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?

DeleteCollege _ID_
Educational History
Enter your college information below (undergraduate and graduate degrees, plus non-degree graduate hours). To enter multiple schools, click "Add Another College" at the end of the section. College/University Attended Start Date Start Date Major or Primary Field Degree Graduation Date (Put end-date of most recent course if no degree granted.) Graduation Date (Put end-date of most recent course if no degree granted.) Choose one of the following: 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.

Add Another College

Please submit a brief resume indicating work and educational background.

Other relevant educational experience (include dates):