•	New Hire
•	Re-Hire
•	Teaching outside area of  appointment 
•	CWRU ID:	 	

Semester/Year:                               ________________

Verification of Credentials Form
This form (Part A or B) with the relevant attachments is to be submitted by the College/School to the Office of the Provost prior to the start of the semester of the teaching assignment
Candidate

Name:	 	

Part A:	Undergraduate Teaching – The individual is being hired to teach undergraduate courses only and does not have a doctor’s or master’s degree in the discipline. The request to hire is based on the following:

The person holds at least a master’s degree with a concentration (minimum of 18 graduate semester hours) in a relevant discipline. Provide the transcript and document the 18 hours of relevant coursework.

Course Prefix and Number	
Course Title	Number of Semester Hours	
Institution	

The person has specific and current exceptional expertise that qualifies him/her to teach the courses to be assigned and an exception to the credentialing guidelines is requested. This is based on the following analysis of course content to be taught. Specific current documentation for each qualification listed (e.g., certifications, licenses, professional training documentation, job descriptions, letters, awards documentation, copies of work products, etc.) is attached.

Course	
Course Content	
Qualifications	Number of Supporting Documents Attached	

Part B:	Graduate Teaching – The individual is being hired to teach graduate courses as part of the teaching assignment and does not have a terminal degree in the discipline. The request to hire this person based on the following:

The person holds at least a terminal degree with a concentration (minimum of 18 graduate semester hours) in a relevant discipline. Provide the transcript and document the 18 hours of relevant coursework.

Course Prefix and Number	
Course Title	Number of Semester Hours	
Institution	

The person has specific and current exceptional expertise that qualifies him/her to teach the courses to be assigned. The request for an exception to the credentialing guidelines is based on the following analysis of the course content to be taught. Current documentation for each qualification listed (e.g., certifications, licenses, professional training documentation, job descriptions, letters, awards documentation, copies of work products, etc.) is attached.

Course	
Course Content	
Qualifications	Number of Supporting Documents Attached	

Name:   	

Approval Signatures

Department Chair (if applicable)

Name	Date

College/School Dean (required)

Name	Date

Provost Office

oApprove	o Disapprove

Name	Date