NOTE: This version
cannot
be submitted electronically. Please feel free, though, to print
out
copies for your use and for other interested individuals. Be
sure to print and complete all three web pages.
(An
on-line form is not currently available.)
EDUCATION (start with most recent)
Name of
Institution
Dates of Attendance
Degree
Date Received
__________________________
________________
_______
_______________
__________________________
________________
_______
_______________
__________________________
________________
_______
_______________
Fields of Study:
________________________________________________________________
EXPERIENCE Total years experience:______
(A) List the teaching positions you have held, beginning with the
current
year.
Name of
School
Dates
Grade
Levels
Subjects Taught
____________________
________
____________ __________________
____________________
________
____________ __________________
____________________
________
____________ __________________
(B) List courses, workshops, and professional teaching of writing
meetings,
memberships, and conferences
you have participated in.
Date:
___________________________________________
_____________________
___________________________________________
_____________________
___________________________________________
_____________________
If necessary and you are selected as a finalist, would you be
willing
to come to Western Kentucky University
at your own expense for a personal interview with the Project staff?
Yes______ No______
If you are selected for the Project and decide to participate in our
Outreach program (designed to provide paid
in-service to schools and districts), do you agree to allow the
Outreach
office to act as your "booking agent"
and make all arrangements?
Yes______ No______
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