EMAIL ADDRESS by cTLPdQ

VIEWS: 0 PAGES: 1

									      California State University, San Bernardino - Office of the Dean of Undergraduate Studies
    RETURNING GRADUATE ASSISTANT APPLICATION
     Please complete all information below and return to Undergraduate Studies (UH 352).

       If you are a NEW graduate assistant, please use the Writing Center Tutor Application.

SECTION A
NAME
                Last                             First                            Middle

EMAIL-ADDRESS:

(Complete if your address or phone number has changed, if no change skip to section B)
        CURRENT ADDRESS
                                        No. & Street


                                        City, State & Zip Code

        CURRENT TELEPHONE #

SECTION B

I am employed by another CSU campus (where)                                                         or CSUSB
department (where)                                        extension                        .


Please provide current graduate program information below:
                Degree          Field                            Institution               Year
Master’s                                                                                            / in progress.
Enrolled: Y     N               # Units: _____


CONTACT IN CASE OF EMERGENCY: (Must be completed)
Name:                                                                    Phone:
Relation:
Optional: Medical Insurance Company & Policy #:


I hereby certify that the information contained in this application is true, complete and correct to the best
of my knowledge.

Signature:                                       SID #:                                     Date:

                                                                                                    USF-039

								
To top