Fillable Form to be completed by the supervising faculty (State University of New York at Plattsburgh)

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Form to be completed by the supervising faculty (State University of New York at Plattsburgh)

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BROWSE STATE UNIVERSITY OF NEW YORK AT PLATTSBURGH FORMS

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CONTRACT FOR TEACHING ASSISTANT – TA
(Course Number 496)
Form to be completed by the supervising faculty member, signed by student and returned to departmental office for the
chairperson’s approval and forwarded to the Registrar’s Office before the end of 1
st
week of classes.
Student’s Name: _
_________________________________________ ID #:_____________________
(Banner ID, Network Login)
Department: _______________________ Practicum Course: ___________496 Credits: ___________
Course in which student will be assisting: __________________________________________________
Semester: Fall________ Winter__________ Spring__________ Summer__________ YEAR________
List courses student has completed in teaching area:
Course Subject and Number
Semester/Year
Grade
Total number of credit hours to be registered for this semester, including requested TA contract credits: _______*
Specific duties of the Teaching Assistant (to be completed by faculty supervisor):
Method of Grading: Letter Grade_________ Pass/Fail____________
Supervising Faculty Member (Please Print) ______________________________________________________________
Signature of Supervising Faculty Member _________________________________________________ Date:_________
Indicate Approval in Email
Signature of Student: _________________________________________________________________ Date: ________
Signature
of Department Chairperson:____________________________________________________ Date: ________
Indicate Approval in Email
*CREDIT OVERLOAD APPROVAL
Ye
s No
Indicate Approval in Email
Chair (of student's major): __________________________________________________ Date: ________
Ye
s No
Indicate Approval in Email
Dean (of student's major): __________________________________________________ Date: ________
________________________________________________ ________________
________________________________________________ ________________
STATE UNIVERSITY OF NEW YORK AT PLATTSBURGH
Student’s Name (Print): _
______________________________________
STATEMENT OF UNDERSTANDING OF THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA)
I understand by virtue of my employment or assignment by SUNY Plattsburgh as a teaching assistant, graduate assistant,
or in another capacity such as work-study or Temp-service student that I may have access to records which contain
identifiable information about former or currently enrolled students, the disclosure of which is prohibited by the Family
Education Rights and Privacy Act of 1974 (FERPA). I acknowledge that I have read SUNY Plattsburgh’s FERPA compliance
policy and that I fully understand that the intentional disclosure by me of protected information to any unauthorized
person(s) could subject me to criminal and civil penalties imposed by law. I further acknowledge that such disclosure
may also violate SUNY Plattsburgh’s FERPA compliance policy and could constitute just cause for disciplinary action
including termination of my employment or assignment or a failing grade in the work-related course regardless of
whether criminal or civil penalties are imposed.
Student’s Signature Date
Supervisor’s Signature Date
□ Please ensure FERPA form is signed and retain in the department
Record Retention: Three years after the term in which the students signs this form.
10/2019
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Form to be completed by the supervising faculty (State University of New York at Plattsburgh)

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Completed 27 August 2020

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