Chemical Engineering Department

Name:
Phone(local):	Extension :
E-mail:
Address:
City:	State: Zip:
Year in School:	Cum. GPA: Credit hrs. this semester:

The number of hours you would like to work per week:
Which semester do you want to work?	Fall Winter Spring

Previous TA Experience:

ChE classes taken which may help as a background for employment:

Classes for which you would prefer to TA:

Any additional information you wish to have noted: