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Texas State University System (TSUS) Non-Voting - Student (Sam Houston State University)

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Texas State University System (TSUS)
Non-Voting - Student Regent
QUALIFICATIONS
• Term: June 1, 2020 – May 31, 2021
• Academics:
o Undergraduate or Graduate student enrolled in a TSUS public institution of higher education
o Good academic standing
o Overall GPA of at least 2.5
• Other:
o Must represent the interests of the students, their university, the university system and the
State of Texas
o Encouraged to be involved with student governments on each campus
o Working relationship with faculty, staff and representative student organizations
o Commit to required regent activities, including TSUS board meetings, orientation sessions
conducted by the Office of the Governor and Texas Higher Education Coordinating Board.
APPLICATION PROCESS
• Due Date: Friday, December 6, 2019
• Submit To: SHSU Vice President for Student Affairs Office (VPSA)
Student Affairs Annex, 919 Bearkat Boulevard or Campus Box 2237
• Application Packet (single-sided):
1. Complete all forms directly following this page (print out the completed forms and sign)
• Include a professional picture either in the designated place within the application or
attach to your application so we may assist. The picture must be able to fit within the
space provided.
2. Resume
3. Three letters of recommendation (one from each of the following)
♦ The Dean of your college major (Example: Accounting Major = Dean, College of Business
Administration)
♦ Faculty Member
♦ Faculty or Staff Member
4. Official Transcript
1
Application Form for Student Regent: State of Texas
June 1, 2020 - May 31, 2021
Background
In 2005, the Texas Legislature approved the position of non-voting student regent. In
accordance with the provisions of the Education Code, Sections 51.355 and 51.356, each
public university board of regents shall include one student member appointed by the
governor. The chancellor of each university system and president of each independent
public university shall “develop a uniform application form to be used by each general
academic teaching institution and medical and dental unit in the university system to
solicit applicants for the position of student regent.” This form is for those systems and
independent public universities who wish to use a standard form in addition to the
appointment application provided by the Office of the Governor.
Student Regent
The student regent is a non-voting participant on the board of regents representing the
students of each Texas public university system or independent public university (a
general academic teaching institution that is not a part of a university system). The
student regent serves a one-year term commencing June 1 and ending May 31 of the
following year. While technically not a member of the board of regents, a student regent
does have the same powers and duties as the members of the board of regents, with the
exception of voting, making or seconding motions, and being counted to determine a
quorum.
To the best of their ability, the student regent represents the interests of the students,
university system/university and the State of Texas. The student regents may serve on
special commissions, task forces and committees during their term and are expected to
participate in required regent activities, including orientation sessions conducted by the
Office of the Governor and the Texas Higher Education Coordinating Board. Student
regents will be required to abide by the laws of the State of Texas applicable to board
service, including the state ethics laws. The student regent is encouraged to be involved
with the student governments on each campus which they represent and to have a
working relationship with faculty, staff and representative student organizations.
Student Regent Qualifications
To qualify, an individual must be enrolled and in good standing as an undergraduate or
graduate student in one of the colleges or universities in The Texas State University
System. The applicant must have earned a minimum of a 2.5 grade point average and
must maintain this minimum performance level throughout his/her term. Please include
an official transcript with the application. The president of the institution where the
student is enrolled is required to notify the Governor if the student regent fails to
maintain his/her qualifications. The Governor, in turn, will declare the position vacant
and fill the vacancy as soon as practicable. A student regent is not eligible for
reappointment. Preference will be given to applicants who are residents of the State of
Texas and who have a general knowledge of the functions of the board of regents.
Student regent applicants must have a strong desire to represent all university students
within their respective system/institution.
Revised 10/2019
Revised 10/2019
2
Overview of the Role of the Boards of Regents
The governor of the State of Texas appoints regents for all public university systems,
including The Texas State University System.
The boards of regents for the State of Texas are vested with the legal and corporate
authority to ensure that the mission of the system/university is carried out, and in doing
so, are accountable to the citizens of Texas. Members of the board of regents are
appointed by the governor with staggered six-year terms. One student regent is appointed
with a one-year term. Many boards of regents operate through standing committees and
also subcommittees and special committees. The boards and their committees meet
throughout the year.
