GRADUATE SCHOOL

FORT HAYS STATE UNIVERSITY

APPLICATION FOR GRADUATE ASSISTANTSHIP

Please read instructions below.

Name ____________________________________________________________
Last

First

Soc. Sec. No. _______ ______ _______

Middle

Permanent address _____________________________________________________________________________________

Street

City

State

Zip

Present address ________________________________________________________________________________________

Street

City

Graduate Major

Degree Sought

Undergraduate Grade Point Average

Graduate Grade Point Average

State
Undergraduate Major

Fall 20____ Spring 20____

Date of Degree

Daytime Phone Number

Specify the semester(s) and year that you are applying for an assistantship:

Zip

Home Phone

Is this a new or renewal application?

Summer 20____

New______ Renewal*______
*If renewal, the application form is all that is required

Is your native language English?

yes

no

(see number 3 in the instructions below)

List names and addresses of all colleges and universities attended:

Institution

Location

Dates Attended

Major

Degree & Date

___________________________ ___________________________ ___________________ ________________ __________________

___________________________ ___________________________ ___________________ ________________ __________________
___________________________ ___________________________ ___________________ ________________ __________________
I certify that to the best of my knowledge all statements that I have made on this application are complete and true.

_____________________________________________________

_______________________________________

Students Signature

Date

INSTRUCTIONS
1.
2.
3.

4.

Complete this form (type or print).

You must be formally admitted to a graduate degree program at Fort Hays State University before you can be considered for a graduate assistantship.
If your native language is not English, an official copy of your Test of Spoken English (TSE) or SPEAK Exam Score is required by the Graduate School
BEFORE an assistantship may be awarded or employment begins. Contact the Kelly Center at 785-628-4401 to schedule the exam or go to the website
http://www.fhsu.edu/kellycenter/testing/speak.shtml.
All applicants are required to consent to a criminal background check as a condition of employment. This check, performed prior to employment,
includes the following: criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction.

Please submit all application materials to:

The Graduate School

Fort Hays State University
600 Park Street
Hays, KS 67601-4099
(785) 628-4236
FAX: 785-628-4479

Notice of Non-DiscriminationFort Hays State University does not discriminate on the basis of sex, race, religion, national origin, age, disability, Vietnam era veteran status or
special disabled veteran status in its programs and activities. The Director of Affirmative Action, Coordinator of Title IX, Title VI, Section 504, and ADA Regulations may be
contacted at 600 Park Street, Hays, KS 67601, (785) 628-4033.
rev 4/13/15

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