Graduate assistantship application form

School of Graduate and Professional Studies • Lasker Hall

700 East Butler Avenue • Doylestown, PA 18901 • 215.489.2401 • [e-mail]

GRADUATE ASSISTANTSHIP APPLICATION FORM

Please return completed application to the address above by March 15, 2016.

Instructions to Applicant:

• 
  The application must be completed (both sides), signed and dated in order to be considered valid.
  
• 
  Two letters of recommendation attesting to the student’s suitability for the particular assistantship must be included with the application.
  
• 
  The applicant must provide a copy of his/her résumé along with the graduate assistantship application.
  
• 
  Please type or print clearly in dark ink.
  
• 
  Applicant must be accepted into a DelVal master’s program to be considered for a graduate assistantship.
  

Application for appointment as a graduate assistant beginning:	Fall		Spring
(insert year for one or both)		Year		Year

Student Information (additional information will be taken from student’s academic application):

Name				Student ID #
Address
City, State, Zip
Home Phone		Cell Phone
Work Phone		Email Address

Graduate Program:
Preferred department for employment:

Over→


For Official Use Only:

Date App Packet Rec'd: _______________________ App _______ Resume _______ Ref #1 _______ Ref #2 _______

Reviewed/Approved by SGPS: _____________________________________________________ Date _______________

Sent to ________________________________________________________________________ Date _______________

Person/Department

Offered job? □Yes □No Hiring dept. _____________________________________

Graduate Assistantship Application – Page Two

Applicant Name:

List any honors or awards received:



List two references and include with this application recommendation letters from them:

Name
Title
Address
City,State, Zip
Phone
Email

Name
Title
Address
City,State, Zip
Phone
Email

I attest that the above information is correct and accurate. If appointed, I will pursue at least nine semester hours of graduate coursework each semester, work at assigned duties for an average of twenty hours each week for the contracted period, and assist my assigned department in any way deemed necessary. I understand that under IRS regulation (IRC 127), tuition waivers awarded to graduate assistants in excess of $5250/calendar year are considered taxable income, and the payroll office will withhold from my stipend any federal, state and local taxes associated with the stipend and the tuition waiver. 

Applicant’s Signature		Date

Application must be submitted by March 15, 2016. A decision will be made shortly after that date.