TA Program Application

Date*

Name*

Preferred prefix (Dr., Ms., Mr., etc.)*

Preferred pronouns (she/her/hers, he/him/his, they/them/theirs, etc.):*

Address*

Phone*

Email*

Degree(s) earned - Check all that apply

Associate

Major Subject

College/University

Date earned/expected

Bachelor

Major subject

College/University

Date earned/expected

Master

Major subject

College/university

Date earned/expected

Doctorate2

Doctorate

Major subject

College/university

Date earned/expected

If your highest degree is still in progress, how many units have you completed?

What is the total number of units needed to complete that degree?

Are you interested in applying the hours you accumulate through our TA Program to an internship requirement for a degree/certificate program you are currently enrolled in?*

Yes

No

Subject interested in teaching at the community college level*

Have you already contacted a Cerritos College instructor who could serve as your mentor?*

If so, whom?

Current occupation*

Years of experience in occupational field*

Are you a current Cerritos College employee?*

Yes

No

If you answered “yes,” what is your current position?

Have you been previously employed at Cerritos College?*

Yes

No

If you answered “yes,” what were your previous position and your dates of employment?

Do you have any relatives who work at Cerritos College?*

Yes

No

If you answered “yes,” please list their name(s), department(s), and relationship(s) to you.

Why are you interested in teaching at the community college level?*

OPTIONAL DEMOGRAPHIC INFORMATION

This information is not used in the selection process, but is helpful for targeting resources.

What is your gender?

Male/man

Female/woman

Non-binary

Transgender

Decline to state

What is your race/ethnicity?

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or other Pacific Islander

White or Caucasian

Two or more

Decline to state

Are you a veteran of the U.S. military?

Yes

No

Step 2: Submit Required Paperwork

To complete your online application, please email the following paperwork to Monique Valencia at mvalencia@cerritos.edu as an attachment:

Current Resume/Curriculum Vitae
Unofficial Transcripts (Please note if name has changed since transcripts were issued)

For questions or concerns, please contact Monique Valencia at mvalencia@cerritos.edu.

TA Program Application

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