College of Arts & Letters Graduate Assistantship Appointment and Financial Aid Form

Student Information: UIN Program Last Degree Candidacy ?First Residency Status Middle Tuition Rate Address Appointment Address Current GPA

Continuing Credit Hours Earned

City Type of Award State Zip Term Amount Phone Employee Class Email SSN For Teaching Assistants: DOB Gender GTAI Institute Date: Race/Ethnicity Instructor of record?

Brief Description of Duties:

Required Materials: Curriculum vitae Military Information Sheet Official transcript of highest degree Conflict of Interests Form I-9 Employment Eligibility Verification Elected Official Disclosure Form Child Support Disclosure and Authorization Federal Income Tax Withholding Form (W-4) Policy Summary Acknowledgment Form Virginia Income Tax Withholding Form (VA-4) Selective Service Registration Verification Direct Deposit (mandatory) EEO Data Form

Graduate Program Director Signature

Associate Dean Dr. Dale E. Miller Signature Date

For Associate Dean’s Office Use Only Form Used: E-1SG / EPAF / ODURF 108 / Memo

Position # / Budget Code / Sub-object Letter Sent

Letter Rec‘d

New Hire

Credits – Date

Form Sent

Form Rec’d

Fall Spring Summer

K:\al\al deans office everyone\Graduate Studies Info\Forms\GA Appointment and Financial Aid Form UPDATED 2014-Dec.docx Revised 07/18/2017

New

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