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* 1. Your Name:

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* 2. Email Address:

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* 3. Phone Number:

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* 4. Business Name (if applicable):

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* 5. Business Email (if applicable):

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* 6. Business Phone Number (if applicable):

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* 7. Please select your areas of expertise below. (Check all that apply.)

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* 8. What is the name of your proposed class?
(Note: If you have several classes, please use a new form for each.)

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* 9. What is the name of your proposed class?
(Note: If you have several classes, please use a new form for each.)

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* 10. Please enter a brief description of your proposed class below.

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* 11. If available, please list the desired objectives/learning outcomes of the proposed class below.

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* 12. Please indicate which of the areas below is covered in your proposed class. (Check all that apply.)

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* 13. Please indicate the target audience / education level of the proposed class. (Check all that apply.)

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* 14. Why are you interested in facilitating classes at CNM?

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* 15. How long have you been working as an educator/facilitator?

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* 16. Have you taught classes at CNM before?

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* 17. Have you had any other type of professional relationship with CNM in the past?

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* 18. Have you facilitated this class in Middle Tennessee before?

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* 19. What is your preference for the class format?

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* 20. If there is additional information about the proposed class that you would like to share, please do so below.

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