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Instructor Application

Name of Instructor:
Name of High School:
Instructor e-mail:
Work Phone Number:
Work Fax Number:
Academic Discipline of Interest:
Do you have a masters degree in the discipline: Yes
If yes, what is your masters degree in:
If no, do you have 18 graduate credits in the discipline: Yes
If apporoved to teach CIHS classes, what colleges can we expect to recieve official transcripts from:
What UMC course(s) are you interested in teaching?
UMC Course:
UMC Course:
UMC Course:
UMC Course:
Other:
What semester would you like to start offering CIHS classes:
Comments or Concerns:

* In addition you must submitt


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