RegistrationTerm:fallspringYear:______________
AreyouaHolmesCommunityCollegeOnlineAdjunctInstructor?
YesNo
RequestingadiscountforOnlineAdjunctInstructor?YesNo
OnlineAdjunctInstructorNameRequired:
Name:______________________________________________
OnlineAdjunctInstructorHolmesIDRequired:
HolmesID___________________________________________
SupervisorName:______________________________________
SupervisorSignature:___________________________________
Date:__________/__________/_____________
EmailthecompletedformtoKalaMoodykmoody@holmescc.edu
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