Fillable CCSU Application for a Graduate Assistantship Position 06050-4010

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CCSU Application for a Graduate Assistantship Position 06050-4010

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GRADUATE SCHOOL—Central Connecticut State University, New Britain, CT
06050-4010
Application for a Graduate Assistantship Position
Submit the COMPLETED form directly to any academic departments where you wish to apply for a graduate
assistantship position. You may use this form to apply to more than one department. If extra space is needed,
please attach the additional pages. Departments may also require a resume, interview, or additional forms.
Contact the Department Chair for further information.
Name (Last, first, middle):
Student ID#:
Street Address (local):
Apartment #:
City, State, Country(if applicable):
Zip code:
Phone # (local):
Cell Phone#:
Sex: Citizenship:
Residency (state or country):
Graduate Major:
Program:
Professional Experience (most recent first): (or attach resume)
Position Duties Dates (from mo/yr-to-mo/yr)
Colleges and Universities Attended (most recent first):
Institution Location (city & state) Dates Attended Major Degree/Date Recd.
Awards, Honors, Prizes:
Experience/Skills Relevant to Graduate Assistantship Position Sought:
References: (List two people who have been asked to submit references and their affiliation to you.
You must be admitted to a graduate program at Central Connecticut State University to qualify for appointment as a graduate
assistant. CCSU is an equal opportunity/affirmative action institution and does not discriminate on the basis of race, color,
religion, sex, national origin, age, handicap, or veteran status in its programs and activities.
Applicant’s Signature: Date:
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CCSU Application for a Graduate Assistantship Position 06050-4010

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Completed 25 December 2019

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