UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES

DEPARTMENT OF AUIDOLOGY AND SPEECH-LANGUAGE PATHOLOGY

APPLICATION FOR GRADUATE ASSISTANTSHIP

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:______________

PLEASE PRINT OR TYPE

  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:

    _______________________________________________________________________________________________________________________________________________________________________________________________________________

  10. Previous graduate assistantship appointments:

_____________________________________________________________________

11. Cumulative GPA: _____________ GPA in the major: _____________

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

 

 

 

 

DATE: ___________________ SIGNATURE:________________________

Return this application to: Financial Aid Committee

UALR/UAMS Dept. of Aud & Speech Path

2801 S. University Ave.

Little Rock, AR 72204

Revised 1/2003