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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