Graduate Assistant Application

Date     (mm/dd/yy)

Application will remain active for one year from date of application. 
 

Personal Information
Name  
Student T Number T  
Intended Major
Undergraduate Major     
Undergraduate Minor     
Graduate Admission  (Have you been admitted to Graduate College at ATU?)
Graduate Enrollment  (Are you currently enrolled in a graduate program at ATU?)
Resident of Arkansas
Present Address  
Permanent Address  
Home Telephone
(U.S. Only) 		( ) - -     
Office Telephone
(U.S. Only) 		( ) - -     
Email Address     
Date of Birth(mm/dd/yy) / /
Computer Experience Yes No WP Excel dBase Other 
  (If you have answered "Yes", please check all that apply.)

  

Education
Beginning with the most recently attended; please list all four-year colleges and universities.

Name of College or University Complete Mailing Address
Dates Attended
(mm/yy)-(mm/yy)		 Major Degree Conferred Date
(mm/yy)
-
   
Name of College or University Complete Mailing Address
Dates Attended
(mm/yy)-(mm/yy)		 Major Degree Conferred Date
(mm/yy)
-
  

   

References
List three persons and include their address, telephone number, and email address.

Name Address
Telephone Email
()- -
 
Name Address
Telephone Email
()- -
 
Name Address
Telephone Email
()- -

 

List Any Academic Honors
Honorary Degrees, Scholarships, Prizes, Fellowships

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