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: Prefix: 

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: