Student Relations Committee Application Spring 2018 We are excited that you would like to apply to be on one the College's Committees. Please let us know more about you and why you would like to serve on a committee. Question Title 1. Personal Information: First Name: Last Name: Preferred First Name: Email Address: Phone Number: Question Title 2. Gender Identity: Female Male Transgender Decline to State Other (please specify) Question Title 3. Race/Ethnicity (please select all that apply): Asian/ Pacific Islander African American White Native American/ American Indian Latino/a / Chicano/a Middle Eastern / North African Mixed Decline to State Other (please specify) Question Title 4. Grade Level 2nd 3rd 4th 5th Graduate Question Title 5. Did you start at Cal as a: Freshman Transfer Graduate Student Question Title 6. Expected graduation date (include "Spring" or "Fall" and year): Question Title 7. Major: Bioengineering (BioE) Civil and Environmental Engineering (CE) Electrical Engineering and Computer Science (EECS) Engineering Science Program (ESP) Industrial Engineering and Operations Research (IEOR) Materials Science and Engineering (MSE) Mechanical Engineering (ME) Nuclear Engineering (NE) Bioengineering/Materials Science & Engineering Electrical & Computer Engineering/ Materials Science & Engineering Electrical & Computer Engineering/ Nuclear Engineering Materials Science & Engineering/ Mechanical Engineering Materials Science & Engineering/ Nuclear Engineering Mechanical Engineering/Nuclear Engineering Other (please specify) Question Title 8. Why do you wish to serve on this committee(s)? (maximum 500 words) Question Title 9. If you are selected to be a committee representative, how will you obtain input from the students you are representing? (maximum 500 words) Question Title 10. I certify that I am in good academic standing with the College of Engineering and with the University of California, Berkeley. Yes No Question Title 11. I certify that I have not been found responsible, or am not currently being investigated for an alleged violation(s), to the student code of conduct. Yes No Thank you for applying. Please allow 6-8 weeks after the applications have been closed for us to notify you with committee decisions. Done