The regents establish policy in areas such as personnel, campus development, student
tuition and fees, admissions, and financial aid. The duties of the regents include
overseeing the financial management of the system/university, its investments and
property holdings as well as major appointments including the chancellors of the systems,
presidents of the universities and other key personnel. The regents delegate a broad range
of authority and responsibility to the system chancellor and university presidents.
Remuneration for Expenses
Although serving without compensation, a student regent is entitled to be reimbursed for
expenses incurred for attendance at meetings of the board, its committees, other official
university events and conferences where travel is approved for board members.
Timeline for The Texas State University System
The Student Government recommends up to five applicants for the position of student
regent and submit all official documents (including an official transcript) to the
president’s office on each campus. (Note: At this stage, each applicant will have his/her
academic, financial and disciplinary standing verified by the registrar and appropriate
student services administrator as well as a criminal records check completed through the
University Police. See the information on page 5 of this application.)
By January 10 The president of the campus will forward the recommendations to
the Chancellor’s Office. The official applications will be filed in
the president’s office and a copy of the complete file forwarded to
The Texas State University System. All applications should be
single sided documents, not double sided.
By January 17 From the materials received, the chancellor will select two or more
applicants (unranked) to submit to the governor for his
consideration.
On June 1 The governor appoints a student regent for a one-year term
expiring the following May 31. (By statute, the governor may
request to review all applications received by the student
governments. Additionally, the governor is not required to appoint
an applicant recommended by the chancellor.)
Revised 10/2019
3
2020-2021 Student Regent Application Form
Please print or type.
Deliver in person or mail to the President’s Office (single sided originals only)
Application for the position of student regent to The Texas State University
System is due to the Chancellor’s Office on: Friday, January 10, 2020 by 5:00
p.m.
Applications received after the deadline will not be eligible for consideration.
This application may be subject to disclosure under the Texas Public Information
Act. By signing this form, applicant waives any exemption from disclosure
afforded by the Family Educational Rights and Privacy Act (FERPA), 12 USC
1232g, with the exception of a Student Identification Number which will be
confidential unless otherwise provided by FERPA.
All applicants must fill out this form and complete the required appointment application
issued by the governor of Texas.
1. Name ________________________________________________________
2. University/Campus ______________________________________________
3. Student Identification Number _____________________________________
4. Campus Mailing Address _________________________________________
5. Campus Telephone Number ______________________________________
6. Email Address _________________________________________________
7. Are you a Texas resident? Yes No
Personal/Permanent Information if Different from Above (Winter/Summer Break
contact):
8. Mailing Address ________________________________________________
9. Telephone Number _____________________________________________
I hereby certify that the foregoing and any attached statements are true, accurate and
complete. I agree that any misstatement, misrepresentation or omission of a fact may
result in my disqualification for appointment. I assign and hereby give The Texas
State University System component college or university full authority to conduct
background investigations pertinent to this application.
Signature of Applicant: _______________________________ Date: ____________
OFFICIAL USE ONLY
The student applicant is in good standing and, to the best of my knowledge, has met all
obligations to which he/she has committed to the university.
Office of the Dean of Students: __Yes __No Initials: _____ Date: ______
Office of the Registrar (verify GPA provided above): Initials: _____ Date: ______
Criminal Records Check Completed by Appropriate Official: Initials: _____ Date: ______
Revised 10/2019
4
Educational Background
10. Please check your class standing for spring term 2020:
Sophomore Junior Senior Graduate
11. Will you be enrolled as a student at this university continuously through the
2020-2021 academic year? Yes No (See the information
provided by Senate Bill 34 on the last two pages to determine if you qualify as
being continuously enrolled through the academic year.)
