INSTRUCTOR INFORMATION

* 1. Last Name

* 2. First Name

* 3. Home Address

* 4. City

* 5. State

* 6. Zip Code

* 7. Phone Number

* 8. Alternate Phone Number

* 9. Email Address

* 10. Term (Fall/Spring/Summer) and year of proposed course

* 11. Are you...

* 12. Are you...

* 13. If you answered "Yes" to any of the above questions, please provide the name(s) of the Departments you are/were affiliated with:

* 14. Instructor’s Biography. Please write a brief (50 word limit) biographical sketch. Tell us how you know your topic and how it interests you. Include your current title, if applicable. (Instructor biographies are subject to revision).

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