UNIVERSITY OF TEXAS AT ARLINGTON
STUDENT GOVERNANCE
SPRING 2016 ELECTIONS
(NOTE: EACH CANDIDATE IS RESPONSIBLE FOR KNOWING THE QUALIFICATIONS OF THE OFFICE FOR
WHICH HE/SHE IS FILING)
SSAC Term: 1 year____ 2 years ____
PLEASE COMPLETE ALL SECTIONS (PRINT ONLY):
OFFICE SEEKING: ______________________________________________________________________
FULL NAME:** __________________________________________________________________________
(NAME WILL APPEAR ON BALLOT AS FIRST AND LAST NAME LISTED IN UNIVERSITY RECORDS)
MAV I.D. NUMBER:*** ___________________________________ GENDER:
M
F
MAJOR: ________________________________________ OVERALL GPA (at UTA) _________________
TOTAL HOURS COMPLETED AT UTA: __________ HOURS CURRENTLY ENROLLED:________________
TOTAL HOURS TRANSFERRED, IF ANY:_______________
UTA EMAIL ADDRESS:___________________________________________________________________
TELEPHONE NUMBER:__________________________________________________________________
I UNDERSTAND THAT THE CANDIDATES MEETING ARE MONDAY, APRIL 4, 2016 at 12:00 P.M. in
Guadalupe, Upper Level of the University Center, and TUESDAY, APRIL 5, 2016 at 12:30 P.M. IN THE Lower
Chambers, Lower Level of the University Center. ATTENDANCE AT ONE OF THESE MEETINGS IS
MANDATORY; HOWEVER, I UNDERSTAND THAT IF I AM NOT ABLE TO ATTEND I MUST SEND A
REPRESENTATIVE, WITH WRITTEN AUTHORIZATION, TO APPEAR FOR ME.
I AM AWARE OF THE QUALIFICATIONS OF THE OFFICE I AM SEEKING AND I CURRENTLY MEET ALL OF
THESE QUALIFICATIONS. I UNDERSTAND THAT IF ANY OF THE INFORMATION PROVIDED ON THIS
APPLICATION IS FALSE, I AM SUBJECT TO DISQUALIFICATION FROM THE ELECTIONS.
I UNDERSTAND THAT UPON FILING THIS APPLICATION I WILL BE REQUIRED TO PAY A $10.00 NON
REFUNDABLE FILING FEE PER OFFICE.
**I UNDERSTAND THAT MY NAME WILL APPEAR ON THE BALLOT WITH FIRST AND LAST NAME ONLY.
***ID NUMBER REFERS TO YOUR GIVEN ID NUMBER. PLEASE DO NOT PLACE YOUR SOCIAL SECURITY
NUMBER. ID NUMBERS CAN BE FOUND ON YOUR MAV ID OR IN MyMAV.
I HAVE READ AND UNDERSTAND THE PROVISIONS OF THE GOVERNING ELECTION CODE.
______________________________________
SIGNATURE OF APPLICANT
___________________
DATE
****************************************FOR OFFICE USE ONLY****************************************
FEE PAID _______
PLATFORM RECEIVED _______
PLACE NUMBER _______