Supplemental Instruction (SI) Leader Application

Step 1 of 2

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Date(Required)

MM slash DD slash YYYY

Name(Required)

First Last

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Name & Number(Required)

Phone(Required)

Are you legally permitted to work for the University of Tennessee?

Yes

Anticipated Graduation Date(Required)

Degree Program(Required)

If you will have other employment while working as an SI Leader, please describe the employer and time commitment. (If not applicable, enter N/A)(Required)

What semester can you begin?(Required)

Number of hours you are available to work per week(Required)

Are you eligible for Work Study?(Required)

Yes

Unsure

For which course(s) would you like to be an SI leader? (Check all that apply) *(Required)

ACCT 200

ANTH/EEB 240

BIOL 150

BIOL 160

BCMB 401

CHEM 102

CHEM 112

CHEM 122

CHEM 132

CHEM 260

CHEM 360

MATH 119

MATH 125

PSYCH 295

STAT 201

List each instructor you had for the above courses. (Instructor Name — Course)(Required)

Why are you interested in becoming an SI leader?(Required)

Why do you think some students do not perform well in these courses, and what advice would you give them to be more successful?(Required)

List any previous positions or related experiences you have had on campus.(Required)

List any honor societies or professional memberships.(Required)

What other information should we know about you?(Required)

Demographics (Optional)

The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution in the provision of its education and employment programs and services. All qualified applicants will receive equal consideration for employment without regard to, and will not be discriminated against on the basis of, race, color, national origin, religion, sex, pregnancy, marital status, sexual orientation, gender identity, age, physical or mental disability, or covered veteran status. Inquiries and charges of violation of Title VI (race, color, national origin), Title IX (sex), Section 504 (disability), ADA (disability), ADEA (age), sexual orientation, or veteran status should be directed to the Office of Equity and Diversity (OED), 1840 Melrose Avenue, Knoxville, TN 37996-3560, telephone (865) 974-2498 (V/TTY available) or 974-2440. Requests for accommodation of a disability should be directed to the ADA Coordinator at the Office of Equity and Diversity.

(Optional) Please provide the race/ethnicity in which you most closely identify with.

(Optional) Please provide the gender in which you most closely identify with.

(Optional) Preferred Pronouns

He/him/his

She/her/hers

They/them/theirs

Other

Understanding

I understand that it is my responsibility to send the Recommendation Form to my references and that my application is not complete until they are received. Your references should be UT Faculty and at least one needs to teach in the department you’d like your SI class to be in. (http://studentsuccess.utk.edu/student-employee-reference/)

Initial Here

I have reviewed the SI leader job description, and, if selected, will fulfill the responsibilities as outlined. I understand that my employment would be for one semester and that my employment for following semester would depend upon my job performance, budget, academic performance, and a judicial report. Successful applicants will present a cumulative UT grade point average of at least 3.0, have a grade of B+ or better in the course(s) for which they are applying, and have completed at least one successful semester (after Fall 2014).*(Required)

Agree

By signing your name below, you are agreeing to allow the ASC and university officials to confirm that you meet the qualifications of this position.

Type your full name here

The University of Tennessee, Knoxville

Academic Success Center
Division of Student Success

Supplemental Instruction (SI) Leader Application