WED 258/259 TRANSMITTAL WORKSHEET
OFF-CAMPUS DEGREE PROGRAMS -- WORKFORCE EDUCATION AND DEVELOPMENT

Please, fill out information, print, and fax form to (618) 453-1909 or mail to 
475 Clocktower Dr., Pulliam Hall, Rm. 212, Mailcode 4605,Carbondale, Illinois 62901-4605 
Name:  ID #:          
Site:       Occupational Specialty:  
Paperclip original plus copy of original and submit to your off-campus site.  Materials will be returned if stapled or bound. Single-sided copies only. 

Documentation Submitted    Date Received      
Work History (required)      
WED 258 Work Experience:  (required).   
For USAF & 9502 (USN) only.  Military Personnel: Performance Evaluations - Most recent/no more than 4 full yrs.; usually 10-15 pgs.  
Civilian Personnel: Employment Letters - 4 yrs. full-time experience; usually 3-8 pgs.
WED 259 Occupational Training (if required).
SMART/AARTS
Licenses  
Apprenticeship Certificates   

Mailed materials to OCDP-WED Office SIUC:     
                                                                             Date Sent         On-Site Representative's Signature

COMPLETE THIS SECTION for CONSIDERATION of CREDIT for NEC 9502
 (Not awarded prior to consideration of WED 258/259; doesn't satisfy WED 258/259 requirements.)

Instructor basic completed   Month/Yr  
Curriculum development courses completed  Month/Yr  
Documentation: (One of the following showing 6 mos. supervised instructional exp.)
1.  Master training specialist certificate    Provided On     
2.  Letter of designation   Provided On   
3.  Instructor Evaluation    Provided On   
4.  Performance Report showing primary instructor duty Provided On   

It is the student's responsibility to ensure that ALL documentation is received in a timely manner. In order to earn maximum credit hours, materials must be received no later than 30 days before graduation date.