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eCore Instructional Faculty Application Form

Title

Last name

First name

Middle initial

Birthdate (MM/DD/YYYY)

Institution

Employment Status at Your Institution

Are You Full Time or Part Time?
Full Time
Part Time

Full Name of Department
(i.e., Dept. of History or Div. of Humanities)
(Please do not use special characters or apostrophes)

Academic Rank

Highest degree earned

in Discipline

Degree Granting Institution

Office Mailing Address
Street:
City	State Zip
Office Phone	Fax
Email
Home Address
Street:
City	State Zip
Home Phone	Cell Phone (optional)

I would like to teach the following eCore course(s):

COMM 1100
ENGL 1101
ENGL 1102
ENGL 2111
ENGL 2132
ETEC 1101
MATH 1101
MATH 1111
MATH 1113
MATH 1401
MATH 1501
HIST 1111
HIST 2111

POLS 1101
ENVS 2202
CHEM 1211
CHEM 1212
GEOL 1101
PHYS 1211
PHIL 1001
PSYC 1101
SOCI 1101
SPAN 2001
SPAN 2002

Would you consider teaching two sections?
yes
no

Indicate your level of proficiency in the following areas:

Course Management System (Vista) functions:

Gradebook
novice
intermediate
advanced

Syllabus tool
novice
intermediate
advanced

Mail tool
novice
intermediate
advanced

Discussion tool
novice
intermediate
advanced

Assignment tool
novice
intermediate
advanced

Assessment tool
novice
intermediate
advanced

Calendar tool
novice
intermediate
advanced

Word Processing Software (e.g. Microsoft Word)
novice
intermediate
advanced

Spreadsheet Software (e.g. Microsoft Excel)
novice
intermediate
advanced

Web browsing Software (e.g. Internet Explorer, Firefox, Safari) functions:

Browse and search the Web
novice
intermediate
advanced

Print from a browser
novice
intermediate
advanced

Change security and pop-up settings within the browser
novice
intermediate
advanced

Troubleshoot basic issues that may arise with browsers
novice
intermediate
advanced

Have you ever (check all that apply):
taken a course delivered entirely online
taken a course on online teaching and learning
taught a web-enhanced course
taught a course entirely online
none of the above

Please indicate the number of online courses you have taught:
Please indicate the number of online courses you have taken:

Please list the name(s) of each online course you have taught:
(Please do not use special characters or apostrophes)

Please indicate which semester(s) and sections you would like or be available to teach.
Summer 2012 1 Section 2 Sections
Fall 2012 1 Section 2 Sections
Spring 2013 1 Section 2 Sections

	Please review the eCore Faculty Expectations Memorandum of Understanding. Print the form and return the signed form to: Melanie N. Clay, Ph.D. Dean, eCore Distance and Distributed Education Center University of West Georgia Carrollton, Georgia 30118 This signed form must be received before you will be placed in a course section.
	I have discussed faculty compensation with the administration of my home institution and I understand that my institution will pay me $1200 per credit hour for teaching eCore out of the funds they receive for the course.

If you would like to add any comments please do so in the box below:
(Please do not use special characters or apostrophes)

Please enter your vita below:
(You may copy and paste directly from Word or other programs, but you may need to adjust the formatting below.)