Dual Credit Instructor
Last Updated: November 2017
Dual Credit Instructor
Teaching Interest Form
Last Name: First Name: MI:
Address: DOB:
City: State: Zip: Country:
Phone - Home: ( ) - Work: ( ) - Cell: ( ) -
Best Time to Call: Days Evenings Email:
Highest Level of Education:
Disclaimer: The required educational level varies per program.
Associate’s Degree Baccalaureate’s Degree Master’s Degree Doctorate’s Degree Other:
Professional/Industry Experience: (List Details in Resume)
Division/Department: Licenses/Certificates:
Resource/Skills Information:
Please check areas of experience to identify what you may have to offer Arizona Western College. (Check all that apply)
Accounting (ACC)
Administration of Justice (AJS)
Agriculture (AGB, AGS)
Allied Health (AHE)
Anthropology (ANT)
Applied Music (MUS)
Art/Art History (ARH, ART)
Automotive (AUT)
Biology (BIO)
Broadcasting (BDC)
Business (BUS)
Chemistry (CHM)
Computer Information Science (CIS)
Community Health Worker (CHW)
Culinary Arts (CUL)
Economics (ECN)
Education (EDU)
English (ENG)
English as a Second Language (ESL)
Entrepreneurial Studies (ENT)
Engineering (EGR)
Emergency Medical Services (EMS)
Family Studies (FAS)
Fire Science (FSC)
French (FRN)
Graphic Art (GRA)
History (HIS)
Hotel/Restaurant Management (HRM)
Journalism (JRN)
Mathematics (MAT)
Massage Therapy (LMT)
Music Appreciation (MUS)
Nursing Assistant (NUR)
Personal Trainer (PTR)
Physical Education (PED)
Philosophy (PHI)
Physical Education Management (PEM)
Physical Education Recreation (PER)
Physics (PHY)
Plant Science (PLS)
Political Science (POS)
Psychology (PSY)
Reading (RDG)
Religion (REL)
Sociology (SOC)
Spanish (SPA)
Speech (SPC)
Theatre (THE)
Voice (MUS)
Wellness Education (WED)
Welding (WLD)
Other:
Languages: Seminars/Workshops/Other:
Approximate Amount of DC Courses to be Taught per Semester: (Check all that apply)
One Two Three Flexible
Teaching Location(s): (Check all that apply)
Antelope HS Bicentennial HS Cibola HS Gila Ridge HS
Kofa HS Parker HS Salome HS San Luis HS
San Pasqual Valley HS Vista HS Yuma HS Yuma Catholic HS Other:
Pl
ease return completed form, resume, copy of your transcripts and verification form. Return complete packet to CTE Office, Yuma Campus P.O. Box 929,
Yuma, AZ 85366 or Fax: (928) 917-6048 or Email: tiffany.tipton-pavey@azwestern.edu
You
will be contacted regarding being a dual credit instructor after review of your credentials by the appropriate Division/Department. For additional questions please
call the Dual Credit / Early College Experience Program Manager @ (928) 344-7742.
