University of Massachusetts School of Public Health
Department of Biostatistics & Epidemiology
Graduate Assistantship Application Form
Complete application and return to Arnold House, Room 415 or email to dosowski@schoolph.umass.edu
Date: ____________________
Name: _______________________________________ Phone: ________________________
Email address:________________________________
Area of Concentration: (circle one) Bio Epi Other: _______________
Degree Program: (circle one) PhD MS MPH Other Non-Degree
Semester first Enrolled: Fall or Spring _________ (year)
Area(s) of Special Interest (if any):
Specific job(s) you are applying (from the job listing):
1st Choice: ___________________________________________________________________
2nd Choice: ___________________________________________________________________
3rd Choice: ___________________________________________________________________
4th Choice: ___________________________________________________________________
Do you wish to be considered for positions in addition to the ones you have indicated? Yes No
Department of Biostatistics & Epidemiology
Graduate Assistantship Application Form (continued)
List any previous relevant work experience (including previous RA/TA work):
List any special skills / experience (e.g. data entry, interviewing, data management or analysis, library research, scientific writing, teaching, R, SAS or other statistical analysis program, etc.):
Do you have a car available for travel if required? Yes No
Would you be willing to travel if required? Yes No
Do you have any other sources of funding for this semester?
Yes (specify) _______________________ No
Are you interested in doing unpaid work on any research projects for the work experience?
Yes No
List up to 2 people you have worked with in the US who could be contacted to give you a reference
______________________________________________________________________________
Name, location, and phone #
______________________________________________________________________________
Name, location, and phone #
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