Academy Membership Application Academy Membership Application First Name * Last Name, Suffixes & Degrees * Pronouns She/HerHe/HimThey/Them Email * WashU program or department * Current educational role at WashU * Years of experience on faculty as an educator (Minimal 3 years non-clinical teaching: inclusive or all institutions.) * Click here for Criteria Matrix Focus Area 1: Please provide a brief description and examples in your statement of interest demonstrating your expertise in Focus Area 1. Review the criteria matrix above for more detail on each Focus Area. * Direct teachingInstructional development and curriculumAdvising and mentorshipEducational administration and leadershipEducational research or scholarshipAssessment and evaluation Focus Area 2: Please provide a brief description and examples in your statement of interest demonstrating your expertise in Focus Area 2. Review the criteria matrix above for more detail on each Focus Area. * Direct teachingInstructional development and curriculumAdvising and mentorshipEducational administration and leadershipEducational research or scholarshipAssessment and evaluation Statement of Interest (limit 2 pages) 1. Brief statement of how Academy membership and involvement will fit your professional and personal goals as an educator. State what you hope to contribute to the Academy. 2. Brief description and examples of expertise in the two areas of focus selected above. * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Academy Sub-Committee Interest: Please select the sub-committee(s) you might be interested in joining if selected as a member of the Academy of Educators. * Awards Education Day Engagement Membership Mentorship Small Grants Why are you interested in the sub-committee(s) you selected? (150 words or less) * Curriculum Vitae * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Educator Portfolio * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Letters of Recommendation (Minimum of 1 letter required): Letter(s) of support should come from a Department/Program chair or someone who can validate your educational expertise and contributions. * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB Click here for Supplementary Documentation Examples Click here for Mentoring History table (if choosing mentoring as a focus area) Supplementary Documentation: As applicable, please attach the required supporting documentation of your expertise by focus area. * Drop a file here or click to upload Choose File Maximum upload size: 51.2MB If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit