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Learning Assistant (LA) Student ApplicationSpring 2020
Please fill out the application using Adobe Acrobat (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
mentors. Faculty mentors will then contact you for an interview. The application deadline is December 4, 2019.
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) for Spring 2020 : 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 :
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10. If you have relevant coursework completed outside of Montgomery College in a STEM field, please
attach a transcript and list relevant courses, date completed, grade received, and name of
college/university.
Transcript attached : Yes No
Relevant Course(s) Date Completed Grade Received Name of College/University
11.
Are you able to attend the LA course at the specified required times?
Yes No
Include any comments about timing/availability here. If the course you are applying for has more
than one time option listed (i.e. A or B), please list the time option(s) you are available for.
12. Please include any teaching/tutoring experience you have had in the past as well as any future
teaching interest you may have.
13. How did you hear about the LA program? Check ALL that apply.
MyMC Announcement
Received email
Taken a class that had an LA
Friend is an LA
Announcement from another program or faculty advisor
Faculty announcement in class
Other ______________________________________________