School:	Business
Department(s) I would like to teach in	Social work
First name	Family name
Photo (optional)
Street	Postcode	Town/city + country
Academic title	Date of birth
Nationality	Place of birth
Email address	Private telephone number
Fax number	Business telephone number
Subjects I would like to teach:
Employer:
Address:
Job title/function:
Qualifications
academic:
professional:
Professional
experience:
Teaching:
experience
Account details:
IBAN	BIC
DHBW VS – 07/2014	Bank	Branch
I agree to the details I have given above being stored electronically for the internal purposes of the Baden-Wuerttemberg University of Cooperative Education (Duale Hochschule).
I agree to the inclusion of my name, academic/professional title and employer (if applicable) in the list of lecturers in the course prospectus and on the Villingen-Schwenningen website of the Baden-Wuerttemberg University of Cooperative Education (Duale Hochschule).
Date (dd/mm/yyyy)	Signature

Personal Data Sheet