JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Membership to Haile T. Debas Teachers' Academy- 2022
* Indicates required question
Email
*
Your email
Title
*
Your answer
Name
*
Your answer
Current Designation
*
Assistant Professor
Associate Professor
Professor
Location
*
Pakistan
Kenya
Tanzania
Uganda
UK
Department
*
Medical College
SONAM
IED
GSMC
ISMC
Other:
Required
Email address
*
Your answer
Contact number
*
Your answer
Are you a full-time faculty member or part-time?
*
Yes
No
Years of experience within AKU, including designations/positions held.
*
Your answer
Years of experience in other higher education institutions (if applicable), including designations/ positions held.
*
Your answer
Insert your link to your teaching dossier
*
Your answer
PERSONAL STATEMENT: Write a narrative about your educational trajectory, your current role, and key responsibilities in relation to teaching and leadership, including mentorship. [Max 250 words]
*
Your answer
FUTURE DIRECTIONS: Provide a detailed account of your proposed engagement with QTL and university wide educational and leadership activities, future direction, and intended contributions to the TA and hence, QTL_net. [Max 300 words]
*
Your answer
RE-APPLICANT STATEMENT (IF APPLICABLE): Individuals who have previously applied to the Academy are asked to address the feedback received from the Membership Committee, including how they have made any recommended changes, in a brief (two-paragraph) statement
Your answer
Send me a copy of my responses.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
