Approval for Non-Academic Graduate Assistant Position
(Offices include: President’s Office, Athletics, Residence Life, & Student Services)
Before submitting this form to the Budget Office 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: _______________________
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
*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
(must total 100%)
______________ Grant _______________________________________ _____________%
______________ Scholarship ______________________________________ _____________%
______________ Other _______________________________________ _____________%
Tuition Waiver: (Only Graduate Level Courses can be waived)
TERM
Summer II
0 - 3
SOURCE (list budget title and code)
Other ________________________________________________
Fall
6 - 9
Other ________________________________________________
Spring
6 - 9
Other ________________________________________________
Summer I
0 - 3
Other ________________________________________________
Total Tuition Waiver hours not to exceed 18 hours per academic year (July 1 – June 30)
NON-ACADEMIC GRADUATE ASSISTANTS MAY ONLY WORK A MAXIMUM OF 29 HOURS PER WEEK.
20 (1/2 Time) Other (Attach Justification)
LIST PERCENT OF DUTIES TO BE PERFORMED BY GRADUATE ASSISTANT TO THE PROGRAM,
DEPARTMENT, COLLEGE, AND/OR UNIVERSITY IN THE FOLLOWING CATEGORIES:
Teaching ____________% Research ______________% Other ______________% (must total 100%)
Specify Other:
__________________________________________________________________________________________
Direct Supervisor Signature: _____________________________________________ Date: _________________________
Director/ VP Signature: ___________________________________________ Date: _________________________
(of the budget supporting GA)
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