First Name:
Middle Initial:
Last Name:

Male Female

Street Address:

City: State: Zip:

Home Phone: Work Phone:

Fax: Email:

Program to which you are applying:

Ph.D. in Urban Studies
Master of Arts in Environmental Studies
Master of Public Administration
Master of Science in Urban Studies
Master of Urban Planning, Design, and Development
Master of Nonprofit Administration and Leadership
MPA/JD
MUPDD/JD
MAES/JD

Concentration:

Check One:

Admitted
Applicant, Proposed start date:
Semester: Year:

If admitted, please check status:

Regular
Non-degree
Conditional

Assistantship requested for the following period:

Commencing (semester): Summer 2010 Fall 2010 Spring 2011

Ending (semester): Summer 2011 Fall 2011 Spring 2012 Summer 2012 Fall 2012

Undergraduate Institutions Attended:

1. Name of Institution
Year Graduated

2. Name of Institution:
Year Graduated

Degree: Major:
Undergraduate GPA:

Graduate Institution Attended:

Name of Institution:
Year Graduated

Degree or Credits Earned: Major: Graduate GPA:

Test Scores (if known): GRE v. q. a. LSAT:

Other Test Scores:

Name of Test Score:

If you have not taken any of the above tests, which test do you anticipate taking and when?

Name of Test: Date of Test:

Financial Assistance: Have you completed a Free Application for Federal Student Aid (FAFSA) form? You must first complete this form to be considered for grants, graduate assistantships, scholarships, and loans.

Yes
No

Do you have any other scholarship support for the semester you are requesting a graduate assistantship?

Yes, Dollar Amount:

No, no other support

II. Work Experience

Please submit a resume and short writing sample as email attachments to: Rachel Singer, r.g.singer88@csuohio.edu. On your resume, list most recent employment first and include the following information:

Extracurricular/Volunteer Experience. List any significant extracurricular or volunteer experience, the roles or office held.

Honors and Awards. List any honors or awards you have received, including scholarships based in part on merit. Include any employer awards.

In the space below, please state the reason you are seeking the position of graduate assistant in the Department of Urban Studies:

III. Teaching Experience. List any teaching experience you have. This includes tutoring, leading discussion sessions and lab assistant work. If you have led seminars for your employer or a professional association, list in this section.

Computer Experience. List any computer experience, including operating systems and software programs with which you are familiar.

Research Experience. Describe any research you have conducted and what tasks you performed (i.e., gathering data, coding, data entry, writing, and library research). Indicate if your undergraduate degree required a senior thesis or research paper.

What do you wish to gain through a graduate assistantship besides the stipend and tuition benefits?

What abilities and strengths can you bring to the position of graduate assistant?

What kind of employment do you intend to seek upon completion of the degree? does this represent a significant change in career for you? Explain.

OR