TEXAS HIGHER EDUCATION COORDINATING BOARD P.O. Box Austin, Texas 78711

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TEXAS HIGHER EDUCATION COORDINATING BOARD P.O. Box 12788 Austin, Texas 78711 n-voting Student Representative To The Texas Higher Education Coordinating Board Background: Section 61.0225 of the Education Code authorizes the Governor to appoint a non-voting student representative to the Texas Higher Education Coordinating Board for a term not to exceed one year beginning on June 1 and ending on May 31 the following calendar year. The student representative shall enjoy the same rights as a regularly appointed board member, except the right to vote or be counted towards a quorum for official board business. The student representative serves without compensation, however shall be reimbursed by the Coordinating Board for expenses incurred during official board business. Qualifications: For initial consideration, nominees must meet the following minimum criteria: Be enrolled as an undergraduate or graduate student in a public institution of higher education; Be in good academic standing as determined by the institution; Commit to fulfill all board related responsibilities during their term of service, to include attendance at no less than 3 of the 4 quarterly board meetings, and 3 of the 4 board committee meetings as scheduled (see attached); and Have a strong drive and self-motivation to contribute to the progress of higher education in Texas. If appointed, the student representative must continue to meet the following criteria for the length of his or her term: Maintain a GPA of at least 2.5 on a 4.0 scale; Maintain enrollment at a public institution of higher education for duration of term; and Maintain a state-wide perspective on higher education (as opposed to representing any single college or university). Process for an institution that is part of a university system: The nomination process begins with the student government at each institution and ends with a final appointment by the Governor. Below are key deadlines for the nomination process: vember 1 Deadline for student government at each institution within a system to begin solicitation for nominees.

January 1 Deadline for student government at each institution within a system to select no more than five applicants for recommendation to the chancellor of the system. February 1 Deadline for the chancellor of the system to nominate to the Governor no less than two applicants for appointment to the Coordinating Board. This deadline includes the submission to the Governor s Appointments Division the following documents (applications must be postmarked by this date): 1. THECB Application 2. Governor s appointment application 3. Resume 4. Unofficial transcript June 1 Deadline for the Governor to appoint a non-voting student representative to the Coordinating Board for a one-year term expiring on May 31. Process for an institution that is not part of a university system: vember 1 Deadline for student government at each institution not part of a university system to begin solicitation for nominees. January 1 Deadline for student government at each institution not part of a university system to select no more than five applicants for recommendation to the president of their institution. February 1 Deadline for the president of each institution not part of a university system to nominate to the Governor no less than two applicants for appointment to the Coordinating Board. This deadline includes the submission to the Governor s Appointments Division the following documents (submissions must be postmarked by this date): 1. THECB Application 2. Governor s appointment application 3. Resume 4. Unofficial transcript June 1 Deadline for the Governor to appoint a non-voting student representative to the Coordinating Board for a term expiring on May 31. The chancellor or president (as indicated above) shall forward a completed nominations packet to the following address: Appointments Division Office of Governor Greg Abbott P.O. Box 12428 Austin, TX 78711 http://gov.texas.gov/appointments Please note that the Governor may request to see information from all applicants during his deliberations, so it is imperative that each institution and university system maintain applicant information until final selection. Additionally, the Governor is authorized to request information beyond what is required in the attached applications.

Print Form TEXAS HIGHER EDUCATION COORDINATING BOARD Application for Student Representative to the Coordinating Board Name: Institution: Graduation Date: Major (s): GPA: Mailing Address: Phone: Email: Please describe an issue related to higher education that you are most interested in and why. Limit to 150 words*. Please explain how you would help your fellow college students by serving. Limit to 150 words*. Please attach a resume and an unofficial transcript when you submit your application. * If additional room is needed please attach a separate document.

GOVERNOR GREG ABBOTT OFFICE OF THE GOVERNOR APPOINTMENT APPLICATION Full Legal Name Preferred Name 1. Personal Information 2. Photograph Physical Home Address City, State Zip, Mailing Address City, State Zip, County Work Telephone Home Telephone Cellular Preferred E-mail Address Secondary E-Mail Address (if applicable) State Senator State Representative 3. State Board(s), Commission(s), or Task Force(s) of Interest to You: The list of all entities to which the Governor makes appointments may be found at: http://www.gov.texas.gov/appointments/positions 4. Employment Information Employer Present Job Title Profession Present Job Description Revised 02/15 1

Name 5. Education/Training Type of School Name and Location of School High School Undergraduate Graduate Other Year Graduated Degree and Field of Study 6. Employment History Employer Position Dates Location 7. References Name Employer City Telephone Relationship 8. Professional Memberships (including any state bar memberships) Organization Title/Position Current/Former 9. Volunteer Participation Organization Title/Position Current/Former 10. Military Service Are you or have you ever been a member of the Armed Forces of the United States: Branch Dates of Service Type of Discharge Revised 02/15 2

