Teaching Affiliate – Expression of Interest Form Version 1.5 Last amended: 12/08/2015 Faculty of Arts Teaching Affiliate - Expression of Interest Form Please return your completed Expression of Interest form to either the Teaching Affiliate Co-ordinator (English) or the Head of Department (CLAS and Humanities) in which you wish to teach. Contact information can be found on the Faculty of Arts webpages. Please also attach your CV. If you are not a student at the University and have a unique taxpayer reference number you may be eligible to be engaged as ‘self-employed’. If you think you may fall into this category please indicate this here and someone will be in contact with you after the interview process to discuss this further with you. PLEASE WRITE IN BLOCK CAPITALS. Postgraduate student at The University of Nottingham: YES / NO School: Department (if applicable): Personal details Title: Mr / Mrs / Miss / Ms / Other (please specify): First name: Surname: Date of Birth (DD/MM/YYYY): Full correspondence address (with postcode): Contact telephone number: University of Nottingham email address (if applicable): Personal email address: Are you self-employed? YES/NO If yes, please provide your 10 digit Unique tax reference code: 1 Teaching Affiliate – Expression of Interest Form Version 1.5 Last amended: 12/08/2015 Teaching Personal statement (please tell us what motivates you to want to teach and list any teaching experience at any level and any relevant professional development courses attended): Modules (please list the modules in the School/Dept on which you would be able to teach): Academic Prizes and achievements (please write a brief outline of any academic prizes awarded, personal achievements etc. to date): Applicant’s signature: Date: Supervisor’s permission If you are currently a postgraduate student you are required to seek permission from your supervisor in order to express interest in becoming a Teaching Affiliate. “I confirm that the student has spoken to me about teaching on a casual basis in the Faculty of Arts and I support their expression of interest.” Lead Supervisor’s Signature: Name: Date: 2