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Forms
CEL - Teaching Assistant Application
Community Engaged Learning Teaching Assistant Application
Contact Information
*Indicates a required field.
*
Semester applying for
Fall
Spring
Summer
*
Instructor First Name
*
Instructor Last Name
*
Instructor Title
*
College
-- Please Select --
Architecture + Planning
Business
Cultural and Social Transformation
Dentistry
Education
Engineering
Fine Arts
Health
Honors College
Humanities
Law
Medicine
Mines & Earth Sciences
Nursing
Pharmacy
Science
Social & Behavioral Science
Social Work
*
Department or Program
*
Instructor Email
*
Instructor Email Confirmation
*
Phone
(e.g. xxx-xxx-xxxx)
Course Information
*
Course Name
*
Course Number and Section
(e.g. COMM 3660-001)
*
Anticipated Enrollment
*
Is this an existing CEL-designated course?
Yes
No
*
Have you previously been awarded funds for a CEL-TA?
Yes
No
If yes, when?
*
Briefly describe this course.
*
Briefly describe how a CEL-TA will help you facilitate a consistent community-engaged learning experience for students enrolled in the course.
*
Will your students be working with specific community partners?
Yes
No
If yes, please list partners.
I would like assistance identifying partners.
Yes
No
*
Have you identified a student to serve as your CEL-TA?
Yes
Not Yet
I would like the Bennion Center to provide a trained TA.
Student First Name
Student Last Name
Year in School
-- Please Select --
Freshman
Sophomore
Junior
Senior
Graduate Student
Student uNID
Student Email
Student Email Confirmation
Has this student attended the mandatory CEL-TA training?
Yes
No
If yes, when?
*
Has your department or program committed to matching any award you may receive?
Yes
No
*
Please provide a chartfield for the stipend transfer
(a 1001 fund is preferred)
Administrative Assistant Contact Information
*
First Name
*
Last Name
*
Email
*
Email Confirmation
*
Phone
(e.g. xxx-xxx-xxxx)
Last Updated: 7/6/18
