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Intention to Teach
Averett University Adult Professional (GPS) Program

GENERAL INFORMATION
Name:
Street Address:
City:
State:
  
Zip:
Work Phone:
  
Home Phone:
Cell/Mobile Phone:
Primary Email Address:
 A value is required.Invalid format.
Other Email Adress:

ACADEMIC BACKGROUND (highest degree first)

  College/University Discipline Major Degree Earned Credit hours earned in this discipline
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2.
3.
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COURSE(S) INTERESTED IN TEACHING

  Course Title Course# Dates (From - To)
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ACCEPTABLE LOCATIONS:

SOUTHERN VA CENTRAL VA TIDEWATER
Danville Quantico Chesapeake
Lynchburg West End (Innsbrook) Newport News
South Boston Southside (Watkins Center) Richmond Bland College
Martinsville Charlottesville  
Roanoke    

HOW DID YOU HEAR ABOUT AVERETT?







This form will automatically submit an email to Robert Sims, Director of Faculty Services. He will contact you when he has received your information. If you have any questions, please call Robert Sims at 1-800-849-0115 or email him at rsims@averett.edu.

Once this form is submitted, you will be redirected to our Faculty Resource Site on Blackboard (our Course Management Resource Center). User name and Password is newfaculty to enter Blackboard. Please review the information contained in the Faculty Candidates Section.