.1. Name 

 2. School

3. School City

 4. School Phone:            

5.  Home Phone

6.  Cell  Phone

10. E-mail address   - School

11.E-mail address  - Home  

Please Verify: All must be answered Yes. 

12. Please indicate YES I am willing to collaborate, share with others as needed for designing and/or teaching an online course.

13.Please indicate YES I accept the Mission and Purpose of Mercy Learning Online.

14a I have spoken with my principal and she/he supports this application. Please indicate YES

14b You can contact my principal via email at

15. My teaching credentials are current and on file at the school named on this application. Please indicate YES

15.. All information on this application is accurate and current. Please indicate YES

16.  I would like to apply to teach a course for Mercy Learning Online. The course I would like to teach is:

.17. Briefly describe your teaching experience.

.

. 

18.  Please describe why you are interested in teaching  this course for Mercy Learning Online.

19.  Name and briefly describe the courses you are teaching this academic school year. 

20.  Please describe your current use of technology in teaching, including use of available resources on the internet. 

23.Submitted by   24. Date