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Sample Form for Graduate Assistant Application

Office of the Graduate School
Center for Business and Graduate Studies, Suite 1312
Graduate Research/Teaching Assistantship Application Form

Name:_____________________________________________________________

Social Security Number: _____________________ Email Address: __________

Phone Number: _______________________ Cell Phone Number: ___________

Address:___________________________________________________________

__________________________________________________________________

Graduate Degree Program: __________________Date of Admission: _______

Graduate Assistantship Type:
Graduate Teaching Assistant ( )
Graduate Research Assistant ( )

Graduate Advisor: ___________________________ Graduate GPA: _______

Undergraduate Institution GPA: ______

Years of Attendance: ______________ Undergraduate Major: ____________

References:
Name: Relationship: Phone Number:
1._____________________________________________________________

2. ____________________________________________________________

The following information will not be used in the selection process.
The information collected will only be used in aggregate form.

Country of Citizenship: ___________________________________________

Gender: _____________Race: ___________ Date of Birth:______________