Certification for 103 Courses
Credit and Continuing Education Credit
I wish to be certified to teach the following 103 computer software courses:

Course Title

Course Number

Please provide Rationale “Why” I am qualified to teach the above course(s):
Education --formal and informal (List dates, course titles, hours, location, etc.):

Occupational Experience (List employer, dates employed, duties performed relevant
to course(s) teaching & hours spent performing these duties.):

Faculty Name (Print)

Faculty Signature


APPROVAL: I have ascertained that this instructor has sufficient competence to
teach the course(s) listed above:

Signature of Program Manager


Western Technical College, Certification, A-115, 400 Seventh St. N., P.O. Box C-0908, La Crosse, WI 54602- Rev 7/17/11