The University of Texas at San Antonio
DEPARTMENT OF GEOLOGICAL SCIENCES

TEACHING ASSISTANTSHIP REQUEST FORM

This is an interactive form, but must be printed out and submitted with original signature.
*Required fields.

 

Name  
            (Last)                                                    (First)                        (Middle Initial)

Banner ID Number  (if known):

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*Applying for term:                                                                                                      

Fall 2008 2009 2010 2011 2012         Spring  2009 2010 2011 2012 2013        Summer  2009 2010 2011 2012 2013     

 *Your degree program is:

Geology            Ph.D. in Environmental Science and Engineering        Other

If other is checked, please specify degree program:

 

*Current Mailing Address:

 Street

 City                                      State                                       Zip

 

*Telephone Number:      

Cell Phone (optional): 

*Email Address:

 

*Are you a citizen of the United States? Yes        No   

  If no, please state visa type.

 

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*GRE Scores: verbal    quantitative    analytical

 

*If not a U.S. citizen, TOEFL Score:

 

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ACADEMIC BACKGROUND:

 

*Overall GPA:    

 

*Degrees Earned                      Date                                Institution Conferring                     Major                  Minor

 

 

  

*RESEARCH / TEACHING EXPERIENCE

Place                                         Name of Institution                Type of Institution            Position                    No. of Years

 

*OTHER TYPES OF EMPLOYMENT:

Place                                         Name of Institution                Type of Institution            Position                    No. of Years

 

 

PUBLICATIONS (if applicable):  (List title of books, pamphlets, articles, research projects, and publication dates.)

 

 

PRESENTATION AND ABSTRACTS (If applicable, where presented and when)

 

MEMBERSHIPS (if applicable):

 

Professional:                                                                         Non-Professional:

 

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The University of Texas as an equal opportunity employer.

 

In accordance with the Rules and Regulations in UTSA’s Handbook of Operating Procedures, the applicant must be admitted unconditionally as a degree-seeking student and in good standing to the Masters Program in the Department of Geological Sciences or the applicant must be admitted in another master's degree program or a Ph.D.  program at UTSA with the proper background to assist teaching in the geological sciences.

 

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*CERTIFICATION:
 

I certify that the statements made by me in this pre-application are true, complete, and correct to the best of my knowledge and belief and are made in good faith.  I understand that any false statements made herein will void this application and any actions based on it.  I understand that any offer of employment tendered me is contingent upon my agreement to abide by the Rules and Regulations of the Board of Regents of The University of Texas System.

 

 

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*Signature of Student Applicant                                                                                                   Date

 

Please mail your completed form to: 

 

 Or you may bring it by the Department Office located in Science Building 4.03.30.

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For Department Use Only:
Application received date: ______________________________
Degree-seeking status: _____________________________________

Term/Year Admitted: _______________________________________