_____________________
APPLICATION FOR GRADUATE ASSISTANTSHIP
Return To: Serena Scully at Serena.Scully@fairmontstate.edu
Phone: 304-367-4151
PLEASE COMPLETE, PRINT, AND SIGN BELOW
1.
NAME:
FSU#:
(Last, First)
2.
ADDRESS:
(No. & Street) (City) (State) (Zip)
3.
PHONE:
4.
EMAIL ADDRESS:
5.
HAVE YOU BEEN ADMITTED TO GRADUATE STUDY?
RESIDENT OF WEST VIRGINIA?
6.
WHEN DO YOU WISH TO BEGIN GRADUATE STUDY? FULL-TIME or PART-TIME?
7.
DO YOU INTEND TO ENROLL IN SUMMER COURSES? YES
NO
ANTICIPATED GRADUATION DATE (i.e. May 2020, December 2020, etc.)
8.
PLEASE INDICATE THE GRADUATE DEGREE PROGRAM YOU INTEND TO PURSUE:
i.
Concentration (if applicable):
9.
Assistantship Type (check all that apply):
Teaching
Research
Service
Assist faculty with instructional responsibilities or serve as the principal instructor of one or more
courses. Duties may include assisting faculty with teaching-related tasks (e.g., leading discussion groups,
lecturing, laboratory, preparing instructional materials, grading exams), responsibilities associated with
a self-contained class, and/or advising students.
Assist faculty in research projects (in research, administrative, academic and other university settings).
Duties vary by discipline and program, but generally include data collection and entry, data analysis,
attending conferences to present results, and training and supervising less experienced researchers.
Assist administrative staff in the operations of the university. Service assistantships are available for
academic and nonacademic units. Duties vary widely but may include gathering, organizing, and analyzing
information, implementating and evaluating programs, academic advising, academic tutoring, career
counseling, preparing marketing materials, and recruitment events.
10.
LIST THREE PERSONS (at least one of whom is a former or present employer if you are or have been employed) who have
the knowledge of your work experience and/or education. By listing these, you authorize the university to contact said
persons for a reference on your behalf and authorize them to release information on your behalf.
Please sign and date this form, attach a copy of your current vita/resume and submit to Serena Scully at Serena.Scully@fairmontstate.edu.
11.
SIGNED:
NOTICE OF COMPLIANCE
DATE:
Fairmont State University, in making decisions regarding employment, student admission, and other functions and operations, adheres to a policy of
nondiscrimination and complies with the Federal regulations and requirements as set forth in Titles VI and VII of the Civil Rights Act of 1964, West Virginia
Human Rights Act, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990,
and the other applicable laws and regulations.
Name
Contact Information
Position
YES
NO
Select One
Select One
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