PVCC Continuing Education

Summer 2012

Instructor Information

This form will hold your information from page to page but does not save it. If you use the back button your information may be lost.

All fields on this page require an entry. If there is no information for a field write "none".

Last Name:

First Name:

Mailing Address:

City/State/Zip:

Email:

Home Phone Number:

Employer Name:

Employer Phone Number:

Which may be released to students who would like to contact you? (check all that apply)

Home phone:

Cell Phone:

Email:

None:

Educational Background

University/College Name	Major	Degree

Licenses/Certifications (name, type, number, etc.)

Name	Type	Received From

Practical experience in the area you wish to teach:

Teaching Experience:

List Credentials as you would like them to appear in the schedule:

References (three names/addresses/phone numbers)

Name	Reference Type (ex: employer, student, friend, etc.)	Address	Phone

Have you ever been convicted of a felony? Yes No

If yes, give nature of conviction and terms of sentencing

Paradise Valley Community College does not discriminate in admission or access to, or treatment or employment in its programs and activities on the basis of race, color, religion, sex, national origin, age or disability status. No question in this application is intended to secure information to be used for such discrimination.

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Course Information
Course Title:
Total number of course sessions Length of each course session (hrs)
Course Description:

Instructor Bio for schedule (brief)

Course Objective (main learning point of the course)

Method of presentation (lecture, deonstration, activity, etc.)

Media Requirements (ex. overhead, TV/VCR)

Recommended Texts (include publisher and ISBN)

Additional Fees for materials (if applicable) $ / student for Please note that black/white copies for course materials are free for instructors. Continuing Education and PVCC does not permit sales in the classroom. No exceptions. If you have materials that must be sold to students, contact us at 602.787.6800 to discuss alternatives and to obtain authorization.

Schedule of Topics / Sessions (limit to fewest number of meetings possible to meet learning objectives)
Session 1
Session 2
Session 3
Session 4
What will students learn from this course

Handouts, syllabus and other materials should be sent to the Contining Education office.

If your course meets the current needs of our students and community, we will contact you for an interview. If hired, you will need a government issued photo ID and an original social security card when you meet with Human Resources. If you are a vendor or out-of-state instructor, we will discuss payment options if your course is selected.
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If you would like to discuss the proposal(s) you plan to submit, contact Victoria Sutton, Office Coordinator or at 602.787.6800.

Paradise Valley Community College | 18401 N. 32nd Street | Phoenix, AZ 85032 | 602.787.6500