Graduate & Extended Learning

TA/GA Appointment Request Form

___ New/Rehire ___ Change in Appt ___ Cancellation or Separation For Academic Year:

Applicant Information: SUNY ID: Banner ID: N

Sal. _____ Name Major Code____________ GPA _______ Last First MI

Address Street City State Zip

Telephone Email (NP or Pers.) __ Home or Mobile

Position Applied for _________________________________ Dept ________________________________________________________

Residency ___ In-State ___ Out-of-State ___ Foreign (Fill out the information below regarding work eligibility)

Country of Citizenship: _______________________ VISA Type:________ Do you have the legal right to accept employment in the United States? ___Yes ___No

Proof of identity AND either US Citizenship or employment authorization are required prior to employment.

I hereby authorize investigation of all statement in this application and attached data as provided. I certify that such documentation are true and understand that misrepresentation or omission of facts called for in this form may be cause for refusal of employment or termination if I am offered a position. I understand that all graduate employees must satisfy the application and reappointment criteria listed in the Teaching Assistant and Graduate Assistant section of the Graduate & Extended Learning website. If offered a position, I will submit evidence of matriculation and registration for at least 6 graduate credits

Signature: ________________________________________________________ Date: _______________________________________________________

SUNY New Paltz does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, marital status, or sexual orientation in accordance with federal and state law. The State University of New York at NEW Paltz is an AA/ EOE/ADA employer.

Transaction Type New Hire Rehire (Attach Prof Dev for TAs) Change in Appointment Cancellation/Separation

Duration of Hire ___ Academic Year (default) ___ Fall* ___ Spring *Contact Vika Shock prior to submitting a fall-only appointment.

Department Account: Appointment Type: TA GA

Department Contact TAGA Supervisor:

Stipend Amount _______________________ Load ___ Full-time (app. 20hrs/week) ___ Half-time (app. 10hrs/week)

Academic year full-time assistant: $5000 |Academic year half-time assistant: $2500 || One Term full-time assistant: $2500 | One Term half-time assistant $1250

TA/GA Assignment—Attach a performance program and insert a 2-3 sentence summary for the contract letter.

Tuition Waiver Information

Tuition Waiver Credits Waived _____ (AY Full TAGA: 6cr/ term | AY Half TAGA: 3 cr/term || One Term Full TAGA: 6 cr | One Term Half TAGA: 3 cr )

Tuition Waiver Rate Academic Year appointees receive the same number of credits waived in the Fall and again in the Spring.

___ In State ___ MFA Scholarship ___ Out of State ____ Foreign || ___ In State MBA ___ Out of State MBA ___ Foreign MBA

Appointment Approval Signatures

Department Chair / Director Date

Academic Dean / VP Date

Graduate & Extended Learning Date

GEL Office Use Only: Banner: SharePoint: SA Spreadsheet: Sent to HR: Signature:

Line # Eligible for Benefits? Yes No

PAYROLL USE ONLY PP#/ Year / PAY RATE $

Eff. date TIME ENTRY: TAS done

Act/Reason EARN CODE DATES AMOUNT 1040

Act/Reason Comment (back)

TA/G

A A

PP

LIC

AN

T SEC

TIO

N

HIR

ING

DEP

AR

TMEN

T SEC

TIO

N

AP

PR

OV

ALS