NAME (print) _________________________________________________ DATE: ____________

Campus mailing address: _______________________________________________________________

Email address: ________________________________________________________________________

Year of graduation/degree expected: _______________________________________________________

Student ID # _____________________________ Soc.Sec.# ___________________________

Campus phone # ______________________ (If your phone # changes, please let us know!)

Please list mathematics, statistics and computer science courses taken and the grade in each:

________________________________________ ______

________________________________________ ______

________________________________________ ______

________________________________________ ______ Courses currently taking:

________________________________________ ______ _______________________________

2. What courses would you like to T.A.? ________________________________________________

3. Would you be willing to be a T.A. for more than one section? _________________

4. Have you been a T.A. before and for which course/professor? _____________________________

5. Federal Work Study money expected: _______YES ________NO

6. Do you have another job on campus? _________ Have you filled out an I-9 form? __________

8. Other relevant information: ________________________________________________________

9. Computer experience? __________UNIX ________WebWork __________ Mathematica

Thank you for your interest. Assignments will be posted by the FIRST DAY OF CLASSES on the bulletin board, 9^th floor of Hylan. You will be notified via e-mail if you have been chosen. Please return this form to: Joan Robinson, Hylan 906, RC Box 270138.