ADVANCED STUDIES LECTURER APPLICATION Sheryl Duquette 6205 Main Street, Williamsville, New York 14221 716-851-1270 duquette@ecc.edu
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High School: High School Address: High School Phone with Extension High School Email: Principal: Courses Interested in Offering: SUNY Erie Department if known:
Semester/ Year:
Home Address: Home/Cell Phone:
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Personal Email:
Are you legally eligible to work in the U.S.?
No
Yes
Have you ever been convicted of a felony?
No
Yes
Are you a Veteran of the U.S. Military Service?
No
Yes
Have you ever worked for SUNY Erie?
No
Yes
Have you ever attended SUNY Erie?
No
Yes
If NO, explain: If YES, explain: If YES, explain: If YES, explain: If YES, explain:
Education Print Name Undergraduate:
Graduate:
Certifications/License
Number and Street. City, State, and Zip Code
Major/Degree
Credit Hours
Date Received