Distance Education Instructor Qualifications Form
Please complete this form to help us evaluate your qualifications for teaching in a distance education environment.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Highest Academic Degree Earned
*
Please Select
Doctorate/PhD
Master’s Degree
Bachelor’s Degree
Other
List Academic or Professional Credentials Relevant to Distance Education
*
Do you have prior experience teaching online or in a distance education format?
*
Yes
No
Which online teaching platforms or tools are you familiar with? (Select all that apply)
*
Zoom
Microsoft Teams
Google Classroom
Canvas
Blackboard
Other
Please list any certifications or training related to online or distance instruction
How would you rate your proficiency with online teaching methodologies?
*
Beginner
1
2
3
4
Expert
5
1 is Beginner, 5 is Expert
Briefly describe your approach to engaging students in a virtual environment
*
Submit Qualifications
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