Youngstown State University does not discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity and/or expression, disability, age,
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questions about this policy.
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COLLEGE CREDIT PLUS (CCP) INSTRUCTOR APPLICATION
APPLICANT INFORMATION (To be completed by the applicant):
________________________________________ ________________________________ ____________________________
Last Name First Name Middle Name or Initial
________________________________________ _________________________________________________________________
Social Security Number or Banner ID Number E-mail Address (YSU E-mail address preferred, if available)
____________________________________________________________________________________________________________
Mailing Address: (Location where you receive mail ----i.e. PO Box, etc.)
________________________________________ __________________________________ ____________________________
City State Zip Code
_____________________________________________ __________________________________________________
Home Phone Cell Phone
____________________________________________________________________________________________________________
Permanent Address: (Location where you receive mail ----i.e. PO Box, etc.)
______________________________________ _________________________________ ____________________________
City State Zip Code
_____________________________________________ __________________________________________________
Primary Employer Business Phone
ACADEMIC BACKGROUND (Transcript showing highest degree earned must be submitted to the academic department to which you are applying):
________ ________________________________ _______ ___________________________________________
Degree Institution Year Major
________ ________________________________ _______ ___________________________________________
Degree Institution Year Major
Have you ever been an employee of YSU? Yes_____ No _____ Are you currently an employee of YSU? Yes _____No _____
Applicant’s Signature on this form verifies the above to be true. ____________________________________ _____________
Applicant Signature Date
To be completed by Department:
APPLICATION REVIEWED; APPLICATION MEETS CRITERIA FOR PART-TIME TEACHING.
DEPARTMENT ___________________________________________________________ DEPT. ORG. NO._______________________
_________________________________ ______________ __________________________________ ______________
Chairperson’s Signature Date Dean’s Signature Date
Doctorate
Masters