Austin Peay State University Center of Excellence
for Study of Flora and Non-game Fauna

I am applying for:
   Undergraduate Research Assistantship
   Graduate Research Assistantship

Personal Information:

Name: 
SSN:

Valid Driver's License? Yes No
License No. State

Permanent Address

Phone: (Home)    
          (Work)   

E-mail:

University -  Dates Attended - Degree - Major

University Class: Fr  So  Jr   Sr 
                        Grad 

Expected date of Graduation

Overall Grade Point Average (on a point scale)

Grade Point Average (last two school terms)

Major  
Minor

Major Advisor

Work Preference: Full-time Part-time

Specify days and hours

School term(s) for which you are applying for Research Assistantship

Approximate Starting Date

Approximate Ending Date

Rank in order (1 through 6) of preference the projects you would like to work in:
  
  Reptiles and Amphibians 
  Macroinvertebrates 
  Stream Ecology/Hydrology 
  Aquatic Toxicology 
  Vascular Flora 
  Forest Communities 

The Center's principal activities will involve extensive field investigations.  Are you willing to endure rigors of field work (ticks, mosquitoes,  heat, cold, and rain, etc.) ?

  Yes No

Career Goals

Employment Experience

Membership in Professional Societies, University or High School Organizations, etc.

Awards or Recognitions from past activities

Additional skills, awards, or activities you would like to make known

Are you covered by a health insurance plan ? 
  Yes    No

Evidence must be provided to insure that all research assistants are covered by a health insurance plan.  

Names, addresses, phone and relationship of two persons whom you have asked to submit letters of reference in your behalf.

Graduate Research Assistantship Application should be accompanied by:

    A. Transcript of undergraduate and graduate studies

    B. Description of a proposed research project you would like to pursue.