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Please complete all applicable fields. All information completed below will be saved to your profile and you will not need to re-enter this information on subsequent proposals.

Note: returning instructors MUST complete this form (you only need do so once). We will not accept proposals with incomplete information or references to see proposals completed in previous years.

Account Basics

Email address*

Password*

Password confirmation*

Enter the same password as above, for verification.

Course Instructor Information

Please provide the following information for the proposed Special Studies course instructor.

First Name*

Middle Name

Last Name*

Address Line 1*

Address Line 2

City*

State*

Zip*

Country*

Phone Number*

Please use the XXX-XXX-XXXX format

Cell Number*

Please use the XXX-XXX-XXXX format

Website

If applicable, please list your website here.

Check here if you are a member of the NOW Generation (young adults ages 21 to 40)

Education And Experience

List colleges/universities attended, course of study, degrees completed and date

1. College/university name

Course of study, degrees completed

Date of completion

2. College/university name

Course of study, degrees completed

Date of completion

3. College/university name

Course of study, degrees completed

Date of completion

Other Relevant Education/Training/Certification

Attach copies of current certifications if applicable.

1. Education/training/certification, including date:

2. Education/training/certification, including date:

3. Education/training/certification, including date:

Teaching Experiences

Relevant to your proposals

1. List experience, including date:*

2. List experience, including date:

3. List experience, including date:

Employment

Relevant to your proposals

1. List employment, including date:*

2. List employment, including date:

3. List employment, including date:

Relevant publications, honors and professional affiliations:

Biography Summary*

Draft a brief biography of fifty (50) words or less as you would like it listed in the course catalog should your course be accepted into the curriculum. Biography will be edited for clarity, consistency and space. Please list education first, relevant work/teaching experience second, other personal data third.

Example: B.A., Univ. of Pennsylvania; M.A., English, Dartmouth College. Twenty years' teaching experience high school and middle school; currently teaching literature/writing at Shady Side Academy, Pittsburgh. Recipient, outstanding PA teacher award, 1991. Independent educational consultant; member Tri-State Curriculum Development Consortium. 450 character maximum.

Reference 1

First Reference Name

First Reference Address

First Reference Email

First Reference Telephone

First Reference Relationship

Reference 2

Second Reference Name

Second Reference Address

Second Reference Email

Second Reference Telephone

Second Reference Relationship

Reference 3

Third Reference Name

Third Reference Address

Third Reference Email

Third Reference Telephone

Third Reference Relationship

Upload documents

Upload your CV or resume, current certifications or additional documentation here.

Education Office Contact Info

Emily Novak • Manager of Community Enrichment • Email: enovak@chq.org • PO Box 28 • Chautauqua NY 14722

Reminder for instructors

*** Reminder: Standard compensation for instructors teaching on grounds and in person includes forty percent (40%) of tuition collected for the course, plus a Chautauqua gate pass and parking permit for the duration of the class. No housing, food or travel allowance is provided. Please be sure to read "More Information About Teaching at Chautauqua" which outlines details of gate pass information and other important information.***

Experience technical difficulties?

If you experience trouble submitting this form online, please email Emily Novak at enovak@chq.org.

Course Proposal Decision Process

APPLICANTS WILL BE NOTIFIED BY THE END OF JANUARY WITH A DECISION REGARDING THEIR PROPOSAL.

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