Non-Academic Graduate Assistant Request Form
(Offices include: President’s Office, Athletics, Resident Life, Student Affairs & all other non-acadmic offices.
)
NON ACADEMIC GAs CANNOT BEGIN WORK PRIOR TO HR APPROVAL
1. Initiate a background check through Self Service Banner.
2. Send the student to Human Resources to complete/update Human Resources paperwork.
3. Submit form to the Graduate College to ensure student is eligible to be a Graduate Assistant
Student is eligible to be a graduate assistant: YES NO
Graduate College Signature: ____________________________________ Date: ___________
4. If YES submit form to Human Resources, if NO return form to requesting department.
HR Approved Start Date: ______________ HR Rep Signature & Date: ___________________________
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.
Is the student holding another paid position at Arkansas Tech University? Yes No
If yes, please answer the following:
Department: ___________________ Supervisor: ________________ Hours/week working: _______
Index of Hiring Department ___________ Hours per week______________ (Max 29)
RATE OF PAY WILL BE $9.25 PER HOUR UNLESS REQUESTED AND APPROVED BELOW
Alternate Pay Rate $ _______ Signature (V.P. Admin/ Finance):__________________________
Stipend Amount
Funding/ Budget Code Index
Percentage
(must total 100%)
______________ Grant ___________________________________ _____________%
______________ Scholarship ______________________________ _____________%
______________ Other ____________________________________ _____________%
Tuition Waiver: (Only Graduate Level Courses can be waived)
Summer II
0 - 3
SOURCE (list budget title and code)
Other ________________________________________________
Other ________________________________________________
Other ________________________________________________
Other ________________________________________________
Total Tuition Waiver hours not to exceed 18 hours per academic year (July 1 – June 30)
Direct Supervisor Signature: _______________________________________ Date: _____________________
Director/VP Signature: _____________________________________________ Date: ____________________
Graduate College Dean: ____________________________________________ Date: ____________________
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