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Graduate Assistant Registration

Welcome, graduate assistants. We are thrilled that you are interested in joining us in a role of service this summer.

Please complete the following information carefully. Note that you will need your parents' help on a few areas, so you will want to complete this application while they are around to provide you with assistance.

For all phone numbers, use (xxx) xxx-xxxx format.

Last Name
A value is required.
Age
A value is required.
First Name
A value is required.
Current Grade
A value is required.
Current School
A value is required.
Gender
Please select an item.
       
Home Address
A value is required.
Your E-Mail
A value is required.Invalid format.
City
A value is required.
Parent E-mail
A value is required.Invalid format.
ZIP
A value is required.Invalid format.
Home Phone

A value is required.Use (xxx) xxx-xxxx format.
Number of Years as a Scholar at DECATS)
A value is required.
Your Cell Phone
A value is required.Use (xxx) xxx-xxxx format.
       
Mother's Name
A value is required.
Father's Name
A value is required.
Mother's Occupation
A value is required.
Father's Occupation
A value is required.
Mother's Work Phone
A value is required.Use (xxx) xxx-xxxx format.
Father's Work Phone
A value is required.Use (xxx) xxx-xxxx format.
Mother's Cell Phone
A value is required.Use (xxx) xxx-xxxx format.
Father's Cell Phone
A value is required.Use (xxx) xxx-xxxx format.
       
Emergency Contact 1 Name
A value is required.
Emergency Contact 2 Name
A value is required.
Phone
A value is required.Use (xxx) xxx-xxxx format.
Phone
A value is required.Use (xxx) xxx-xxxx format.
Relationship to You
A value is required.
Relationship to You
A value is required.
       
Doctor's Name
A value is required.
Insurance Carrier
A value is required.
Doctor's Phone Number
A value is required.Use (xxx) xxx-xxxx format.
Policy / Group Numbers
A value is required.
Preferred Hospital
A value is required.
Carrier Phone Number
A value is required.Use (xxx) xxx-xxxx format.
Preferred Hospital Phone
A value is required.Use (xxx) xxx-xxxx format.    

     
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