Applications: Extension Center Teacher

Currently, Seminary Extension requires an actual signature before we can process a teacher application; therefore, we are unable to accept applications electronically at this time. Fill in all the information on this application. Using the print option on your browser menu, print the completed form and sign at the appropriate arrow. Forward the completed teacher application to your local extension center director for his signature (arrow marks signature line for director) and have him mail the completed application to Seminary Extension, 901 Commerce St., Suite 500, Nashville, TN 37203-3631.

General Information
Name
Street Address
City
State
Zip
Home Telephone
Work Telephone
Email
Date of Birth
Social Security Number

Educational Background
High School	Institution City/State Major/Minor Degree Date Completed/ Attended
College	Institution City/State Major/Minor Degree Date Completed/ Attended
Seminary/Graduate	Institution City/State Major/Minor Degree Date Completed/ Attended
Educational certificate or licenses now held, issued by whom, and date

Teaching Experience
	Location Courses Taught Dates
	Location Courses Taught Dates
Vocational Background/ Denominational Background
Current Educational Responsibilities (Courses(s) projected to teach through Seminary Extension)

Summary of Qualifications
	It is required that instructors be qualified by education and experience. A Seminary Extension teacher must be a person who has a genuine interest in helping students receive effective training for Christian ministry. They must meet the following qualifications as minimum requirements. (Check all items that apply.)
	In order to be qualified to teach I realize that as a faculty member I must: hold a master's degree from a CHEA accredited school preferably in the area of the course to be taught for the Diploma Series. hold a high school (GED) diploma and be a person well qualified to teach the selected course for the Basic Series (non-transferable courses).

Employee's Statement
	Have you ever been convicted of a violation of any law other than a minor traffic violation?
	Yes* No   If Yes, attach an explanation.
	I will teach according to and not contrary to the 2000 Baptist Faith and Message. I hereby certify that the above statements are true and accurate to the best of my knowledge.
Teacher Signature	___________________________________________________
Date	___________________________________________________
Complete and return this form to:	Seminary Extension 901 Commerce St., Suite 500 Nashville, TN 37203-3631

SE Center Information
Certification Requested	Basic Diploma (Accredited Master's Degree or equivalent required)
Sponsor Number
Sponsor Name
Center Director
Address
City
State
Zip

To Be Completed by local SE Center Director
	I recommend without reservation ___________________________________________________ for certification as a Seminary Extension teacher.
Signature of SE Center Director	___________________________________________________
Date	___________________________________________________

SE Office Use Only
	___ Basic Level ___ Diploma Level
EC Approval
Date

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