LAST NAME, DATE OF INITIAL ACADEMIC DEGREES TEACHING AND NON-TEACHING AREA(S) OF LICENSURE/ FIRST NAME APPOINTMENT RESPONSIBILITY CERTIFICATION Undergraduate Degree(s): name of degree/date of completion Alphabetical Month/Year Course: Prefix, Number, Role/Responsibilities Current licensure: Graduate Degree(s): name of Order by Last state/license number/ Committees; Course, Clinical, Laboratory degree/specialty/date of Name expiration date Coordination, etc. completion Current certifications: Waiver/exception (if applicable) type/date acquired/ for credential/experience expiration date requirements: (explain) Currently enrolled: name of degree/projected date of completion Faculty Profile Table Qualifications of Part-Time Faculty Shared Teaching Responsibilities in More than One Nursing Program Directions: Complete requested information below for each part-time shared faculty member teaching at the time of the site visit. Insert additional rows as needed. Each person listed here should also be included in the Qualification and Professional Development Addendum. 1 2 3 4 5
LAST NAME, FIRST NAME Alphabetical Order by Last Name DATE OF INITIAL APPOINTMENT Month/Year ACADEMIC DEGREES Undergraduate Degree(s): name of degree/date of completion Graduate Degree(s): name of degree/specialty/date of completion Waiver/exception (if applicable) for credential/experience requirements: (explain) Currently enrolled: name of degree/projected date of completion LICENSURE/ CERTIFICATION Current licensure: state/license number/ expiration date Current certifications: type/date acquired/ expiration date TEACHING AND NON-TEACHING AREA(S) OF RESPONSIBILITY Course: Prefix, Number, Role/Responsibilities Committees; Course, Clinical, Laboratory Coordination, etc. Faculty Profile Table Qualifications of Part-Time Faculty Shared Teaching Responsibilities in More than One Nursing Program Directions: Complete requested information below for each part-time shared faculty member teaching at the time of the site visit. Insert additional rows as needed. Each person listed here should also be included in the Qualification and Professional Development Addendum. 1 2 3 4 5
FacultyProfile2018.docx