The Department of Chemistry at the University of Illinois

Teaching Assistant Application - Undergraduates


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
During the semester I am applying for, I will be a:
My Degree will be:
My Degree Area will be:
I expect to receive this degree in:
 

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

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:
 

References

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. Chemistry Annex Map
 
 
Chemistry at Illinois University of Illinois at Urbana-Champaign