CCEC Nomination Form - The University of Texas System

2024 CCEC Nomination Form

Nominations for the term beginning September 1, 2024, are now being accepted through April 30, 2024.

Date:
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Required*

Your Name:
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Required*

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

Phone Number:
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RequiredPlease enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.*

The nominee:

The nominee may be a current member of the Chancellor’s Council and will have given $25,000 cumulatively to one or more UT institutions.

Nominees will be forwarded to the Nominating Committee for consideration of Executive Committee membership for a three-year term beginning September 1, 2024. Please submit a separate form for each nominee.

Biographical Information

Nominee's Name:
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Required*

Spouse's Name, if applicable:
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Required*

Mailing Address:
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Required*

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

Phone Number:
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RequiredPlease enter a 10-digit phone number. You can use hyphens or periods to separate numerals, and you can put the area code in parenthesis.*

Educational Information

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

Affiliations and Volunteer Engagement at UT Institutions

RequiredPlease select all that apply:

UT Arlington

UT Austin

UT Dallas

UT El Paso

UT Permian Basin

UT Rio Grande Valley (those previously affiliated with UT Brownsville or UT Pan American)

UT San Antonio

UT Tyler (now including UT Health Science Center at 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

Stephen F. Austin State University

UT System Administration

Other biographical, community, or business information:
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Required*

We take your privacy seriously and will not use the information you provide for purposes other than those needed to contact you about participation on the CCEC and provide information and updates about our program.

If you have questions about whether someone meets the requirements to be eligible to serve on the CCEC, feel free to contact us at ccec@utsystem.edu or (512) 499-4279.