Non-Academic Graduate Assistant Request Form
**For Graduate College Office Only**
Offices include: President's Office, Athletics, Resident Life, Student Affairs & all other non-academic offices
STIPEND AMOUNT
_________________
FUNDING/BUDGET CODE INDEX
____________________________________________
PERCENTAGE must total100%
TUITION WAIVER: (Only Graduate Level Courses can be waived)
TERM HOURS
Summer II
0-3
Fall
6-9
Spring
6-9
Summer I
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)
Once this form is received, all areas are complete with required signatures and GA has been approved, the Graduate College will
initiate a background check. The Human Resources office will notify the supervisor once the student’s background check is
clear. HR will also notify both the supervisor and student if employment paperwork is required from the student.
Date Background Check Cleared _________________ Date HR Paperwork was completed ________________
STUDENTS MAY NOT BEGIN WORK PRIOR TO RECEIVING A CLEAR BACKGROUND CHECK AND THE COMPLETION OF THEIR HR
PAPERWORK. FAILURE TO COMPLETE HR PAPERWORK IN A TIMELY MANNER COULD ALSO DELAY THE STUDENTS START DATE
Semester Hours: ____________ GPA: ____________
Graduate College Signature: ______________________________________________ Date: ________________
Student is eligible for a GA position : Yes
No
Requesting Program/Office: __________________________________________ Name of Supervisor: ______________________________________
Student's Full Legal Name: _______________________________________________________________________ Student T#: _________________
Student Degree Program: _________________________________________________ Student ATU Email: _________________________________
Anticipated Graduation Date: _________________ Student Gender: Male Female Student Phone # (______) -______-________
First and last day of work for assistantship : _______/_______/__________ to ______/______/__________
mm dd yyyy mm dd yyyy
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 28)
RATE OF PAY WILL BE $9.25 PER HOUR UNLESS STATED DIFFERENTLY Alternate Pay Rate $ ___________
___________________________________________________________________________________________________________
Direct Supervisor Signature: ___________________________________________________________________ Date: ______________________
Director/VP Signature: _________________________________________________________________________ Date: _____________________
Graduate College Dean Signature: _______________________________________________________________ Date: _____________________
The Student and Supervisor are advised that until the process initiated by this form are complete, the student is not eligible to work.
_____________________ %
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