Graduate Assistantship Request Form

University departments use this form to request a Graduate Assistant position. Deadlines for making a request: July 31^st for the fall semester; December 15^th for the spring semester. Return this form with appropriate signatures and attachments to the Dean of Graduate Studies, Barnard Hall, Room 102.

Semester: Fall Spring Year:

Department/Area:

School/Division:

G.A. Supervisor:

Campus Phone No.:

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Graduate Assistant’s Name (if known):

CCSU ID#: Social Security #:

Assignment Type: Laboratory Research Service/Partnership *Teaching
        *Teaching assignments provide graduate students with opportunities to assist in classes only. For a teaching assignment, please specify the
course name, course number, and instructor involved below.
*Course Name and Number (PSY 235, ENG 110, etc.):
*Teaching Faculty Instructor:

Describe G.A. Duties and Responsibilities:

Provide Goals and Objectives for G. A.:

Evaluation procedures to be used by the supervisor to determine overall effectiveness of the Graduate Assistant and assignment:


         Required Signatures:
Department Chair/Division Head Date
Approved Not Approved

Funding Source Designee Date
Approved Not Approved Banner Funding Source Index Code:

Dean, Graduate School Date
          Approved Not Approved