Sample Graduate Assistantship Appointment Form (Page 2 of 2) in pdf

Type of Graduate Assistantship (check one or more; see policy for definition):

Research (GRA) _____ Teaching/Instructor of record (GTA) _____ Teaching/Faculty Assistant (GFA) ______

Program (GPA) _____ Graduate Student Assistant (GSA) _____

Semester in which the Assistantship is to begin: ___________________ Year: _________

This assistantship is for the time period: ____________ 1 year _____________ 1 semester (Note: If a GA resigns or

is terminated prior to the end of this time period, a termination PAR must be submitted to Human Resources by the

supervisor to avoid overpayment.)

Amount of stipend/semester: ______________ Budget Account No: _______________________________________

Number of hours, the GA is expected to work: ______ (Approval of provost needed if <19)_______________________

Tuition Waiver: (check one if applicable)

Full Waiver - requires at least (19 work hours per week and fulltime graduate enrollment) ________

Partial Waiver - requires ≈ (10 work hours per week and at least part-time enrollment)

________

No tuition waiver. Tuition is paid by: (Check one and provide information, if applicable)

The student:

_________

Scholarship or Third Party:

_____________________________________________ (identify)

Department/Division:____________________________________________________ (identify)

If by Scholarship or Department/Division, Give Account No: ____________________________________

Signature of Graduate Assistant Supervisor _______________________________________ Date ___________

Signature of Chair/Director of Employing Department_______________________________ Date ___________

Signature of Graduate Director (Program or College) _______________________________ Date ___________

Signature of Academic Dean ___________________________________________________

Date ___________

_________________________________________________________________________________________________

I accept this graduate assistantship and understand the terms described above to include eligibility, reduction in tuition

rate and mandatory health insurance requirements.

Signature of Graduate Assistant ________________________________________________

Date ___________

_________________________________________________________________________________________________

The above student is eligible for enrollment in a graduate degree, certificate, or diploma program at Columbus State

University and (if tuition has been waived) has been assessed at the reduced rate for the term stipulated and mandatory

health insurance applied.

Signature of Graduate School Director ___________________________________________

Date ___________

Signature of Registrar or Designee ______________________________________________

Date ___________

Signature of Human Resources Director or Designee _______________________________

Date ___________

7-22-13

Sample Graduate Assistantship Appointment Form Page 2