BCA Instructor Enrollment Application Form

First Name      Last Name

Birth Date (mm/dd/yyyy)                    Male Female

Address

City      State      Zip

Phone           E-Mail Address

Dates Requested in attending CueSport College       - to - (mm/dd/yyyy)

1:) In what year did you become involved with the sport of pocket billiards?     

2:) How long have you been teaching pool?      Years

3:) During the past year, how many students have you worked with on a fee basis?     

4:) How many total hours did that include?     

5:) Do you teach primarily at a single location?      Yes       No

If Yes ... Please provide Name, Address and Phone Number

Name:

Address:

Phone:

6:) Do you work with other BCA Instructors?      Yes       No

If Yes, then whom have or do you currently work with?

7:) Are your lessons?      Individual       Group       - or -       Both

8:) Do you use any special equipment, printed material, video tapes, video camera, etc...(Include examples if appropriate)

10:) Do you have any previous teaching experience other than billiards?      Yes       No

If Yes, what other experience do you have?

'A confirmation paid deposit is required to reserve all tentative enrollment and/or dates'

*** For your convenience we accept all major credit cards ***

* Please expect our follow up telephone call to receive your deposit for confirmation of enrollment *

CueSport College International

325 S. Bellevue Ave.

Peoria, IL 61604

(309) 697-2774