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* 1. What is your name?

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* 2. What is your Eastern-affiliated email address?

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* 3. What department(s) are you affiliated with at Eastern University?

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* 4. Are you interested in teaching with Eastern's Prison Education Program (PEP)?

If you have selected “No” above, please skip the remaining questions and submit your response. Thank you!

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* 5. Of these REQUIRED courses for Eastern’s A.A. Liberal Arts Degree, which are you able to confidently teach?

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* 6. Which discipline(s) can you teach 100-level and/or 200-level courses as electives?

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* 7. Please list any 100-level and 200-level classes within your selected discipline(s) that you would be willing to offer in future semesters for PEP students. 
If you selected “None”, please enter “N/A”.
Ex: ENGL 206, ENGL 215

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* 8. Tentatively, what would be a good semester for you to teach one of the courses noted above?

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* 9. Please list any comments, concerns, or questions you may have below:

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