Formal Resume by lju16692

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									                                         UNIVERSITY OF CHICAGO
                          SPORT CLUB INSTRUCTOR INFORMATION AND PASS REQUEST

NOTE:              *Authorization for Instruction with the club requires a formal resume of related experience,
                    years of service, and certifications must be attached.
                   **Clubs may request one (1) pass. The Director of Campus Recreation will review additional passes.
                   ***Passes are granted to instructors/coaches using the facility for their respective club practices

Club Requesting                                                                Date
Authorized Agent

                                                                                                                          ID Number
Instructor/Coach   Date(s) of Request                                     to                                              Assigned

                   Name                                                        Email

                   Address                                                     Phone

                   City                                                        Zip Code

                   Affiliation             Enrolled Student                               Volunteer
                                           Faculty/Staff                                  Hired Employee
                                           Alumni                                         Other (Describe Relationship)
Instructional Fee Charged
                                 Students                                 Alumni          Total Amount:
                                 Faculty/Staff                            Spouses

                                                                                                                          ID Number
Instructor/Coach   Date(s) of Request                                     to                                              Assigned
                   Name                                                        Email

                   Address                                                     Phone
                   City                                                        Zip Code

                   Affiliation             Enrolled Student                               Volunteer
                                           Faculty/Staff                                  Hired Employee
                                           Alumni                                         Other (Describe Relationship)

Instructional Fee Charged
                                 Students                                 Alumni          Total Amount:
                                 Faculty/Staff                            Spouses

                                                                                                                          ID Number
Instructor/Coach   Date(s) of Request                                     to                                              Assigned
                   Name                                                        Email

                   Address                                                     Phone
                   City                                                        Zip Code

                   Affiliation             Enrolled Student                               Volunteer
                                           Faculty/Staff                                  Hired Employee
                                           Alumni                                         Other (Describe Relationship)
Instructional Fee Charged
                                 Students                                 Alumni          Total Amount:
                                 Faculty/Staff                            Spouses


Office Use Only
Date Received                              Sport Club Director Approval                                       Date

                                           Facitlity Manager Approval                                         Date

								
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