1. Applicant Data

* 1. I am applying to start working as an LA in:

* 2. What are your preferences for teaching? You may choose up to 2 disciplines.

  1st 2nd
Astronomy
Biology
Chemistry
Computer Science
Environmental Studies
Electrical Engineering
Biomedical Engineering
Civil Engineering
Mathematics
Physics
Psychology

* 3. In which course(s) would you like to work? List up to 4 courses.

* 4. First Name:

* 5. Last Name:

* 6. Panther ID:

* 8. Primary Email (i.e. one you check regularly):

* 9. Primary Phone Number (i.e. one you answer regularly):

* 11. Date of Birth (mm/dd/yyyy):

* 12. If you are under 18, please provide Parent/Guardian Information:

* 13. Relationship to the Applicant:

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