INDEPENDENT TEACHING AGREEMENT

Bachelor of Music Program: Work Integrated Learning

Information below must be completed in full and returned to your WIL Program Administrator (WPA) for
approval BEFORE beginning independent private teaching (i.e not working for a music school, store, etc.).

A teaching agreement must be completed and submitted for approval for each private student. More
information regarding IPT approval and additional IPT requirements are provided in the Work Term Guidelines.
Please make sure to follow all instructions carefully in order to ensure hours can be counted.

Humber Student Name:________________________ Humber Student #: ________________________

Phone #:____________________________________ Email: ____________________________________

PRIVATE LESSON EMPLOYER INFORMATION:

Name of student: _____________________________ Instrument:________________________________
Name of parent/guardian if student is under age __________________________________________________
Phone #:__________________________________ Email:____________________________________

STUDENT PROPOSED LESSON SCHEDULE (summer semester)

Specific Proposed Lesson Dates Duration of Lesson
i.e. July 3, Year i.e. 1 hour
I verify the above information to be accurate and true.

Humber Student Signature:____________________________ Date: __________________________

Student or Guardian Signature:_________________________ Date: __________________________

PLACEMENT OFFICE ONLY:

WIL Program Admin Signature: _________________________ Date:__________________________

IF YOU HAVE ANY QUESTIONS REGARDING THIS FORM PLEASE CONTACT YOUR WPA