1. Faculty Qualifications Verification Summary
    1.       EDUCATION
      1. Licensures /Certifications



Faculty Qualifications Verification Summary

Name:                Social Security Number:


Division:                Department:


Position:                Status:
_________________________________________________________________________________________
 



            EDUCATION


Degree:                Degree Field:


Institution:
 
Degree:                Degree Field:


Institution:
 
Degree:                Degree Field:


Institution:
 
 



Licensures /Certifications

 

Certification:             Certification Source:

 
Valid Until:


Certification:             Certification Source:

 
Valid Until:
 
Certification:             Certification Source:

 
Valid Until:
 
Courses approved to teach:


        ______________________________________      _________
       Division Dean               Date
 
   

 

                 
       ____________________________________________    _________
       Vice Chancellor for Academic Affairs and Student Affairs    Date
 
 

Form 2122/007 (4/22)

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