Abhes Faculty Data Form

ABHES FACULTY DATA FORM

(This document should be typewritten.

All information identified on this form must be substantiated in the faculty file)

Name of Employee:
Name of Institution:
City & State:

CURRENT POSITION HELD:

Position Title (Director of Education, President, Faculty, etc.)
Date of employment by this institution: / Full-Time / Part-Time
Date of first day of instruction
(If different from first day of employment, due to training etc.)
Date of 30 day evaluation

EDUCATIONAL BACKGROUND:

List below all post-secondary education, beginning with the most recent:

NAME OF INSTITUTION / LOCATION
(city/state) / MAJOR / DATES
ATTENDED / DEGREE & DATE RECEIVED
Title of educational certificate or license currently held:
This document was issued by: / Date:
Certificate/license expiration date:

PROFESSIONAL EXPERIENCE (Start with position held immediately prior to present one):

NAME OF ORGANIZATION / TITLE / NATURE OF DUTIES / DATES
FROM / TO

IN-SERVICE SESSIONS ATTENDED (during last 12 months):

NAME(S) OF PRESENTER / TOPIC(S) / LOCATION / DATE ATTENDED

PROFESSIONAL EDUCATIONAL DEVELOPMENT (during last 12 months):

(Documentation evidencing activities listed must be in faculty file)

ACTIVITY (seminar, workshop, conventions, continuing education, coursework, etc.) / TITLE/TOPIC/COURSE / DATE(S) / LOCATION
List professional organizations related to what you are teaching in which you currently hold membership:
List current professional publications subscriptions related to what you are teaching:

CURRENT EDUCATIONAL RESPONSIBILITIES: Identify your teaching schedule for a typical week during the past month. List all classes taught.

COURSES TAUGHT / INDICATE THE NUMBER OF HOURS ALLOTTED TO TEACHING EACH DAY
SUN / MON / TUE / WED / THUR / FRI / SAT
SIGNATURE OF FACULTY MEMBER / DATE