Full Name:

PSU ID#:

Email Address:

Local Address:

Local Phone Number:

Home Address:

Home Phone Number:

Expected Graduation Date:
May     December     Year: 

Major:

Minor:

Are you enrolled in the Work-Study Program?
Yes     No     I'm not sure.

Cummulative GPA:  

List one Penn State math faculty member who you have asked to email a brief reference on your behalf to MichellePrevite@psu.edu.
(Type "Reference on File" if you've graded for us previously.)

Please list the lower division math (e.g. Math 140) and stat (e.g. Statbd 303) courses you have taken with the grades in each.

COURSE              GRADE

            

            

            

            

            

            

            

            

            

If you've graded for us before, please list the courses you have graded.

Special Requests (e.g. desired courses, instructor preference):

How many hours per week are you available for grading?  

I certify that all of the above information is correct.