University of Texas At Austin
Department of Mathematics
Undergraduate Grader Application
Fall 2017

(Please complete ALL questions on this form!)
Date:  09/21/2017
Full name:
Departmental use only

Hourly rate:
Monthly rate:
Total Stipend:

Local address:
Permanent address:
Citizenship:   US Citizen    Non-citizen    Non-citizen permanent resident
Gender:  Male    Female
Classification:    Fr    So    Jr    Sr  
Have you worked previously for UT?       Yes    No

Have you previously worked as a grader for the UT MathDepartnemt?       Yes    No
  If yes, what courses and when? (enter n/a if no)

Number of hours you prefer to work:
(most students are appointed for 8 or 16 hours a week)

Number of hours you will be registered for during the next semester:

Will you be holding another position at UT or any other State agency Fall 2017?  Yes    No
 If yes, how many hours per week:

Are you related to any University employee or Regent?  Yes    No
 If yes, please list person's name, relationship, position and department

Additional Comments

Please list each math class you've taken, including your grade, and where taken if not UT

  I consent to a release of my records for determination of my eligibility for employment.
Please make sure you have answered everything before submitting. We will not accept incomplete applications.
Any student who falsifies information on this application will be subject to immediate termination.