Name 11. Social Media Information additional information. Facebook Username Twitter Handle @ Instagram Username LinkedIn Profile Google+ Username 12. Spouse Information This Section t Applicable Job Title/Position Does your spouse conduct any business with or before the Texas Legislature or any other state entity? If yes, please list agencies: 13. Miscellaneous Information (a) serving on the governing board of directors or (b) a ten (10) percent or greater ownership. This does not apply to any mutual funds in which you do not exercise authority in investment decisions. Have you filed federal income tax returns for the past five (5) years? If no, give details. Are you, your spouse, or any company in which you have a material interest currently delinquent in any local, state or federal taxes? If yes, give details. Have you ever defaulted on a personal, business or student loan? If yes, give details. Type of Loan Date Details Have you, your spouse, or any company in which you have a material interest or of which you have been an officer or principal been involved in any bankruptcy proceeding? If yes, give details including dates. Do you currently serve, or have you ever served, on any local, state or federal government board, commission or committee or in any elected or appointed office? Compensated Entity Position Dates (Y/N) Reimbursed (Y/N) Revised 02/15 3

Name 13. Miscellaneous Information (Continued) Are you or your spouse related to a local, state, or federal public official? Name of Official and Title Relationship Do you or your spouse have any material interest in, or are either of you employed by, any company that does business with or receives funds from the State of Texas? If yes, give full name and details: Name of Company Details Are you or your spouse an officer, director, employee or paid consultant of a trade association? If yes, please list association and position: Self Spouse Have you or your spouse ever been registered as a lobbyist or received compensation to represent someone before a local, state, or federal government? Self or Entity Represented Entity Lobbied Dates Spouse Have you, your spouse, or any company in which you or your spouse have a material interest been party to litigation? If yes, give details. In the last five years, have you, or any company in which you have a material interest, been licensed by a Texas state agency? If yes, give details. Agency Type of License License # Expiration Have you ever been delinquent in child support payments? If yes, give details. t Applicable Revised 02/15 4

Name 13. Miscellaneous Information (Continued) To the best of your knowledge, has any federal, state or local law enforcement or regulatory agency (on behalf of itself or any other person or entity) filed or investigated any grievance or complaint against you, your spouse, or an entity in which you have a material interest? If yes, give details and disposition (investigated, dismissed, reprimanded) Agency Date Details and Disposition To the best of your knowledge, have you, your spouse, or any company in which you have a material interest been investigated, reprimanded, fined or suspended from doing business with any state or federal agency? If yes, give details and disposition (investigated, reprimanded, fined, suspended) Agency Date Details and Disposition Have you ever been convicted in a criminal proceeding (excluding traffic violations), placed on probation, required to perform community service, or had a criminal proceeding disposed of by pre-trial diversion, deferred prosecution, deferred adjudication, or some similar proceeding? If yes, list the charge, the date of the offense, the city and/or county and state in which it allegedly occurred, and the disposition thereof. Revised 02/15 5

14. Certification Full Legal Name Date of Birth / / Texas Driver License or DPS ID# Are you a U.S. Citizen? Place of Birth Date of naturalization (if not a citizen upon birth) / / Ethnicity: (optional; check all that apply) White African American Hispanic Asian American Native American Other tes: Appointment to a Board or Commission may require the annual filing of a Personal Financial Statement (PFS) Form with the Texas Ethics Commission. A resume must be attached in order for this application to be considered complete. Judicial candidates must also complete a Judicial Questionnaire. Any information provided on the application or attached may be subject to the Texas Public Information Act. This means that an individual requesting copies of the information in your file may be provided access to that information. CERTIFICATION OF APPLICANT I hereby certify that the foregoing and any attached statements are true, accurate and complete. I agree that any misstatement, misrepresentation, or omission of a fact may result in my disqualification for appointment. I assign and hereby give the Office of the Governor full authority to conduct background investigations pertinent to this application. I specifically authorize the Texas Department of Public Safety to conduct a background investigation and to disclose the results of that investigation to the Governor or his authorized representative. Submit to: Date Appointments Staff (512) 463-1828 Office of the Governor (512) 475-2576 fax PO Box 12428 www.gov.texas.gov Austin, Texas 78711 ServingTexas@gov.texas.gov (with scanned signature page) Revised 02/15 6

TO: The Office of the Executive Vice President for Academic and Research Affairs UTHEALTH ACKNOWLEGEMENT FORM - STUDENT REGENT/THECB APPLICATION As the academic/faculty advisor or associate dean for student,, I acknowledge and approve their choice to apply for the position of the UT System Student Regent and/or the Texas Higher Education Coordinating Board n- Voting Student Member. The time commitment for both positions has been explained, so if chosen, the student will be allowed to honor these commitments. Associate Dean/Academic or Faculty Advisor Print Name Date 713-500-3065 Kathy Rodgers Kathy.Rodgers@uth.tmc.edu Office of the Executive VP Academic & Research Affairs 7000 Fannin, Suite 1565D Houston, Texas 77030