Ashland University Professional Development Services

     Adjunct Instructor Application

 

Thank you for your interest in becoming an approved Adjunct Instructor for Professional Development Services. Please complete the following information and return to the address below as soon as possible.  When your application has been approved, a letter will be sent to your from Dr. Dwight McElfresh, Assistant Dean, Professional Development Services.  Please make sure all materials are attached and complete before returning them to our office as this will expedite the approval process.

 

 

If you have any questions contact Patty Canupp at (614) 794-4850 or pcanupp@ashland.edu.  If you would like further specifics concerning your role as Adjunct Instructor, feel free to review the Adjunct Manual on our website:

 

http://www.ashland.edu/pds/adjunct.html

 

 

Please be sure all required adjunct application materials (listed at bottom of page) are either emailed to us or sent to the following address:

 

Ashland University

Professional Development Services

1900 E. Dublin-Granville Rd.

Columbus, OH  43229

Attn:  Patty Canupp

 

Date:                                          

 

Name:                                                                                    Social Security Number:                                                

 

Position:                                                      

 

 

Work Address:                                                          

                          

                            

 

Home Address:        

                          

                                                                              

 

 

 

Work Phone:       

 

Home Phone:                                      

 

Fax Number:                                         

 

E-Mail:                                                

 

 

 

Proposed Workshop Title:           ­­          

 

 

In order for your application to be approved, ALL of the following must be included.

 

1.     Vita/Resume (Be sure that substantial evidence is provided that documents qualifications to teach the proposed graduate level workshop.)

 

2.     Photocopy of Teaching Certificate/License

 

3.     Photocopy of Masters Degree Grade Transcript

 

4.     Completed HQ PDS Proposal (Parts I, II, III)

               

 

     5.  ______ Yes                       _______No

Check here if you are receiving an instructor fee paid to you by Ashland University as stated on your Request for Credit Form with the workshop proposal.  If yes, please download the State and Federal tax forms below and return with your adjunct information.

 

      Tax Forms (needed ONLY if receiving Instructional Fee from University)

 

·        Ohio Employee's Withholding Exemption Certificate (IT-4)

 

·        Federal Employee's Withholding Allowance Certificate (W-4)

 

·        U.S. Department of Justice Employment Eligibility Verification (I-9)

Please include photocopies of appropriate identification pieces as listed in Section 2

 

·         Employee Form