Download this application form .

APPLICATION FOR A GRADUATE ASSISTANTSHIP

DEPARTMENT OF MATHEMATICS
SOUTHEAST MISSOURI STATE UNIVERSITY
Cape Girardeau, Missouri  63701

(Equal Opportunity Employer)

Date ____________________

Name in full __________________________________________________________________________

Social Security Number _________________________________________________________________

Mailing Address _______________________________________________________________________

                        ________________________________________________________________________

Home Phone: (        ) ________________________  Business Phone: (        ) ________________

E-mail address: ________________________________________________________________________

Scholastic training:  Give names of institutions as indicated below:

Major subjects studied:

a.  In undergraduate work ______________________________________________________________

b.  In graduate work ___________________________________________________________________

c.  Special Education Programs __________________________________________________________

Honors (Honorary societies, scholarships, prizes, etc.) _______________________________________

____________________________________________________________________________________

Membership in organizations ___________________________________________________________

___________________________________________________________________________________

Teaching or Professional experiences (List in chronological order with most recent position first)

Title of Position                   Company or Organization             Dates                         Nature of Duties
                                             Name or Location            

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

References.  Letters of recommendation will be sent from the following three individuals:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

On a separate sheet, add any information you wish to offer to support your application.

ATTACH TRANSCRIPTS OF BOTH UNDERGRADUATE AND GRADUATE WORK.

YOU MUST APPLY FOR ADMISSION TO THE GRADUATE SCHOOL.

                                                                        Signature _______________________________________

Return form to:    Department of Mathematics MS6700
                           Southeast Missouri State University
                           Cape Girardeau, MO  63701

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