?
Are you offering this program anywhere else?*
1. Yes
1. No
Where else do you offer this program?
Certifications/Licenses
List all that are related to this program proposal.
Title
Issue Date
Expiration
Title
Issue Date
Expiration
Title
Issue Date
Expiration
Title
Issue Date
Expiration
References
Name
Position
Organization
Phone/Email
Name
Position
Organization
Phone/Email
Name
Position
Organization
Phone/Email
Name
Position
Organization
Phone/Email
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Program Goals*
Please describe how your program will benefit our community.
Prerequisites *
Please describe the knowledge or skills a participant must have prior to enrolling in your program.
Safety/Emergency Information*
Please list all safety and risk factors of which participants should be aware.
Additional Information
Please include any information that a participant must know prior to attending your program (e.g. supplies to bring, how to dress, etc.).
What makes you the best choice to provide this program?*
How will you market and promote this program?*
Additional Materials
If you wish, you can upload flyers, program testimonials or other any other information relevant to your program proposal.

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