Mercy Learning Online 2012 - Teacher Application
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First Name
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Last Name
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School
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School City
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Cell Phone
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Home Phone
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School Phone
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Email
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I am familiar with the Mercy Learning Online program and accept its Mission and Purpose.
Yes
No
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I am willing to participate in the online in-service program to learn the updates to the platform.
Yes
No
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I am willing to collaborate or share with others as needed for designing and/or teaching an online course.
Yes
No
I would like to design a course for 2012
Yes
No
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The course(s) I wish to teach for Summer 2012 are:
Have you taken or taught a course online? If yes, please describe. Also are you familiar with the Blackboard platform? (New teacher only)
Please describe your current use of technology in your teaching, including use of available resources on the internet. (New teacher only)
Please describe why you are interested in participating in the Mercy Learning Online program. (New teacher only)
How many summers have you taught with Mercy Learning Online? (not including 2012) (Returning teachers only)
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I have informed my principal that I am submitting this request to continue teaching in the program and I have her/his support.
Yes
No
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My teaching credentials are current and are on file at the school named on this form.
Yes
No
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All information on this form is accurate. My choice of Yes indicates my sign off on the information.
Yes
No
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Date
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Submitted by
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Indicates Response Required