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The University of Memphis VERIFICATION OF ACADEMIC CREDENTIALS (University of Memphis)

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Local Address: Telephone:
Name: Banner ID:
Last First Middle
Academic Credentials
(To be completed by approved appointee - An official transcript must be on file in the Graduate School)
The Southern Association of Colleges and Schools criteria requires that graduate teaching assistants must hold a master’s in the teaching discipline or must have
completed at least 18 graduate semester hours in the teaching discipline, direct supervision by a faculty member experienced in the teaching discipline, regular
in-service training, and planned and periodic evaluations. DO NOT RESPOND “See Vita” on any part of this form.
1. List all degrees from highest to lowest.
EARNED DOCTORATE EARNED MASTERS
DEGREE
MAJOR
INSTITUTION
YEAR
EARNED
CITY, STATE,
COUNTRY
TEACHING
DISCIPLINE
YES / NO (please circle one)
DEGREE
MAJOR
INSTITUTION
YEAR
EARNED
CITY, STATE,
COUNTRY
TEACHING
DISCIPLINE
YES / NO (please circle one)
EARNED BACCALAUREATE OTHER / ABD
2. To be completed if the Graduate Teaching Assistant does not have 18 graduate semester hours in the teaching discipline.
TITLE OF COURSE HOURS
EARNED
INSTITUTION DATE
EARNED
DEGREE
MAJOR
INSTITUTION
YEAR
EARNED
CITY, STATE,
COUNTRY
TEACHING
DISCIPLINE
YES / NO (please circle one)
DEGREE
MAJOR
INSTITUTION
YEAR
EARNED
CITY, STATE,
COUNTRY
TEACHING
DISCIPLINE
YES / NO (please circle one)
I certify that the information given on this form is true and complete to the best of my knowledge. I understand that falsified information or omission of
facts shall be considered sufficient cause for dismissal.
Signature: _________________________________________________________________________________ Date: __________________________
For Teaching Assistants Responsible for Credit Courses Only
215 Administration Building
Memphis, TN 38152
Phone: (901) 678-2531
FAX: (901) 678-0378
VERIFICATION OF ACADEMIC CREDENTIALS
THE GRADUATE SCHOOL
The University of Memphis
CITY, STATE, COUNTRY
Please provide justification for employment if the student does not have 18 semester hours in the teaching discipline.
Chair or Designee (print name) (phone) Date
Academic Credentials
Proficiency in Oral English
(To be completed by department if student does not have 18 semester hours in the teaching discipline)
(To be completed by department)
A Tennessee Board of Regents Institution
By signing I indicate that I have REVIEWED, VERIFIED, and/or COMPLETED the information on this form.
Pursuant to Tennessee Board of Regents Policy 5:02:01:03, I certify that ___________________________________________________
candidate for a teaching assistantship in the Department of ______________________________________________________________
meets the following criteria:
a. An ability to SPEAK ENGLISH CLEARLY.
b. An ability to UNDERSTAND SPOKEN ENGLISH.
c. An ability to COMMUNICATE EFFECTIVELY in an academic environment (e.g., previous successful employment in an
academic institution).
SPEAK Test Score (if applicable): __________
Revised: 04/08
Please indicate course(s) being taught:
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The University of Memphis VERIFICATION OF ACADEMIC CREDENTIALS (University of Memphis)

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Completed 29 August 2020

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