SI Leader Application Form
Name
Name
*
First
Last
Student ID Number (100xxxxxxx number)
*
NetID
*
UTA Email Address
*
Primary Phone With Voicemail
Primary Phone With Voicemail
*
-
###
-
###
####
Anticipated Major
*
Classification
*
First Year
Sophomore
Junior
Senior
Graduate Student
Cumulative UTA GPA
*
Previous Degrees Held (if none, please mark N/A)
*
Expected Graduation Date (mm/yy)
*
In which semester did you first enroll for classes at UTA? (mm/yy)
*
Have you applied on Handshake?
*
Have you applied on Handshake?
Yes
No
Are you currently employed at UTA?
*
Are you currently employed at UTA?
Yes-Division of Student Success
Yes-somewhere else on campus
No
If so, which department and what is your position?
Are you currently applying for other positions at UTA?
*
Are you currently applying for other positions at UTA?
Yes-Division of Student Success
Yes-somewhere else on campus
No
If so, which department and what position?
Subjects interested in leading for SI (Note: Preference will be given to students who completed the course at UTA with the professor teaching the selected course.)
*
Subjects interested in leading for SI (Note: Preference will be given to students who completed the course at UTA with the professor teaching the selected course.)
BIOL 1345
BIOL 1441
BIOL 2457
BIOL 2458
BIOL 2460
BIOL 3315
CHEM 1451
CSE 1320
CSE 2315
CSE 3318
FINA 3313
INSY 2303
INSY 3300
MAE 1140
MAE 2323
MATH 1301
MATH 1315
NURS 3366
PSYC 3322
How did you hear about the SI Leader position?
*
Please describe any previous tutoring, teaching, or coaching experience you have.
*
What qualities do you have that would enhance the peer educator/student relationship?
*
Why do you think students have trouble in the discipline(s) you want to SI?
*
How would you use your expertise to assist students?
*
Please write a paragraph offering information about yourself that you feel will be helpful.
*
Will you be able to attend the mandatory training (tentatively scheduled for Jan 8-9, 2026)
*
Will you be able to attend the mandatory training (tentatively scheduled for Jan 8-9, 2026)
Yes
No
Unsure
Faculty Recommendation
Professor's Name
*
Professor's UTA Email
*
Professor's Subject Area
*
Professor's Name
Professor's UTA Email
Professor's Subject Area