PORTLAND STATE UNIVERSITY

Preference is given to applications completed and received by February 1.

Student ID/SSN: ___________________________

Address:     _______________________________    Phone Number: _____________________
                   _______________________________
                   _______________________________    E-mail address: _____________________

GRE scores:    Verbal _________    Quantitative _________    Analytical __________

TOEFL score _______________    Year taken: __________

Your enrollment status (please check one):

____   Currently enrolled in a graduate program in the Department of Mathematics & Statistics

____   Accepted for admission to a graduate program in the Department of Mathematics & Statistics

____   Applied for admission to a graduate program in the Department of Mathematics & Statistics

           Please specify the program:  ___ MA/MS        ___ MS-Stats            ___  MAT/MST

                                                       ___ Ph.D.-Math        ___ Ph.D.-Math Ed.

Date you began or expect to begin this program:

Term: ___ Fall    ___ Winter    ___ Spring    ___ Summer

Year: ________ 

NOTE: Applicant must be admitted as a regular-degree student at the time of appointment.

List all post-high school degrees obtained (most recent first):

Principle courses that you would feel most comfortable teaching.  Please select 3 courses from the list below (see http://www.mth.pdx.edu for a description of the topics included in each of these courses):

___ MTH 70, Elementary Algebra

___ MTH 95, Intermediate Algebra

___ MTH 111, Introductory College Mathematics I

___ MTH 112, Introductory College Mathematics II

___ STAT 243, Introduction to Probability and Statistics I

___ STAT 244, Introduction to Probability and Statistics II

Have you accepted any form of employment or fellowship for Fall of the year for which you are applying?    ____ yes    ____ no

If yes, please explain the form of employment, place of employment, etc.:

________________________________________________________________________

Please list the names of persons from whom you have requested references:

1. ___________________________________

2. ___________________________________

3. ___________________________________

 Include with this form the following:
 ٱ   A separate statement describing your background in mathematics and previous teaching, tutoring, and/or grading experiences.
 ٱ   Transcripts from all universities/colleges attended.

Please have at least two recommendation letters from past professors or employers who are familiar with your undergraduate work in mathematics/statistics and/or with your teaching abilities sent to the address below.

Signature ____________________________________ Date ___________________

Mail to:
Dept. of Mathematics and Statistics
Graduate Teaching Assistantship Committee
Portland State University                                                             Phone: (503)725-3621
P.O. Box 751                                                                              Fax:     (503)725-3661
Portland, OR 97207-0751