Graduate Programs Office
206 Showalter Hall • Cheney, WA 99004-2444 • (voice) 509.359.6297 • (fax) 509.359.6044 • www.ewu.edu/grad
Eastern Washington University is committed to equal opportunity and affirmative action in employment.
Application for Graduate Service Appointment (GSA)
PERSONAL DATA
1. Legal Name: (Last, First Middle)
3. EWU ID (if known):
2. Former Names:
4. Appointment Requested for:
 Annual
5. Mailing Address: (Street, City, State, Zip)
6. Email Address:
 Fall
 Winter
 Spring
7. Primary Telephone:
9. In what department or program is appointment requested?
Year __________
8. Other:
10. Degree and area of specialization sought?
COLLEGE HISTORY
11. From what college did you graduate?
12. What was your undergraduate major?
13. List other colleges attended:
WORK EXPERIENCE
14. List pertinent work experiences, if any, since college graduation. Use back if necessary.
REFERENCES
15. List names, addresses and phone numbers of your supervisors for your last two positions:
ACKNOWLEDGEMENT AND SIGNATURE
16. All applicants are required to submit financial aid paperwork unless financial aid ineligibility is verified.
Signature: ______________________________________________
Date: ___________________________
Complete in duplicate and return this application to the Department where the appointment is sought.
9.25.2015