Honors Academy Instructor Application

Teacher Information

First Name

Last Name

Preferred Name

Previous name(s)

High School (where you will offer the course)

School Email Address

Personal Email Address

Home Mailing Address

Country

Street

City

Region

Postal Code

T-Shirt Size
(WHA teachers get a free t-shirt each year.)

School Phone

Cell Phone

Total Years Teaching

Years at Current School

Course Information

Name of high school course proposed for Wesleyan Honors Academy

When are you hoping to start offering this course for dual credit through Wesleyan Honors Academy?

College Information

Enter your college information below (undergraduate and graduate degrees, plus non-degree graduate hours).

How many colleges/universities have you attended? (Count separately for each degree/level.)

College 1

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic (preferred): Email to Heather Zaruba, hzaruba@nebrwesleyan.edu
OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

College 2

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic: Email to Heather Zaruba, hzaruba@nebrwesleyan.edu OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

College 3

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic: Email to Heather Zaruba, hzaruba@nebrwesleyan.edu OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

College 4

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic: Email to Heather Zaruba, hzaruba@nebrwesleyan.edu OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

College 5

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic: Email to Heather Zaruba, hzaruba@nebrwesleyan.edu OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

College 6

College/University Attended

Start Date

Major or Primary Field

Degree

Graduation Date
(Put end-date of most recent course if no degree granted.)

Choose one of the following:

Degree completed

In-progress

Non-degree program

Send Official Transcripts
Electronic: Email to Heather Zaruba, hzaruba@nebrwesleyan.edu OR
USPS: Heather Zaruba, Honors Academy

Nebraska Wesleyan University
5000 St. Paul Ave
Lincoln, NE 68504

To facilitate approval, optionally add unofficial transcripts.

Please submit a brief resume indicating work and educational background.

Other relevant educational experience (include dates and/or number of years):

Experience in teaching the course you would like to offer for dual credit
Non-credit continuing education opportunities
Enrollment in a program to earn additional graduate hours in the subject area
Subject-area institutes and workshops attended
Certificates received
Teaching awards or special recognitions
Heritage speaker of language (for Modern Languages courses)
Demonstrated success in leading competitive student programs in the discipline (Coaching/sponsoring an event or organization with state/national qualifiers in multiple years ---- speech or debate for a communications teacher, FBLA for a business teacher, mock trial for a political science teacher, etc. -- or peer organization recognition for career/coaching success)