Name:  
Address:  
City: State: Zip/Postal Code:
Country:  
 
Date of Birth: (MM/DD/YY)  
     
Home Phone:  
Cell Phone:  
Skype Address  
E-mail:  
     
Educational Background  
     
Schools:
Degrees & Dates:
Major Emphasis:
     
Teaching or other experience in area of expertise:
     
A statement of your approach and teaching philosophy in your primary teaching area:
     
What do you expect to gain from the Belvoir experience?
     
Why does Belvoir seem appropriate for you this summer?
     
Do you smoke? Yes No  
Do you drive? Yes No  
     
What date could you begin work?
What date must you finish?
     
What salary do you feel appropriate for a seven week session (plus one week of orientation) that provides room and board?
     
References
List 3 references with Name, Address, Phone Numbers
     
Name:  
Address:  
City/State/Zip:  
Phone Number:  
Email:  
     
Name:  
Address:  
City/State/Zip:  
Phone Number:  
Email:  
     
Name:  
Address:  
City/State/Zip:  
Phone Number:  
Email:  
     
Pertinent Certifications:
How did you hear about Belvoir Terrace?:
     
     


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