The University of New Mexico
Application for Graduate Teaching/Research Assistantship
in the Department of Physics & Astronomy
(Submit this form at about the same time you submit your application)
Term applying for: Fall. Year:  Today's date: 
Personal Information:
Email address 
Last Name: First Name: Middle Name: 
Current Telephone Number: Fax Number: 
Present Address: City, State, Zip: 
Permanent Address: City, State, Zip: 
Place and date of birth: Citizenship: 
How did you learn about our program?
Academic Information:
Please list courses in which you are currently enrolled and which will not, therefore, appear on your transcripts:
List all junior/community colleges, 4-year colleges, and universities that you have attended: 
1. Name of Institution: 
 Dates Attended:
 		 Degree Received:
 		 Year:
 
2. Name of Institution: 
 Dates Attended:
 		 Degree Received:
 		 Year:
 
3. Name of Institution: 
 Dates Attended:
 		 Degree Received:
 		 Year:
 
Undergraduate major subject: Minor subject: 
Graduate work to date, major subject:  Minor subject: 
Have you ever been on probation or found it necessary to withdraw temporarily for academic reasons? Yes. No. If so, explain in full: 
Numerical rank or percentile rank in graduating class: 
Advanced degree sought at The University of New Mexico: 
Proposed major subject: 
Additional Information:
What is your specific interest in these fields (high school teaching, 
college teaching, academic research, government, business, industry, etc.)? 

If both were available, would you prefer: Teaching Assistant Research Assistant 
List titles of all publications (including thesis titles), 
giving full bibliographic references: 

List all teaching and other professional positions held to date, beginning with the most recent:
1. Employer:  Position:  Dates: 
2. Employer:  Position:  Dates: 
3. Employer:  Position:  Dates: 
List all honors, scholarships, prizes, honorary societies, etc. 

List the names and address of three persons who have been asked to write letters of recommendation in support of your application to this graduate program:
1. Name:  Position:  Address: 
2. Name:  Position:  Address: 
3. Name:  Position: Address: 
To submit your application form to the Department of Physics & Astronomy
at the University of New Mexico, press this button: .

To clear the form, press this button: .

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