ISAS Staff Information Form 2020

Please complete the below form by February 7, 2020. Each faculty/staff member is required to complete this form for our ISAS Re-accreditation.

First Namerequired

Middle Namerequired

Last Namerequired

Genderrequired

Ethnicityrequired

These options come directly from ISAS.

Year Hiredrequired

Titlerequired

i.e. Teacher, Teacher Aid, School Nurse, etc.

Teaching Assignment

Grade Level (and subject for Middle School)

High School Information

High School Namerequired

High School Locationrequired

High School Graduation Yearrequired

Higher Education Information

I have completed College or Graduate School or am currently working on my degree:*

Yes No

How Many Degrees Have You Completed?

Please include any you are currently working on in this count.

Institution 1: Name

(i.e. college and/or graduate school)

Institution 1 Major and Minor

If no minor, please just write your major

Institution 1: Start Date

Month/Year

Institution 1: Finish Date

Month/Year

Institution 1: Degree Awarded

(i.e. Bachelor of Arts in English, Master of Education)

Institution 2: Name

(i.e. college and/or graduate school)

Institution 2 Major and Minor

If no minor, please just write your major

Institution 2: Start Date

Month/Year

Institution 2: Finish Date

Month/Year

Institution 2: Degree Awarded

(i.e. Bachelor of Arts in English, Master of Education)

Institution 3: Name

(i.e. college and/or graduate school)

Institution 3 Major and Minor

If no minor, please just write your major

Institution 3: Start Date

Month/Year

Institution 3: Finish Date

Month/Year

Institution 3: Degree Awarded

(i.e. Bachelor of Arts in English, Master of Education)

Institution 4: Name

(i.e. college and/or graduate school)

Institution 4 Major and Minor

If no minor, please just write your major

Institution 4: Start Date

Month/Year

Institution 4: Finish Date

Month/Year

Institution 4: Degree Awarded

(i.e. Bachelor of Arts in English, Master of Education)

Prior Teaching Experience

Are you a Teacher or a Staff Member?*

Staff members will skip the Prior Teaching Experience section. All faculty members need to complete the following section.

Teaching Faculty Member Staff Member

Prior to joining Regis, how many other schools have you worked at?

(choose up to 5)

One Two Three Four Five

Institution/School 1: Name

Institution/School 1: Location

Institution/School 1: Dates Employed (Start)

Month/Year

Institution/School 1: Dates Employed (End)

Month/Year

Institution/School 1: Title or Teaching Assignment

Institution/School 2: Name

Institution/School 2: Location

Institution/School 2: Dates Employed (Start)

Month/Year

Institution/School 2: Dates Employed (End)

Month/Year

Institution/School 2: Title or Teaching Assignment

Institution/School 3: Name

Institution/School 3: Location

Institution/School 3: Dates Employed (Start)

Month/Year

Institution/School 3: Dates Employed (End)

Month/Year

Institution/School 3: Title or Teaching Assignment

Institution/School 4: Name

Institution/School 4: Location

Institution/School 4: Dates Employed (Start)

Month/Year

Institution/School 4: Dates Employed (End)

Month/Year

Institution/School 4: Title or Teaching Assignment

Institution/School 5: Name

Institution/School 5: Location

Institution/School 5: Dates Employed (Start)

Month/Year

Institution/School 5: Dates Employed (End)

Month/Year

Institution/School 5: Title or Teaching Assignment

Memberships

Please list any memberships related to your school responsibilities (i.e. HAIS groups, etc).

Related Memberships:

Current Teaching Assignments

Course 1: Title and/or Subject

Course 1: Grade Level

Course 1: Number of Students in Class

Course 2: Title and/or Subject

Course 2: Grade Level

Course 2: Number of Students in Class

Course 3: Title and/or Subject

Course 3: Grade Level

Course 3: Number of Students in Class

Course 4: Title and/or Subject

Course 4: Grade Level

Course 4: Number of Students in Class

Course 5: Title and/or Subject

Course 5: Grade Level

Course 5: Number of Students in Class

Course 6: Title and/or Subject

Course 6: Grade Level

Course 6: Number of Students in Class

Course 7: Title and/or Subject

Course 7: Grade Level

Course 7: Number of Students in Class

Course 8: Title and/or Subject

Course 8: Grade Level

Course 8: Number of Students in Class

Supervisory Duties

Please list any supervisory duties you may have (i.e. advisory, study hall, carpool duty, lunch duty, detention duty, etc.)

Supervisory Duties:

Extra-Curricular and Sports Assignments

Please list any extra-curricular and/or sports assignments you have. Include the grade level and season for each.

Extra-Curricular and/or Sports Assignments:

Administrative Responsibilities

Please list any administrative responsibilities you might have. If none, please leave this section blank.

Administrative Responsibilities:

Committee Assignments

Please list any committee assignments you may have (i.e. Admissions application review committee, Heart to Heart committee, Formation to Mission committee, etc.)

Committee Assignments: