First Name

Last Name

Campus

E-mail

Phone #

Current Address

Status

Undergraduate
Graduate
Professional

School

Major

Year

Why do you want to serve on a committee? What do you think should be the role of student representatives on committees? [250 word max]

Committee Preference #1
Please select a committee University Committee on Library and Scholarly Communication (Grad preferred) UC Undergraduate Experience Survey Steering Committee (Undergrad and Grad) Informational Technology and Telecommunications Policy (Grad preferred) Academic Freedom (Grad preferred) Intersegmental Coordinating Committee California Student Aid Commission (2 year term)

Why are you interested in this committee? How would your campus, community or job related experiences enhance your ability to serve on this committee? [250 word max]

Committee Preference #2
Please select a committee University Committee on Library and Scholarly Communication (Grad preferred) UC Undergraduate Experience Survey Steering Committee (Undergrad and Grad) Informational Technology and Telecommunications Policy (Grad preferred) Academic Freedom (Grad preferred) Intersegmental Coordinating Committee California Student Aid Commission (2 year term)

Why are you interested in this committee? How would your campus, community or job related experiences enhance your ability to serve on this committee? [250 word max]

Committee Preference #3
Please select a committee Please select a committee University Committee on Library and Scholarly Communication (Grad preferred) UC Undergraduate Experience Survey Steering Committee (Undergrad and Grad) Informational Technology and Telecommunications Policy (Grad preferred) Academic Freedom (Grad preferred) Intersegmental Coordinating Committee California Student Aid Commission (2 year term)

Why are you interested in this committee? How would your campus, community or job related experiences enhance your ability to serve on this committee? [250 word max]

Are there any other committees you are interested in serving on?

Additional Committee 1
Please select a committee University Committee on Library and Scholarly Communication (Grad preferred) UC Undergraduate Experience Survey Steering Committee (Undergrad and Grad) Informational Technology and Telecommunications Policy (Grad preferred) Academic Freedom (Grad preferred) Intersegmental Coordinating Committee California Student Aid Commission (2 year term)

Additional Committee 2
Please select a committee University Committee on Library and Scholarly Communication (Grad preferred) UC Undergraduate Experience Survey Steering Committee (Undergrad and Grad) Informational Technology and Telecommunications Policy (Grad preferred) Academic Freedom (Grad preferred) Intersegmental Coordinating Committee California Student Aid Commission (2 year term)