Certificate in College & University Teaching


Please fill out the requested information below

1. BSU ID number


2. Please provide the following contact information

First Name
Last Name
Middle Initial
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

3. Please describe your educational history

        Year(s):

        Institution: 

         Program/Major: 

        Degree Earned: 

 

Year(s):

Institution: 

Program/Major: 

Degree Earned: 

4. Current Student Status, if applicable:

        Degree Sought:  

        Date Expected:  

        Institution:  

        Program/Major: 

        Advisor name and contact information:


5. Current Employment Status, if applicable

        Job Title: 

        Institution or Company: 

        Department: 

6. Please describe any teaching or teaching-related experience(s) you have:


7. What are your primary objectives in seeking to obtain a Certificate in College & University Teaching?


8. Do you plan to pursue the Certificate part-time or full-time?

Part-time
Full-time

9. Please provide the names, mailing addresses, email addresses, and phone numbers for three people willing to serve as references for you:

        Reference 1:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail

        Reference 2:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail

        Reference 3:

Name
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
E-mail
     

 

Program Director

Thalia M. Mulvihill, Ph.D.

Program Director, Certificate in College & University Teaching

Associate Professor of Social Foundations of Education and Higher Education

Associate Director of the Adult, Higher and Community Education Doctoral Program

tmulvihi@bsu.edu

 


Revised: 09/14/05