Syracuse University Professional Development Programs of the Graduate School

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All-University TA Orientation

August 2009 Pre-Registration form
[FORM R]

Demographic Information

Country of Citizenship:

Native Language(s):

Gender:
Male Female

5 E-mail Address:

Name exactly as you would like it to appear on your name badge (nicknames are fine):

First Name:

Last Name:

Address(es) and telephone number(s) where we can contact you BEFORE the start of the orientation:

	(first address)	(second address)
street address:
city:
state/zip:
province:
country:
telephone:

Above address valid until:
(mm/dd/yy)

In case of emergency during the orientation, who should be contacted? (If possible, list a friend or relative in the United States.)

a - Program of study at Syracuse University:

b - Which degree will you be pursuing?:
Master's
Doctoral

c - What is your anticipated completion date?:
Month (mm)
Year (yyyy)

a - Department in which you hold your TA appointment:

b - Have you formally accepted your assistantship?: Yes No

* * IF YOU ANSWERED "NO," PLEASE CONTACT YOUR DEPARTMENT IMMEDIATELY * *

TA Program Housing Information

11	For those participants who need housing for any portion of the TA Orientation Program, please complete and return the request for temporary housing [FORM H] along with your completed pre-registration [FORM R]. Please note: [FORM H] is NOT an application for permanent campus housing during the academic year.
	Yes, I do need housing and will complete and return [FORM H].
	No, I do not need housing. My permanent address for the academic year is:
	Street:	Apt. #:	City:
	Zip Code:	Phone:
		(123)456-7890

Special Needs

12	Do you have any special medical or physical conditions of which you would like us to be aware of?
	Yes No
	If yes, please describe:

Teaching Skills

Have you ever held a teaching position?

Yes No

If yes to #13, please indicate where you held a teaching position, the number of years you taught at that level, and in which language(s) you taught. (Check all that apply.)

College/University	(# of years)	(language in which you taught)
K-12 School	(# of years)	(language in which you taught)
Public/Private Agency	(# of years)	(agency name) (language in which you taught)
Other (please specify)	(# of years)	(agency name) (language in which you taught)

Have you had any formal preparation in teaching?

Yes No

If yes, please describe briefly.

TA Program

Future Professoriate Program (FPP)

Professional Development Seminars (PDS)

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