Fields with asterisks (*) are required.

First name *

Last name *

Email *

PhD Research Advisor

Dissertation title (if known)

Are you applying for a new GTA appointment or a renewal of an existing GTA appointment? *

New appointment

Renewal of existing appointment

Semester first enrolled as PhD student *

Please Select Winter 2017 Spring/Summer 2017 Fall 2017 Winter 2018 Spring/Summer 2018 Fall 2018 Winter 2019 Spring/Summer 2019 Fall 2019 Winter 2020 Spring/Summer 2020 Fall 2020 Winter 2021 Spring/Summer 2021 Fall 2021 Winter 2022

PhD Plan of Work submitted? *

Yes

No

Date PhD Plan of Work was submitted

Did you pass the ME PhD Written Qualifying Exam? *

Yes

No

Date you passed ME PhD Written Qualifying Exam

Did you complete your PhD Prospectus? *

Yes

No

Date you completed PhD Prospectus

Planned PhD Defense? *

Yes

No

Date (expected)

Number of credits completed, including courses with grades of "Y" *

Overall GPA *

Dissertation credits completed *

Please list semesters you completed the following Dissertation courses: ME 9991, 9992, 9993, 9994 *

Please list all previous GTA and Rumble Fellowship appointments you have held in the department *

Please attach a copy of your CV *