MCC COURSE(S) YOU ARE APPLYING TO TEACH:
Visit www.manchestercc.edu/catalog for a complete course listing found in the academic catalog. The MCC course number and name (example: ACC* 231: Cost Accounting I ) must be
listed in order to direct your application to the appropriate department.
I understand that obtaining certification requires me to adhere to all standards set by Manchester Community College. I also understand that professional development and workshop
attendance are necessary to remain certified to teach MCC courses. My principal has agreed to allow me elease time to attend MCC workshops on campus.
Course Number Course Name
Course Number Course Name
Course Number Course Name
College Career Pathways
Teacher Certification Application
APPLICANT INFORMATION
Last Name First Name MI
High School Name High School Main Phone/Extension
Principal’s Name Phone/Extension
INSTITUTION INFORMATION
REQUIRED
Please complete this form, sign, date and mail with your resume and transcripts to:
Robert A. Henderson, Director of Cooperative Education, Manchester Community College, MS #8, P.O. Box 1046, Manchester, CT 06045-1046
Email: rhenderson@manchestercc.edu Phone: 860-512-3312 Fax: 860-512-3371
Street Address
City State Zip
Street Address
City State Zip
Home Phone Number Cell Phone Number Work Phone Number
Applicant’s Signature Date
Principal’s Signature Date
Personal Email Work Email
February2017/PR
This application must be submitted with a resume and transcripts from undergraduate and graduate studies.
Copies of transcripts on file with your institution or Board of Education will be accepted.
EDUCATIONAL BACKGROUND
It is the policy of the Board to recognize only those degrees granted by regionally accredited institutions of learning. If the institution of higher learning is located
outside the United States, you are responsible for providing documentation from a recognized USA accrediting service that specializes in determining foreign education
equivalences. The responsibility for any costs associated with obtaining equivalency information rests on the applicant.
Please list coursework related to subject.
Please list any licenses or professional designations (e.g. P.E., C.P. A.)
TEACHING EXPERIENCE
List in reverse chronological order beginning with your current/last position
Dates (From – To) Institution and Location Subject(s)
Dates (From – To) Institution Location (city, state) Degree Awarded (e.g. B.A.) Major/Concentration
Please describe other professional development, continuing education or experience that should be considered in your application to teach Manchester Community
College courses.
EMPLOYMENT OTHER THAN TEACHING
List in reverse chronological order beginning with your current/last position
Dates (From – To) Institution and Location Position
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