12. What is your Major? ______________ Minor? ________________________
13. What is your intended degree and expected year of award? ______________
14. What is your overall grade point average as of the latest completed semester?
___________
15. To the best of your knowledge, are you in good standing at the present time
with the university in all respects, with no delinquent financial obligations or
pending disciplinary actions? Yes No
16. Have you been disciplined while attending this or any other institution of
higher education for infractions of university policy? Yes No
17. List all colleges or universities you have attended with the dates you attended
and any degrees you were awarded:
Institution Attended Dates Attended
Semester Credit
Hours Completed
Degree
Awarded
Revised 10/2019
5
18. Provide references below (limit three). One of your references must be a
faculty member of this system/university who is familiar with your academic
work and/or extracurricular leadership. Please include these supporting
documents with your application (may be submitted in sealed envelope).
Name/Title
Relationship
to Applicant
Email Address Telephone Number
( )
( )
( )
On additional paper, please respond to the questions below. Limit your response to each
question to not more than 250 words. Finally, you may wish to include your resumé with
this application (limit two pages).
19. Brief Essay: Explain your interest in serving on the board of regents of The
Texas State University System and identify the issues you wish to address as a
board member.
20. List participation in student activities and social organizations at this or other
higher education campuses, including the approximate beginning month/year
and ending month/year, noting where service as an officer applies.
21. List participation in civic and/or social organizations not affiliated with higher
education, including the approximate beginning month/year and ending
month/year, noting where service as an officer applies.
22. List any employment or other experiences that you deem to be significant.
Revised 6/19 1
GOVERNOR GREG ABBOTT
OFFICE OF THE GOVERNOR
APPOINTMENT APPLICATION
1. Personal Information 2. Photograph
Full Legal Name
(Photo may be attached
as a separate
attachment/document)
Preferred Name
Spouse’s Name
Physical Home Address
City, State Zip ,
Mailing Address
City, State Zip ,
Work Telephone
- -
Home Telephone
- -
Preferred E-mail Address
State Senator
Secondary E-Mail Address (if applicable)
State Representative
3. State Board(s), Commission(s), Task Force(s) or Areas of Interest to You:
The list of all entities to which the Governor makes appointments and areas of interest
may be found at:
https://gov.texas.gov/organization/appointments/positions. If you are
applying for a judicial or district attorney appointment, please list the position below.
4. Employment Information
Employer
Employer’s Address
Present Job Title
Profession
Present Job Description
Revised 6/19 2
Name
5. Education/Training
Type of School Name and Location of School
Year
Graduated
Degree and
Field of Study
High School
Undergraduate
Graduate
Other
6. Employment History
Employer
Position
Dates
Location
7. References
8. Professional Memberships (including any state bar memberships)
Organization
Title/Position
Current/Former
9. Volunteer Participation
Organization
Title/Position
Current/Former
10. Military Service
Are you or have you ever been a member of the Armed Forces of the United States: Yes No
Branch
Dates of Service
Type of Discharge
Name
Employer
City
Telephone
Relationship
- -
- -
- -
- -
- -
Revised 6/19 3
Name
11. Social Media Information
Do you use, or have you ever used, any of the following? If “yes,” provide additional information.
Facebook Yes No
Username
Twitter Yes No
Handle @
Instagram Yes No
Username
LinkedIn Yes No
Profile
12. Spouse Information This Section Not Applicable
Spouse’s Employer
Job Title/Position
Does your spouse conduct any business with or before the
Texas Legislature or any other state entity? Yes No
If yes, please list agencies:
13. Miscellaneous Information
Note: “Material interest” is defined as (a) serving on the governing board of directors or (b) a ten (10)
percent or greater ownership. This does not apply to any mutual funds in which you do not exercise
authority in investment decisions.
Have you filed federal income tax returns for the past five (5) years? If no, give details.
Yes No
Have you ever defaulted on a personal, business or student loan? If yes, give details.
Yes No
Type of Loan
Date
Details
Are you, your spouse, or any company in which you have a material interest currently
delinquent in any local, state or federal taxes? If yes, give details.
Yes No
Have you, your spouse, or any company in which you have a material interest or of which
you have been an officer or principal been involved in any bankruptcy proceeding? If yes,
give details including dates.
