2016-2017 UNIV 100 INSTRUCTOR RENEWAL APPLICATION
Characteristics of Successful Applicants:
1. Desire to work with first year students inside and outside the classroom
2. Understanding of and appreciation for unique needs of first year students
3. Ability and willingness to teach outside of an
own subject/disciplinary area
4. Ability and willingness to work with a diverse group of people
5. Ability and willingness to connect course content to real life contexts
6. Willingness to be trained in (and have an interest in) Human Well-being topics, concepts & issues
Name of Applicant: _________________________________________________
WIU Email ______________________________________________________________
Address: _________________________________________________________
Office Phone: ____________________________
Other Phone (e.g., Cell phone): __________________________________
Campus Mail Address: __________________________________________________
Status:
____Faculty, Unit A
____Faculty, Unit B
____Staff
____Other
Date/Year started at Western Illinois University: _______________________
Have you taught FYE or Univ 100 courses at WIU before? ____Yes ____No
*If no, please fill out the WIU New Instructor Application*
If yes, please indicate the courses and number of times taught:
__________________________________________________________________
Highest degree obtained: ________ Academic Discipline: ____________________
Institution: _______________________
If you are interested in working with a specific student as a peer mentor, please list (note that when assigning peer mentors, the
FYE Peer Mentor Subcommittee takes the requests of the peer mentors prior to those of instructor):
_________________________________________________
Responsibilities/Expectations:
1. Attend all training and/or informational sessions
2. Teach at least one section
3. Collect and report assessment data to FYE assessment and/or leadership committees, as well as to other appropriate
parties
4. Adhere to common course syllabus, including utilizing the required common text and WesternOnline; work and
communicate w i t h p e e r m e n t o r s a t w e e k l y s c h e d u l e d m e e t i n g s , plan at least two campus and community
explorations for your section(s)
5. Assist students in being aware of and accessing various University resources
6. Submit all required reports including but not limited to Early Warning and Final Grade Reports
I agree to abide by the above responsibilities/expectations.
Signature of Applicant _____________________________________________________
Date: ___________________________
Department/Unit Support: __________________________________________________
Date: ___________________________
Signature of Supervisor ______________________________________________________
Date: __________________________
Date Approved
Office): _____________________________________________
IF SELECTED, PLEASE IDENTIFY THE NUMBER OF SECTIONS AND YOUR PREFERRED DAYS AND TIME
TO TEACH: ______________________________________________________________________________________________
Submit the following 2 items by February 5, 2016 to Dr. Nancy Parsons, Associate Provost, Sherman Hall 211:
1. Completed application
2. Statement of Interest for renewal applicants (no more than one double spaced typed page)
 After reflecting on your previous UNIV 100 experiences and student evaluations, please discuss what you
believe you did well and what you would like to change going forward in future semesters.
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