Graduate assistants serve as clinical, teaching or administrative assistants and are expected to be enrolled in a full time course of study (a minimum of 10 hours in the fall and spring semesters; a minimum of 7 hours in the summer). Applicants must have satisfactory academic records and adequate preparation for graduate study in the major field. In addition, some graduate assistantships may require previous practicum experience and/or specific course work.

MAJOR FIELD OF GRADUATE STUDY: (check one)

Speech Pathology______ Audiology______

YEAR OF ANTICIPATED ENROLLMENT:______________

1. Name: _________________________________________________________

    

2. Current complete mailing address:______________________________________

   __________________________________________________________________

3. Current phone: _________________ Daytime phone: ________________

   Cell phone: _____________________ Email address: ____________________

4. Permanent address: _________________________________________________

   __________________________________________________________________

5. Permanent phone: __________________________
6. Personal information:

   A. Date of birth: _______________ Age: ______________________

   B. *Race: _____________________

   C. Resident of Arkansas? __________________

   D. Citizen of the United States? ______________

   F. Social Security Number: _______________________

   *This information is optional, but indication of race may assist in identifying candidates who may qualify for any available minority assistantships.

    

7. Colleges and universities attended, dates and degrees:

   _______________________________________________________________________________________________________________________________________________________________________________________________________________

8. Scholastic honors and extracurricular activities:

   _______________________________________________________________________________________________________________________________________________________________________________________________________________

9. Work experience:

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10. Previous graduate assistantship appointments:

12. Estimated number of practicum clock hours completed by anticipated start of graduate school: _____________________________
13. Please attach a brief statement of why you wish to be considered for a graduate assistantship