Academic Graduate Assistant Request Form
Preferred
request deadline to the Graduate College is June 1
st
for the upcoming fiscal year.
Before submitting this form to the Graduate College you must complete the
following:
1. Initiate a background check through Self Service Banner. You will receive an email once the
student has receive a clear background check. Date background check cleared _______________
2. Once you have initiated a background check send the student to Human Resources to
complete/update Human Resources paperwork. Date HR paperwork completed ____________
Failure to complete the above requirements will result in this form being returned to you
and delaying the student’s start date. Students may not begin work prior to receiving a
clear background check and the completion of their HR paperwork.
Requesting Program/Office: ____________________ Name of Supervisor: _________________
If you do not have an allocated position filled by May 1
st
, you must submit a request for an extension via
email to the Graduate College. Upon filling the position, please send this form to gradcollege@atu.edu
Student Name: Student Degree Program:
Student T#:______________ Anticipated Graduation Date: _____________ GPA: _________
Student ATU Email: _________________________
First and last day of work for assistantship*:______/_____/______ to ______/______/_____
mm dd yyyy mm dd yyyy
*Supervisors should initiate background checks. Students may not work prior to receiving a clear background check and
the completion of their HR paperwork or beyond their graduation date.
Are you holding another paid position at Arkansas Tech University? Yes No
If yes, please answer the following:
Department: ___________________ Supervisor: ________________ Hours/week working: _______
Stipend Amount Source Percentage
(For budgets other than Graduate College, list budget title and code) (must total 100%)
______________ Graduate College _________%
______________ Other _________________________________________________%
______________ Other _________________________________________________%
Tuition Waiver: (Only Graduate Level Courses can be waived)
TERM
Summer II
0 - 3
SOURCE (For budgets other than
Graduate College
Graduate College, list budget title and code)
Fall
6 - 9
Graduate College
Spring
6 - 9
Graduate College
Summer I
0 - 3
Graduate College
Total Tuition Waiver hours not to exceed 18 hours per academic year (July 1 – June 30)
