Associate Instructor Application

   * represents required information.

Name*:

Student ID # (Not your SSN):

E-mail Address*:

Current Address:

Street*:
City/State/Zip*:
Phone (e.g., 812-855-7313)*:

Permanent Address: (Location from April through August)

Street:
City/State/Zip:

Phone (e.g., 812-855-7313):

Educational Background:

Undergraduate:

Address:
Major/Minor:
Graduation Date (mm/dd/yyyy):

Graduate:

Degree (If applicable):
address:
Major/Minor:

Graduation Date (mm/dd/yyyy):


Current Program:
Degree Sought:

Major/Minor:

Date Admitted (e.g., mm/dd/yyyy):
Hours Completed:
Expected Graduation Date (mm/dd/yyyy):

Interest/Honors/Professional Activities:



Prior Experience 1: (Please include only those positions relevant to your application for the assistantship)

Employer:
Address:
Supervisor:
Phone (e.g., 812-855-7313):
Position:
Date of employment (mm/dd/yyyy):
Position Responsibilities:

Prior Experience 2: (Please include only those positions relevant to your application for the assistantship)

Employer:
Address:
Supervisor:
Phone (e.g., 812-855-7313):
Position:
Date of employment (mm/dd/yyyy):
Position Responsibilities:

Prior Experience 3: (Please include only those positions relevant to your application for the assistantship)

Employer:
Address:
Supervisor:
Phone (e.g., 812-855-7313):
Position:
Date of employment (mm/dd/yyyy):
Position Responsibilities:

 

One Page Candidate Statement*
- Let us know how you view the learning need and issues encountered by college students, how you would help students address these issues, and the resources you would bring to an appointment at the Student Academic Center.



Return to top | Student Academic Center Home


Indiana University
Student Academic Center
316 North Jordan Avenue
Bloomington, IN 47405

Main Telephone Number(812) 855-7313
Send E-Mailsac@indiana.edu