CCEC Nomination Form 2016 - The University of Texas System

2016 Application for CCEC

RequiredDate:*

RequiredYour Name:*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email Address: *

RequiredPhone Number:*

Nominations for the term beginning September 1, 2016 are now being accepted. Please use this application to nominate yourself or someone else for service on the CCEC.

Please follow this link for information on the roles and responsibilities of Chancellor's Council Executive Committee members.

The person being nominated:

Must be a member of the Chancellor’s Council and have made cumulative outright gifts of $25,000 or more to a UT institution or the UT System.

A complete listing of Chancellor’s Council members can be found here.

The following Chancellor’s Council member is forwarded to the Nominating Committee for consideration for Executive Committee membership for a three-year term beginning September 1, 2016. Please submit a separate form for each nominee.*

Biographical Information*

RequiredCandidate's Name:*

RequiredSpouse's Name, if applicable:*

RequiredMailing Address:*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email:*

RequiredPhone Number:*

Educational Background *

Please include university name(s), degree(s) received, and class year(s).*

Required*

Affiliations and volunteer engagement at UT institutions:
Please select all that apply.
*

Required

UT Arlington

UT Austin

UT Dallas

UT El Paso

UT Permian Basin

UT Rio Grande Valley (this includes alumni of UT Brownsville and UT Pan American)

UT San Antonio

UT Tyler

UT Southwestern Medical Center

UT Medical Branch at Galveston

UT Health Science Center at Houston

UT Health Science Center at San Antonio

UT MD Anderson Cancer Center

UT Health Science Center at Tyler

UT System Administration

RequiredOther biographical, community, or business information: *

If you have questions about whether someone meets the requirements to serve on the CCEC, feel free to contact a member of the External Relations team at (512) 499-4740 or chancellorscouncil@utsystem.edu.