| Name: | Student ID # | ||||||||
| Last 4 digits | |||||||||
| Street Address: | |||||||||
| City, Zip Code: | Telephone: | ||||||||
| Expected | |||||||||
| E-mail: | Date of Graduation: | ||||||||
| Check here if Graduate Student | |||||||||
| List Volunteer, Service, Youth Groups, or Organizations with a Service Component | |||||||||
| in which you have served and in what capacity. Include dates. | |||||||||
| A. | |||||||||
| B. | |||||||||
| C. | |||||||||
| D. | |||||||||
| E. | |||||||||
| In a short essay (1000 words or less) describe in detail your involvement with these | |||||||||
| groups. (Please attach) | |||||||||
| Please provide letter(s) of recommendation concerning your volunteer activities. | |||||||||
| Applicant Signature | Date | ||||||||
| Mail application by April 21, 2006 to the Student Governance and Organizations, | |||||||||
| Office, Box 19350, UTA, Arlington, Tx. 76019 Telephone 817-272-2293. | |||||||||
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State
Law requires that each student identify any relation to a current
member of The University of Texas System Board of Regents. A student
who is related to a current member of the U.T. System Board of
Regents is prohibited from receiving scholarships unless the
scholarship is awarded exclusively based on academic merit or is an
athletic scholarship. It is a class B misdemeanor to file a false
statement. Are you related to any member of the U.T. System Board of Regents? If yes, please identify the Board member and the relationship. Applicable relationships include one of the following: 1. Regent’s—spouse, spouse’s child, spouse’s parent, child’s spouse, parent’s spouse; 2. Regent’s—spouse’s brother or sister, spouse’s grandparent, spouse’s grandchild, brother’s or sister’s spouse, grandparent’s spouse, grandchild’s spouse; 3. Regent’s—parent, daughter, son; 4. Regent’s—brother, sister, grandparent, grandchild; or 5. Regent’s—great-grandparent, great-grandchild, uncle or aunt (brother or sister of parent), nephew or niece (son or daughter of brother or sister). A list of the current members of The University of Texas System Board of Regents is available at http://www.utsystem.edu/bor/currentRegents.htm.
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| You may be entitled to know what information The University of Texas at Arlington (UT Arlington) collects concerning you. You may review and have UT Arlington correct this information according to procedures set forth in UTS 139. The law is found in sections 552.021, 552.023 and 559.004 of the Texas Government Code. | |||||||||