Georgia College & State University
Graduate Assistant Application


Name: _____________________________________________________________________________________
                                    Last                                                              First                                                             Middle

Social Security Number: ________________________   Major: ________________________________________


Permanent Address:                                                                 Local Address: (if different from permanent)

___________________________________________        ___________________________________________

___________________________________________        ___________________________________________

 


Local Phone Number: (____) ____________________       E-mail Address: _______________________________


Currently Enrolled?    ____ (Y) ____ (N)                   Term You Plan To Enter: ______________________________

Colleges or Universities                 Dates                             Degree(s)                                   Major Field
         Attended                                                                    Received                                     of Study

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Work Experience: (Include research, teaching, tutoring, paper grading, industrial, farm and military.) Please attach
resume if available.

        Dates                                     Employer                                                                            Nature of Work

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

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Special Skills: (Include computer experience)______________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

I hereby certify that the facts set forth in this application for a graduate assistantship are true and complete to the best of my knowledge.
I understand that if I receive an assistantship, any falsified statement herein is considered sufficient cause for dismissal. I understand
that information concerning past employment, references, education and other facts are subject to inquiry. I have read and understand the rules and
regulations of an assistantship and the two-year time limit (six consecutive semesters). I agree to abide by the regulations governing the assistantship program.


__________________________________________                                         ___________________________
Signature of Applicant                                                                                            Date