School of Graduate Studies
Graduate Assistantship Appointment Form
To appoint a Graduate Assistant: Fill out this form completely and return it with appropriate signatures to
the Dean of Graduate Studies, Barnard Hall, Room 102. Deadline for submission: the first week of each
semester (fall and spring) or when the position is offered.
☐ Fall 2017 ☐ Spring 2018
Name: _________________________________________ CCSU ID#: ________________
Phone: ________________
Address: __________________________________________ New GA Appointment: ☐
__________________________________________ Renewal GA Appointment: ☐
Number of Years: ____
Graduate Program: ______________________________ GPA at least a 3.00: Yes ☐ No ☐
Background check required: Yes ☐ No ☐
Will register: ☐ Full-time (all full-time graduate assistants must be registered for nine semester hours or more).
☐ Part-time (all part-time graduate assistants must be registered for at least 3 semester hours).
Fall 2017
Half Assistantship - Amount: $ _____________ Full Assistantship - Amount: $ _____________
Spring 2018
Half Assistantship - Amount: $ _____________ Full Assistantship - Amount: $ _____________
Half Assistantship Full Assistantship
$1200.00 - $1500.00
$1500.00 - $1800.00
$1800.00 - $2100.00
$2100.00 - $2400.00
$2400.00 - $3000.00
$3000.00 - $3600.00
$3600.00 - $4200.00
$4200.00 - $4800.00
Faculty/staff member(s) who will supervise: ________________________________________
Fall Banner Funding Code Spring Banner Funding Code
_____________________________ ___________________________ ___________
Signature of Department Chair/Director/Grants PI Print Name Extension
_____________________________ __________________________ ___________
Department Dean/Director Date
_____________________________________________________________________________________________________________________
_______________________________________________ ☐ Approved Associate V.P.
Academic Affairs/Dean of Graduate Studies Revised 05.8.17
