Learning Assistant (LA) Student Application – SAMPLE
Please fill out the application (using Adobe) (*Chrome/web users – select ‘print’ ‘save as pdf’ to save data), save it, and email
to Carolyn.Schick@montgomerycollege.edu Approved applications will be sent to appropriate faculty members.
Faculty mentors will then contact you for an interview.
Notes: If you would like to apply for more than one position, you must submit a separate application for each
position you apply for. Please register for your classes first, then select LA positions that fit your schedule.
1. Student Name :
2.
Student MC ID : Gender : Male Female
3.
What is your major :
4. Please answer the following statements related to funding.
I am a U.S. Citizen, Permanent Resident, or Refugee Alien : Yes No
Please indicate your visa status if you are an international student :
Have you worked at Montgomery College previously? Yes No
If yes, what is the last semester you worked at Montgomery College?
5. For program requirements, please confirm your enrollment status.
I have been a Montgomery College student for at least one semester : Yes No
I am enrolled as a Montgomery College student (minimum 6 credits) next semester : Yes No
6. Contact Information
MC email address :
Alternate email address :
Phone number :
7. Select your desired LA course (this course MUST be from the pull-down list below). LA course
listings are also found on the program website www.montgomerycollege.edu/LAProgram
LA Course :
8. Review the prerequisite requirements for the position you are seeking. Please list your prerequisite
courses, date completed, and grade expected or received that show you meet the requirements.
Prerequisite Course(s) Date Completed Grade Expected/Received
9. Provide the name of a faculty member who knows you and can be a reference for you.
Faculty Name :
Campus :
Department :
