Graduate Assistant Information Form
PLEASE COMPLETE THIS FORM IN ITS ENTIRETY (Pages 1 and 2)
(PLEASE USE PERMANENT ADDRESS)
PLEASE PRINT:
Name
(Last) (Family Name)
(First) (Given Name)
Address
City
State
Telephone
Zip Code
E-mail
Date of Employment
Student ID
No. of Dependents
Date of Birth
Department
Married
Single
Male
Previously employed by Villanova University?
If yes,
Department
Female
Yes
Position
No
Termination Date
Rev August 17, 2011
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Demographics:
Ethnic Group. Villanova University must provide information on ethnic diversity to various agencies including
the various federal government agencies. These data are used for reporting purposes only and responding to this
inquiry is optional.
Are you Hispanic/Latino?
Yes, Hispanic or Latino (including Spain)
No
Regardless of your answer to the prior question, please select one or more of the following races that best describe
you:
American Indian or Alaskan Native (including all Original Peoples of the Americas)
Asian (including Indian subcontinent and Philippines)
Black or African American (including Africa and Caribbean)
Native Hawaiian or Other Pacific Islander (Original Peoples)
White (including Middle Eastern)
Citizenship:
U.S. Citizen
Yes
No
Permanent Resident
Foreign National
Country
Type of Visa
IN CASE OF EMERGENCY NOTIFY:
Name
Relationship
Address
City
Home Telephone
I have filed my W4 form
State
Zip
Business Telephone
Yes
No
I have filled out my Employment Eligibility Verification Form (I-9)
Yes
No
PLEASE NOTE: The I-9 form requires acceptable documents to be presented to a staff member in the Graduate
Studies Office. For a complete list of acceptable documents accompanying the I-9 form, please refer to Form I-9,
Employment Eligibility Verification.
Rev. August 17, 2011
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