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University of the Third Age
Nepean-Blue-Mountains-Chifley Chapter Inc.
3 Castlereagh St, Penrith NSW 2750
PO Box 958, Penrith NSW 2751
Tel: (02) 4722 3405
Email: u3anepoff@pnc.com.au
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Tutor Information
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If you wish to be a U3A tutor, please complete all the questions on this survey form and forward it by email, fax, post or in person to the address shown above. If you wish, you can use your own document ( instead of this form) provided all questions are answered and the document is signed and dated. Emails do not need to be signed.
Please note that we are a not-for-profit, non-political and non-sectarian organisation and all tutors are volunteers (i.e. they do not get paid).

Name:  __________________________________________________________

Address:  ____________________________________________________________________________________

Postcode:  __________   Telephone:  _____________________   Email:  _________________________________

Title of the Course you propose to offer  ________________________________________________________________________

Duration of course: Please enter the term(s) that the course would run:

E.g. Term 1, 2, 3, 4  _____________________________________

OR Short Course (less than a Term). Please enter the number of weeks:  _____________________________

Frequency of the course. Please enter Weekly or Fortnightly:  ___________________

Preferred weekday (in order of your preference)  ________________________________

Preferred time (in order of your preference): (e.g. 10.00am – 11.30 am)  _____________________________

Preferred location: (e.g. Penrith, Lawson, Springwood, etc. If private home, give address).  ____________________________
Every effort will be made to find a suitable location.

Proposed commencement date:   _______________________

 

COURSE SUMMARY

1.  Please briefly summarise your course and state any prior knowledge needed: what books or materials will be needed, where they can be purchased and likely cost?


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2.  Please briefly summarise your qualifications to teach this proposed course e.g. Retired teacher of this subject; previous tutor for U3A, or whatever you think is relevant for the Committee in considering your offer.


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3.  Do YOU have any special requirements for this course? (e.g. Minimum/Maximum number of students, a whiteboard, VCR etc).


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Signature:  __________________________________     Date:  _____________________

 

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