* 1. Name:

* 2. Subject taught:

* 3. Teach at Location (i.e. Main Campus, Specific Education Center, etc.)

* 4. Email address:

* 5. Faculty Status:

* 6. Number of years teaching:

* 7. Number of years teaching at KC:

* 8. Provide a brief summary of your teaching experience:

* 9. Why are you interested in participating in the Teachership Academy?

* 10. What do you expect to gain from this experience?

* 11. Which of the following topics would you be interested in covering during the teachership cohort that would benefit you as an educator or applying to your students in the classroom (click all that apply):

* 12. What are your research interests?

* 13. Any other information you would like included in your application:

Thank you for your application! Your application will be submitted to your respective dean for their approval of your participation. We will be informing the accepted cohort in early August. If you have any questions about the process please contact the Title III office.

Thanks again!