Fillable Dual Enrollment Instructor Pre-Qualification Form Pasco-Hernando State College (Pasco-Hernando State College)

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Dual Enrollment Instructor Pre-Qualification Form Pasco-Hernando State College (Pasco-Hernando State College)

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The Dual Enrollment Instructor Pre-Qualification Form Pasco-Hernando State College (Pasco-Hernando State College) form is 1 page long and contains:

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  • 4 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

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Dual Enrollment Instructor Pre-Qualification Form
Pasco-Hernando State College
Name of High School: ___________________________________ County: ______________________
Instructor Name: _________________________________ Email: ______________________________
Social Security # _____________________________________ DOB:___________________________
High School DE Contact Name: _________________________ Email: __________________________
Proposed Term/Year (circle): Fall Spring ______ Date Submitted: ___________________
Year
Request to be evaluated as Adjunct Instructor to teach at PHSC as well as at high school?
Yes
No
Course
Prefix/
Number
(Ex. ENC1102)
Course Title
Note: This is a Pre-Qualification only and does not guarantee that the instructor will be able to teach
the course or that the high school will be able to offer the course.
School Administrator: _________________________________ _________________________________
Print Name Signed Date
Phone # ______________________________
Date received: _______________ Approved Denied
Pre-Qualification review completed by: _______________________________ Date:____________
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Dual Enrollment Instructor Pre-Qualification Form Pasco-Hernando State College (Pasco-Hernando State College)

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Completed 22 July 2020

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