DE Enrollment Instructor Application

DUAL ENROLLMENT

INSTRUCTOR APPLICATION
Please enter your personal information. When you have finished, select "Next" to continue to the next section of the application.
Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address*

Street address

City, State and Zip code

City

Zip Code
Name of the DE course (s) you are applying for:
For example: Introduction to Business
EQUAL OPPORTUNITY EMPLOYER

Reading Area Community College, an equal opportunity college, does not discriminate against person in employment, educational programs or activities, voactional programs or awarding of contracts based on reace, gender, religion, national origin, age, color, sexual orientation, veteran status or disability. This Board of Trustees policy #840 on nondiscrimination extends to all other legally protected classifications and is published in accordance with state and federal laws including Title IX of the Edcuation Amendments of 1972, Sections 503 and 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990. Affirmative Action inquiries should be directed to the Affirmative Action Officer, RACC, PO Box 1706, Reading PA 19603 (telephone: 610-372-4721).
Education and Employment History
Some High SchoolHigh School equivalent or GEDAssociates DegreeBachelors DegreeMasters DegreeDoctorateProfessional Degree
College, please indicate:
Additional college, please indicate:
Additional college, please indicate:
If you attended a trade school, or have other specialized training, please indicate:
REGARDING YOUR PROPOSED DUAL ENROLLMENT COURSE: 1. Provide examples of professional experiences that qualify you to teach this DE course:
2. How long have you been teaching this proposed dual enrollment course in your current high school?
3. Provide a brief description of one assignment (in this course) demonstrating college level rigor
Employment Record
Current Employer
YES (Thank you! Please continue to the next questions)NO (Please upload a file below)
File Upload

File types: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, zip, mp3, wma, mpg, flv, avi, jpg, jpeg, png, gif
Cancelof
Course Syllabus Template (scroll to view whole document)
SUBMISSION AND CERTIFICATE
Please read carefully the terms below. You are certifying the information provided in this application when you submit this form to Reading Area Community College.
Should be Empty:

DUAL ENROLLMENT

Education and Employment History

Employment Record