Department of Chemistry, SCS, UIUC
TA Application - Undergrad and non-chem grads
Personal Information
Name (first middle last):
UIN:
Email:
ALT:
Phone:
ALT:
Local Address:
(Street)
(City)
(State)
(Zip)
Permanent Address:
(Street)
(City)
(State)
(Zip)
Employment Information
Assistantship Term
Fall 2008
Spring 2009
1
During the semester I am applying for, I will be a:
Freshman
Sophomore
Junior
Senior
Graduate Student
1
My Degree will be:
My Degree Area will be:
I expect to receive this degree in:
May
August
December
1
2006
2007
2008
2009
2010
2011
1
Academic Training (Please name all junior colleges, colleges, universities, and graduate and professional schools you have attended)
Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):
Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):
Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):
Institution (City and State):
Major/Minor:
Dates Attended:
Degree(s):
GPA:
Undergraduate:
/4.0
Graduate:
/4.0
List All Chemistry, Biochemistry, and Chem E. Courses Taken (Attach a copy of a recent transcript showing all courses taken)
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Course Name:
Grade:
Sem/Yr Taken:
Experiences (teaching, research, professional, business, military, etc.)
Institution/Organization:
City/State:
Nature of Work:
Dates:
Institution/Organization:
City/State:
Nature of Work:
Dates:
Institution/Organization:
City/State:
Nature of Work:
Dates:
Institution/Organization:
City/State:
Nature of Work:
Dates:
Honors/Memberships
Membership in honor societies,
learned and professional
organizations:
Please list below the names and addresses of the three persons to whom you have given Letter of Reference forms. Each should be well acquainted with your educational background, intellectual abilities, and personal character. Three letters of reference should be on file by the deadline date for the application to be considered.
Name of Reference 1:
Address:
Name of Reference 2:
Address:
Name of Reference 3:
Address:
Statement of Purpose
Describe your academic work, non-course educational experiences, teaching or other relevant employment, your plans for graduate study and/or career, and why you want to be a TA. Statements more than approximately 300 words will be truncated. Unfortunately, applicants will not know how much of their statement is sent so please keep your statement concise.
International Students Only
(please provide scores):
Speak
TSE
TOEFL Speak
Schedule and Availability.
Once you have completed your application, please go to room 107 in the Chemistry Annex Building to complete a schedule card.
