2025 CCEC Nomination Form

2025 CCEC Nomination Form

Nominations for the term beginning September 1, 2025, are now being accepted through January 31, 2025.
Date*

MonthDayYear
Date
Your Name*

First NameLast Name
Email*
Cell Phone *
The nominee:

The nominee will have already given at least $25,000 cumulatively to one or more UT institutions or UT System.

Nominees will be forwarded to the Nominating Committee for consideration of Executive Committee membership for a three-year term beginning September 1, 2025. Please submit a separate form for each nominee.
Biographical Information
Nominee's Name*

First NameLast Name
Spouse's Name, if applicable

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
Phone Number
Educational Information
Please include university name(s), degree(s) received, and class year(s)
Affiliations and Volunteer Engagement at UT Institutions
Please select all that apply:

UT ArlingtonUT AustinUT DallasUT El PasoUT Permian BasinUT Rio Grande ValleyUT San AntonioUT TylerUT Southwestern Medical CenterUT Medical Branch at GalvestonUT Health Science Center at HoustonUT Health Science Center at San AntonioUT MD Anderson Cancer CenterStephen F. Austin State UniversityUT System Administration
Other biographical, community, or business information
We take your privacy seriously and will not use the information you provide for purposes other than those needed to contact you about participation on the CCEC and provide information and updates about our program.

If you have questions about whether someone meets the requirements to be eligible to serve on the CCEC, feel free to contact us at ccec@utsystem.edu or (512) 499-4279.
Should be Empty:

2025 CCEC Nomination Form

Biographical Information

Educational Information

Affiliations and Volunteer Engagement at UT Institutions