PLEASE COMPLETE BOTH SIDES PLEASE SUBMIT FORM TO THE DIVISION OFFICE by January 29, 2016 EDUCATION AND CAREER &TECHNICAL EDUCATION INSTRUCTOR INFORMATION SHEET Name: ID#: Address: Date of Birth: _________________ Home Phone: Office Phone: Office Room: Cell Phone: *PT-Faculty Office Location: E-Mail Address: EMERGENCY, Please contact: Name: Phone: Please provide a number to facilitate students to contact you _________________ Full-time Part-time Returning New NOTE: Please fill out the above blank spaces for our files. It’s imperative to notify the division office if you should have a change of address, telephone number, etc. Thank you. OFFICE HOURS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY Your mail folder will be at: VV TM RG NWC 1 of 2 MDP SAT/SUN PLEASE COMPLETE BOTH SIDES PLEASE SUBMIT FORM TO THE DIVISION OFFICE by January 29, 2016 RELEASE ADDRESS FORM Often times, other departments within the college request home addresses and phone numbers of our instructors. Please fill out the information below so we will have a record of your preference for the release of information. Please note, this information will be released to the Coordinators but will not be released to students, faculty Or staff. Thank you! Name: Authorized to release home address? Yes No Authorized to release home phone number? Yes No PLEASE SUBMIT FORM TO THE DIVISION OFFICE 2 of 2