Form

Graduate Assistant Request Form

Appointment for SPRING Semester 2012

NOTE: This form will not be accepted without student, faculty and chair electronic signature approvals .

All new graduate assistants must complete a Graduate Assistant Hire Packet in the Office of Human Resources located on the 3rd floor of One Park Place.

Your signature indicates that you have also read the CPS Graduate Assistant Policy located at http://www.gsu.edu/images/HR/GRAPolicy.pdf

SEMESTER REQUEST*

SPRING 2012

First Name*

Last Name*

Panther ID #*

ADP Emp. ID#

Telephone (000-000-0000)*

GSU E-mail*

CPS Program

I am a*

ResidentNon-Resident

Total Number of Hours Enrolled:*

All CPS Graduate Assistants MUST register for CPS 7975 Seminar for Graduate Assistants. This is a variable credit hour course(3-9 credit hours). Please register for the appropriate number of credit hours as follows:
1 assistantship = 3 credit hours
2 assistantships = 6 credit hours
3 assistantships = 9 credit hours

Mandatory Health Insurance
All students must provide proof of health insurance each semester employed.

***Failure to register for CPS 7975 will result in loss of assistantship and tuition waiver.
Students must attend a MANDATORY orientation each semester. See the GoSolar comments section of CPS 7975 for date and time of orientation.***

Total number of graduate assistantships within the university:*

Name of Department if more than one assistantship?*

Is this your 1st assistantship with GSU?*

YesNo

If no, when was your last assistantship?

Semester/Year*

Is this your first assignment as instructor?*

Yes (If yes, please see LaRose Raston)NoN/A

CPS Faculty member you will be working with?

Faculty First Name*

Faculty Last Name*

CPS Faculty E-Mail {see Directory on www.gsu.edu}*

Student E-Signature (Full Name)*

Signature date*

- Month - Day Year

at

/ Hour Minutes

For Office Use Only ___Database ___Waiver to CB ___REG. for 7975 ___Hire Form