UC Davis Administrative Advisory Committees

Application for Membership: 2008-09

Information Practices Act Privacy Notice: The State of California Information Practices Act of 1977 (effective July 1, 1978) requires the University to provide the following information to individuals who are asked to supply information about themselves. The principal purpose for requesting information on this form is to provide information for appointment to UCD Administrative Advisory Committees. UC Davis Policy and Procedure Manual Section 200-15 authorizes maintenance of this information. Furnishing all information requested on this form is voluntary. Information furnished may be used by various University departments in identifying persons interested in serving on Administrative Advisory Committees and will be transmitted to the State and Federal governments if required by law. Individuals have the right of access to this record as it pertains to themselves. The official responsible for maintaining the information contained on this form is the Chancellor of the University of California, Davis, Offices of the Chancellor and Provost.

CONTACT INFORMATION: Title: Dr. Ms Mr. First name: Initial: Last name: Street/Campus Address: City: State: Zip Code: Department: (for staff/faculty) Affiliation: Academic Federation Academic Senate Staff Student Telephone: Campus e-mail address: FOR STUDENTS ONLY: Present class year: Freshman Sophmore Junior Senior Graduate Major: Expected Degree Month: March June August December and Year: 2008 2009 2010 2011 2012 2013 2014 2015 2016

COMMITTEE SELECTION: A. I am interested in serving on one of the following Administrative Advisory Committees during 2008-09. Select the name of the committee for a description of its responsibilities. The following committees advise on policies affecting campus life: Arts and Lectures Athletics Campus Judical Board Campus Unions and Recreation Board Child Care Disability Issues Regent's Scholarship Status of Women at Davis Student Services and Fees Transportation and Parking Services     The following committees perform administrative tasks based upon established policies and are required by outside agencies or the Office of the President: Biological Safety Chemical Safety Conflict of Interest Institutional Animal Use and Animal Care Radiation Safety The following groups are not within the Administrative Advisory Committee System. However, you may use the Administrative Advisory Committee application for these groups if you are interested in membership. Diving Control Board   Media Board In order of preference, please select the committees on which you are interested in serving: First: Arts and Lectures AAC Athletics AAC Campus Unions and Recreation Board Child Care AAC Disability Issues AAC Regents' Scholarship AAC Status of Women at Davis AAC Student Services and Fees AAC Transportation and Parking Services AAC Biological Safety AAC Institutional Animal Use and Animal Care AAC Radiation Safety AAC Campus Judicial Board and Student Conduct Committee Diving Control Board Media Board Second: Arts and Lectures AAC Athletics AAC Campus Unions and Recreation Board Child Care AAC Disability Issues AAC Regents' Scholarship AAC Status of Women at Davis AAC Student Services and Fees AAC Transportation and Parking Services AAC Biological Safety AAC Institutional Animal Use and Animal Care AAC UCD Radiation Safety AAC Campus Judicial Board and Student Conduct Committee Diving Control Board Media Board Third: Arts and Lectures AAC Athletics AAC Campus Unions and Recreation Board Child Care AAC Disability Issues AAC Regents' Scholarship AAC Status of Women at Davis AAC Student Services and Fees AAC Transportation and Parking Services AAC Biological Safety AAC Institutional Animal Use and Animal Care AAC UCD Radiation Safety AAC Campus Judicial Board and Student Conduct Committee Diving Control Board Media Board Fourth: Arts and Lectures AAC Athletics AAC Campus Unions and Recreation Board Child Care AAC Disability Issues AAC Regents' Scholarship AAC Status of Women at Davis AAC Student Services and Fees AAC Transportation and Parking Services AAC Biological Safety AAC Institutional Animal Use and Animal Care AAC UCD Radiation Safety AAC Campus Judicial Board and Student Conduct Committee Diving Control Board Media Board B. What are your interests, goals, and ideas related to the specific committees you have selected? C. Please list any prior committee service or related experience. D. Applications are sought from individuals representing the broad range of diversity that exists at UC Davis. If you wish, please provide any information that would assist us in that goal. (Optional)