CTE Online UTA Student Application Form
There are three parts to this application: Part 1: The Application Form (to be filled by the student) Part 2: The Essay (to be filled by the student) Part 3: The Faculty Mentor Form (to be filled out by faculty mentor)
Applicant's Information:
Applicant's Name		:
Student ID (SID)		:
Local Address                   Line 1		:
Line 2		:
Local Phone Number		:
Home  Address                 Line 1		:
Line 2		:
Home Phone Number		:
Email Address		:
Mentor's Information:
Mentor's Name		:
Department		:
Mentor's Office Address      Line 1		:
Line 2		:
Mentor's Office Phone Number		:
Mentor's Email Address		:
Course Information:
Course(s) (in preferential order) in which you would like to assist. Please include the instructor's name if possible. Please note you must have completed the course(s) with a grade of A.
1.	Course Name	:
	Instructor's Name	:
2.	Course Name	:
	Instructor's Name	:
3.	Course Name	:
	Instructor's Name	:
Cumulative GPA		:
Grade for UTA Course		:
Total Credits Earned by End
of Semester		:
Essay:
Please state your reasons for wishing to serve as an Undergraduate Teaching Assistant. Include any special qualifications you may have for the position.