TA Development Program Part-Time Consultant Application
2023-24 Academic Year
Personal Information
Full Name
*
First Name
Last Name
UCR Email
*
myname@ucr.edu
UCR Student ID#
*
861***
Phone Number
*
Please enter a valid phone number.
Degree Information
Academic Program
*
Degree Objectives
*
EX: MFA, PhD, etc.
UCR Grad Program Entry Quarter
*
EX: Fall 2022
Expected Graduation Term
*
EX: Spring 2023
Employment Information
Have you ever worked at UCR?
*
Yes
No
Employee ID#
*
EX: 851***
Most Recent UCR Employment
Title
*
EX: TA, CSR, Reader, etc.
Supervisor
*
Department
*
EX: English, Psychology, etc.
Term
*
EX: Fall 2021
Recommender Information
Your recommender can submit their recommendation here: https://www.jotform.com/232497612506155
Recommender Name
*
Recommender Department
*
Relationship to Applicant
*
PI/Research Advisor
Dissertation Committee Chair
Program Graduate Advisor (faculty)
Recommender Email
*
example@example.com
Recommender Phone
*
Please enter a valid phone number.
Do you have a second recommender?
*
Yes
No
Second Recommender Name
*
Second Recommender Department
*
Second Recommender Relationship to Applicant
*
PI/Research Advisor
Dissertation Committee Chair
Program Graduate Advisor (faculty)
Other
Second Recommender Email
*
example@example.com
Second Recommender Phone
*
Please enter a valid phone number.
Application Documents
Upload Your Cover Letter
*
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Upload Your CV
*
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Certifications and Submission
Do you have any employment or fellowships that would prevent you from working during the 23-24 academic year?
*
Yes
No
Unknown (EX: I applied for a fellowship but haven't heard back yet.)
Please explain.
*
List fellowships for which you have applied or other employment.
By signing I certify that all information on this application is accurate to the best of my knowledge.
*
Submit
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