DEPARTMENT OF NEUROBIOLOGY, PHYSIOLOGY & BEHAVIOR UNIVERSITY OF CALIFORNIA, DAVIS 1 SHIELDS AVENUE DAVIS, CA 95616 APPLICATION FOR TEACHING ASSISTANTSHIP ACADEMIC YEAR _______________ PLEASE PRINT OR TYPE. DO NOT USE PENCIL NAME_____________________________ e-mail address________________________ Campus address______________________ Home address________________________ ______________________ ________________________ Campus phone_________________ Home phone_____________________ Phone where you can always be contacted (e.g., during summer) ___________________ ______________________________________________________________________________________ QUARTERS YOU WISH TO TEACH: FALL __ WINTER __ SPRING__ SUMMER__ Are you currently a registered graduate student at UC Davis? Yes ___ No ___ If yes, in which graduate program are you enrolled? ______________________________ If no, have you applied to or been accepted by a graduate program at UC Davis? Applied to: ______________________ Accepted by: ______________________ Degree sought: MS (Plan I)_____ MS (Plan II)_____ Ph.D._____ Provide the name, address and phone number of two references. 1. Name __________________________ 2. Name ___________________________ Address ________________________ Address _________________________ ________________________ _________________________ Phone __________________________ Phone ___________________________ Colleges or Universities Attended Dates Degree Major GPA List below the physiology/neurobiology/other biology courses you have completed and the grades received. For courses not taken at UC Davis, attach a brief description. Course No. & Title Institution Grade List below previous teaching experience, qualifications as a lab instructor, and any other related employment experiences that might aid in evaluating your application. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Indicate below the courses you feel qualified to TA. Lab courses for which each TA position is 35-50% time: EXB 104L Exercise Biology Lab Fall, Spring EXB 106L Gross Anatomy Winter EXB 111 Envir. Effects on Physical Perf. Winter EXB 112 Clinical Exercise Physiology Winter EXB 115 Biomechanical Bases of Movement Fall EXB 126 Tissue Mechanics Winter NPB 100L Neurobiology Fall NPB 101L Systemic Physiology Fall, Winter, Spring, S.S NPB 111L Adv. Systemic Physiology Winter NPB 124 Comparative Neuroanatomy Winter NPB 141, 141P Physiological Adaptation Spring Of Marine Organisms, Lab Lecture courses for which each TA position is 35-50% time: BIS 10 General Biology Winter EXB 10 Exercise & Fitness Fall, Winter EXB 101 Exercise Physiology Fall, Spring EXB 102 Motor Learn. & Sport Psych. Fall, Winter EXB 103 Intro to Human Movement Spring NPB 10 Elementary Human Physiology Winter, S.S. NPB 12 Human Nervous System Fall NPB 14 Illusions and the Brain Winter NPB 15 The Physiology of Human Aging Fall NPB 68 Intro to Biology of Addiction Spring NPB 100 Neurobiology Fall, Winter, Spring, S.S. NPB 101 Systemic Physiology Fall, Winter, Spring, S.S. NPB 102 Animal Behavior Winter, Spring NPB 107 Cell Signaling in Health & Disease Winter NPB 114 Gastrointestinal Physiology Fall, S.S NPB 132 Genes Nutrients Health Fall NPB 152 Hormones and Behavior Spring NPB 168 Neurobiology of Addictive Drugs Spring 50% 50% 50% 50% 35% 50% 50% 50% 50% 50% 50% 50% 35% 50% 35% 50% 35% 50% 35% 35% 35% 50% 50% 50% 35% 50% 50% 50% 50% From those checked above, list (in order of preference) the courses you prefer to TA. 1. _______________ 2. _______________ 3. _______________ 4. _______________ 5. _______________ (I-FALL; II-WINTER; III-SPRING; S.S.-SUMMER) Which courses will you not TA under any circumstances? ________________________ How many quarters of your program’s teaching requirement have you NOT yet completed? (i.e., How many more quarters are you required to TA?) 0 _____ 1 _____ 2 _____ 3_____ Not applicable _____ All international students must take UC Davis’ SPEAK test before they are allowed to serve as a teaching assistant. Please indicate your status below. _____ U.S. citizen _____ Permanent resident _____ International student Country of citizenship _______________________ Date SPEAK test completed __________________ California resident status is established by an adult who has relinquished prior residence and is physically present within the state for one year with the intent to make California a permanent home. Other factors, however, may affect residency status and you should consult the General Catalog for more information. Are you a California resident? Yes _____ No _____ I certify that all the statements made in this application are true, complete and accurate to the best of my knowledge and belief, and are made in good faith. _______________________________ Signature of Applicant ____________ Date Please return to: Department of Neurobiology, Physiology, & Behavior One Shields Ave. - 188 Briggs University of California, Davis Davis, CA 95616 NOTE: Department affiliation is not a criterion for selection of teaching assistants.