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Board of Counselors Application

All applications must be reviewed and approved the Board of Counselors Membership and Steering Committees.
The Board of Counselors Annual Financial Commitment is $300.
($150 membership dues and a minimum of $150 towards UT’s Annual Fund) 

* Denotes required field.
 
*Applicant's Name:  First:

Middle:
 
Last:  
Business 
*Title:   
*Company:   
*Describe Firm's Activity:   
*Business Address:   
*City:   
*State:   
*Zip:   
*Email Address:   
*Website Address:   
*Business Phone:   
*Cell Phone:   
*Fax:   
*I Prefer Mail be Sent to My: 
                      
 
Personal 
*Home Address:   
*City:   
*State:   
*Zip:   
*Home Phone:   
*Applicant's Birthday:  (ex: MM/DD/YY )
*Education:(Check all that apply) 
                      

Other:  
*College Name/Degrees/Years:  Degree 1:

Degree 2:

Degree 3:
 
*Are you a UT Alum?:
 
           
 
Is your spouse a UT Alum?:
 
           
 
Spouse's Name:   
Why do you want to be a member of the Board of Counselors?:     
*Professional or Service Club Affiliations:   
*Interests:   
*Proposed/Referred By:   
I was a past BOC member: