Academic Graduate Assistant Request Form
Spring 2017/Fall 2017
Preferred request deadline to the Graduate College is May 1, 2017.
Page 1 of 2
Section 1:
Requesting Program/Office: ___________________ Name of Supervisor: ___________________
If you do not have an allocated position filled by May 1
st
, you must submit this form with sections 2, 3, and 4
indicating you are requesting an extension of the position but do not have a recommended student at this
time. Upon filling the position, please send all information contained in Section 1 of this form to
mmcminn@atu.edu
Student Name: _________________________ Student Degree Program: ____________________
Student T#: _____________ Anticipated Graduation Date: _____________ GPA: ___________
Student Email: __________________@atu.edu
First and last day of work for assistantship: ______ / ______ / ______ to ______ / ______ /______
*Students may not work beyond their graduation date (Must indicate month, day, & year)
Are you holding another paid position at Arkansas Tech University? Yes No
If yes, please describe: ______________________________________________________________
This student has undergone the required background check, and is eligible for employment.
**All Human Resource paperwork must be completed/updated prior to the indicated beginning date.
Section 2:
Stipend Amount Source Percentage
(For budgets other than Graduate College, list budget title and code)
_______________ Graduate College __________ %
_______________ Other _________________________________________ __________ %
_______________ Other _________________________________________ __________ %
Tuition Waiver: (Only Graduate Level Courses can be waived)
TERM HOURS SOURCE (For budgets other than Graduate College, list budget title and code)
Summer II 0 - 3 Graduate College Other _____________________________
Fall 6 - 9 Graduate College Other _____________________________
Spring 6 - 9 Graduate College Other _____________________________
Summer I 0 - 3 Graduate College Other _____________________________
Total Tuition Waiver hours not to exceed 18 hours per academic year (July 1 – June 30)
