Department of Chemistry

TA Application Process

 

Personal Information

Name (first middle last):
UIN:
Email: ALT:
Phone: ALT:
Local Address: (Street)
(City)
(State)
(Zip)
Permanent Address: (Street)
(City)
(State)
(Zip)

Employment Information

Assistantship Term
During the semester I am applying for, I will be a:
My Degree will be:
My Degree Area will be:
I expect to receive this degree in:

Academic Training (Please name all junior colleges, colleges, universities, and graduate and professional schools you have attended)

Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):

Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):

Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):

Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):
GPA: Undergraduate: /4.0   Graduate: /4.0

List All Chemistry, Biochemistry, and Chem E. Courses Taken (Attach a copy of a recent transcript showing all courses taken)

Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:
Course Name: Grade: Semester/Year Taken:

Experiences (teaching, research, professional, business, military, etc.)

Institution/Organization:
City/State:
Nature of Work:
Dates:

Institution/Organization:
City/State:
Nature of Work:
Dates:

Institution/Organization:
City/State:
Nature of Work:
Dates:

Institution/Organization:
City/State:
Nature of Work:
Dates:

Honors/Memberships

Membership in honor societies,
learned and professional
organizations:
Scholarships, prizes,
honors or other recognition:

Please list below the names and addresses of the two persons to whom you have given Letter of Reference forms. Each should be well acquainted with your educational background, intellectual abilities, and personal character.

Name of Reference 1: Address:
Name of Reference 2: Address:

Statement of Purpose

Describe your academic work, non-course educational experiences, teaching or other relevant employment, your plans for graduate study and/or career, and why you want to be a TA. Statements more than approximately 300 words will be truncated. Unfortunately, applicants will not know how much of their statement is sent so please keep your statement concise.
 
International Students Only
(please provide scores):
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