UCSC Alumni Association, University of California, Santa Cruz, 1156 High St., Santa Cruz

UCSC Alumni Association, University of California, Santa Cruz, 1156 High St., Santa Cruz CA 95064

Application Form

UCSC Alumni Regent

Application deadline July 1, 2011

E-mail or Mail to:

Carolyn Christopherson

Executive Director

UCSC Alumni Association

1156 High Street

Santa Cruz, CA 95064

Email:

(831) 459-4886

Last / First / Middle

Name:

Last / First / Mid. Initial

Name as it appears on UCSC student records:

Mailing address:

Home / Business / FAX / Email

Telephone:

Education (begin with most recent)

School / Location / Grad Year / Major / Degree

List special awards (academic, professional, community, etc.) you have received.

Name of Award / Year of Receiving Award / Type of Award
(academic, professional, etc.)

If you answer "yes" to any of the questions below, please attach a note of explanation.

Yes / No

1. Have you ever been convicted of a felony?

Yes / No

2. Have you ever been dismissed by an educational institution?

References (whom we may contact)

Please list (in the following space or attach a separate sheet) at least two personal and/or professional references, people with whom you have been acquainted for at least three years (you may list additional references). Please do not list relatives by blood or marriage.

Personal references

Name/Relationship / Mailing Address / Phone / Email

Professional references

Name/Relationship / Mailing Address / Phone / Email

Please respond to the questions below.

1. What contributions have you made to the university as a student and since your graduation from UCSC that demonstrate your concern for the university community (not to exceed 350 words)?

2. Please describe your qualifications for this position, including your professional accomplishments, civic and volunteer service and any experience you have had developing policy and long range plans? Explain why you wish to serve as an Alumni Regent (not to exceed 350 words).

3. Please describe the key challenges you see facing the University of California in the coming years and how best the University should address them? What do you foresee the key challenges our students will face and what will be of interest to them (not to exceed 500 words)?

4. It is conservatively estimated that a member of the Board of Regents spends at least four days a month preparing for and attending university-related functions. Given your current and future time commitments, how do you see incorporating the duties of this position into your schedule (not to exceed 100 words)?

5. While out-of-pocket expenses vary according to individuals, it is conservatively estimated that a member of the Board of Regents spends a minimum of $2,500 annually in addition to the per diem reimbursement given to a Regent or Regent-designate while on official university business. The expenses can include secretarial support, telephone, mail, entertainment, lodging cost beyond per diem reimbursement, and other miscellaneous expenditures. Would the financial obligation of this position be a problem for you? If so, what steps would you take to meet that obligation (not to exceed 75 words)?

Please attach cover letter, a résumé including complete employment history since graduation from UCSC and 2 letters of recommendation.

Thank you for applying for the UCSC Alumni Regent.