Instructor Application

K-12 Teacher Professional Development – Secondary Instructor Approval Form

All required information is marked with an asterisk. After you submit this form, a confirmation email will be sent to you to keep for your records.

Please Note: Approval to serve as the instructor of record for Professional Development courses does not extend beyond these types of classes. You are being approved as an instructor for K-12 Teacher Professional Development courses only.

COURSE INFORMATION
Name of the course for which you are applying to be an instructor. * Required
We must have both the Instructor Application and Course Setup Application in order to process the request. Please remember to submit a Course Setup Application for this course, if you have not done so already.
CONTACT INFORMATION
Name * Required
First Last
Date of Birth: * Required
MM
DD
YYYY
Citizenship Status * Required
Country of Citizenship * Required
Home Phone: * Required
Home Address * Required
Street Address City State ZIP Code
Name of School/Organization * Required
Email: * Required
EDUCATION
Highest Degree Earned: * Required
Area of Study: * Required
Awarding Institution: * Required
Year Awarded: * Required
Areas of Endorsement/Certification: * Required
PROFESSIONAL EXPERIENCE
Please list your work experience in chronological order, starting with your present position.
1. Title or Position: * Required
School/Organization: * Required
Dates of Employment : * Required
2. Title or Position:
School/Organization:
Dates of Employment:
3. Title or Position:
School/Organization:
Dates of Employment:

Instructor Application

K-12 Teacher Professional Development – Secondary Instructor Approval Form

COURSE INFORMATION

CONTACT INFORMATION

EDUCATION

PROFESSIONAL EXPERIENCE