Academic Graduate Assistant Request Form
Preferred request deadline to the Graduate College is April 1
st
for the upcoming fiscal year.
For Graduate College Office Only
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’S FULL LEGAL NAME: _______________________________________________________________________
STUDENT T#: ______________________ STUDENT DEGREE PROGRAM: _____________________________________
STUDENT ATU EMAIL: _________________________________ ANTICIPATED GRADUATION DATE: __________________
STUDENT GENDER: Male _______ Female _______ STUDENT PHONE # (______) - _____________________________
FIRST AND LAST DAY OF WORK FOR ASSISTANTSHIP: _______/_______/__________ TO ______/______/__________
mm dd yyyy mm dd yyyy
Is the student 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 HOURS SOURCE (For budgets other than Graduate College, list budget title and code)
Summer II
0-3
Graduate College
Fall
6-9
Graduate College
Spring
6-9
Graduate College
Summer I
0-3
Graduate College
Other _____________________________________________
Other _____________________________________________
Other _____________________________________________
Other _____________________________________________
TOTAL TUITION WAIVER HOURS NOT TO EXCEED 18 HOURS PER ACADEMIC YEAR (JULY 1 – JUNE 30)
Once this form is received, all areas are complete with required signatures and GA has been approved, the Graduate College will
initiate a background check. The Human Resources office will notify the supervisor once the student’s background check is
clear. HR will also notify both the supervisor and student if employment paperwork is required from the student.
Date Background Check Cleared _________________ Date HR Paperwork was completed ________________
STUDENTS MAY NOT BEGIN WORK PRIOR TO RECEIVING A CLEAR BACKGROUND CHECK AND THE COMPLETION OF THEIR HR
PAPERWORK. FAILURE TO COMPLETE HR PAPERWORK IN A TIMELY MANNER COULD ALSO DELAY THE STUDENTS START DATE
Student is eligible for a GA position : Yes
Semester Hours: ____________ GPA: ____________
Graduate College Signature: ______________________________________________ Date: ________________
No
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