Yes No
Do you currently serve, or have you ever served, on any local, state or federal government
board, commission or committee or in any elected or appointed office?
Yes No
Entity Position Dates
Compensated
(Y/N)
Reimbursed
(Y/N)
Revised 6/19 4
Name
13. Miscellaneous Information (Continued)
Are you or your spouse related to a local, state, or federal public official?
Yes No
Name of Official and Title
Relationship
Do you or your spouse have any material interest in, or are either of you employed by, any
company that does business with or receives funds from the State of Texas?
If yes, give full name and details:
Yes No
Name of Company
Details
Are you or your spouse an officer, director, employee or paid
consultant of a trade association? Yes
No
If yes, please list association and position:
Self
Spouse
Have you or your spouse ever been registered as a lobbyist or received compensation to
represent someone before a local, state, or federal government?
Yes No
Self or
Spouse
Entity Represented
Entity Lobbied
Dates
Have you, your spouse, or any company in which you or your spouse have a material
interest been party to litigation? If yes, give details.
Yes No
In the last five years, have you, or any company in which you have a material interest, been
licensed by a Texas state agency? If yes, give details.
Yes No
Agency
Type of License
License #
Expiration
Have you ever been delinquent in child support payments? If yes, give details.
Yes No
Not
Applicable
Revised 6/19 5
13. Miscellaneous Information (Continued)
Have you ever been convicted in a criminal proceeding (excluding traffic violations), placed
on probation, required to perform community service, or had a criminal proceeding disposed
of by pre-trial diversion, deferred prosecution, deferred adjudication, or some similar
proceeding?
If yes, list the charge, the date of the offense, the city and/or county and state in which it
allegedly occurred, and the disposition thereof.
Yes No
Name
To the best of your knowledge, has any federal, state or local law enforcement or regulatory
agency (on behalf of itself or any other person or entity) filed or investigated any grievance or
complaint against you, your spouse, or an entity in which you have a material interest? If
yes, give details and disposition (investigated, dismissed, reprimanded)
Yes No
Agency
Date
Details and Disposition
To the best of your knowledge, have you, your spouse, or any company in which you have a
material interest been investigated, reprimanded, fined or suspended from doing business
with any state or federal agency? If yes, give details and disposition (investigated,
reprimanded, fined, suspended)
Yes No
Agency
Date
Details and Disposition
Revised 6/19 6
14. Certification
Full Legal Name
Date of Birth / /
Texas Driver License or DPS ID#
Are you a U.S. Citizen? Yes No
Place of Birth
Date of naturalization (if not a citizen upon birth) / /
Ethnicity: (optional; check all that apply)
White African American Native American
Hispanic Asian American Native Hawaiian or Other Pacific Islander Two or More Races Other
Notes:
• Appointment to a Board or Commission may require the annual filing of
a Personal Financial Statement (PFS) Form with the Texas Ethics
Commission.
• A resume must be attached in order for this application to be
considered complete.
• All current and former attorneys must also complete the State Bar and
Judicial Conduct Release Form.
• Judicial and district attorney candidates must also complete the
Judicial Questionnaire and the State Bar and Judicial Conduct Release
From.
• Any information provided on the application or attached may be subject
to the Texas Public Information Act. This means that an individual
requesting copies of the information in your file may be provided
access to that information.
CERTIFICATION OF APPLICANT
I hereby certify that the foregoing and any attached statements are true, accurate
and complete. I agree that any misstatement, misrepresentation, or omission of a
fact may result in my disqualification for appointment. I assign and hereby give
the Office of the Governor full authority to conduct background investigations
pertinent to this application. I specifically authorize the Texas Department of
Public Safety to conduct a background investigation and to disclose the results of
that investigation to the Governor or his authorized representative.
__________________________
Applicant’s Signature
__________________________
Submit by ONE of the following: Date
Appointments Staff (512) 475-2576 fax
Office of the Governor
PO Box 12428
Austin, Texas 78711
ServingTexas@gov.texas.gov (with signed signature page)
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Texas State University System (TSUS) Non-Voting - Student (Sam Houston State University)

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Completed 26 August 2020

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