Register As a Project VisAbility Instructor

If you are interested in applying to become a Project VisAbility instructor or know someone who would be,
please complete the following information. Due to the nature of these positions and the quantity of requests
we receive, we will contact you only if there is a strong match between your background and current opportunities.

Personal Information
Your Name *
Please enter your full name.
Your Email *
Please give a valid email address.
Address
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City
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State (US only)
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Zip
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URL of Your Website
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Phone
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Type of Disability
(describe)
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Education and Training
list all that apply)
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Exercise Experience
(list all types)
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What type of exercise do you currently
do on a regular basis? How often?
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Where do you exercise?
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Have you participated in group exercise
programs in the past?
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Location(s) where you would like to teach
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Why do you want to be a group exercise
instructor?
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Are you certified in basic CPR?
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Can you commit to a 3-month training
program
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Date available to begin
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Do you have any health issues which
would impact your ability to teach?
(list and describe all that apply)?
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Please list anything else you would like
us to know in considering your application
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References

Please list two people who we may contact regarding your qualifications:
Reference 1 Name
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Reference 2 Name
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By filling in your name below, you agree that all information is correct and that you are applying to be considered as a Project VisAbility instructor. You also agree to have your personal information, including your name, city, state, zip code, email address, and website URL, visible on our website and searchable by the public. Submission of this application does not imply acceptance. Project VisAbility management will review your application and respond accordingly.

I agree (type name) *
Please type your name.		 Date *
Please select a date when we should contact you.
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