Orange Santa 2009!

Orange Santa 2009 Application

Application Deadline: Received by 5 p.m. on Tuesday, November 24, 2009. If you have not received notification of your shopping appointment by Wednesday, December 2, please call the Office of Relationship Management and University Events at 471-7753.

Eligibility Requirements

Applicants for the Orange Santa program must be current employees or students at The University of Texas at Austin. Applicants who participate in the Orange Santa Program cannot benefit from other programs sponsored by the Austin Christmas Bureau.

Personal Information

Employee

Student

Last Name (as it appears on official UT records)

First Name (as it appears on official UT records)

Middle Initial

Date of Birth (mm/dd/yyyy)

Home Address

City

State

Zip Code

Home Telephone (###-###-####)

Work Telephone (###-###-####)

Cell Phone (###-###-####)

E-Mail Address

University Information

UT EID

Department/Unit/College

Work Location (i.e. building)

Campus Mail Code

Supervisor's Name

Supervisor's Phone

Preferred Method of Notification

E-mail Campus Mail

Phone Message from Supervisor

**Should your address or phone number change after submitting this application, please call 471-7753.

Shopping Appointments

Please pick three times you are available to shop. A letter with your assigned shopping time will be sent by the method you have chosen. Your shopping time may not be the same as what you requested.

First Preferred Shopping Time

Second Preferred Shopping Time

Third Preferred Shopping Time

Eligible Children

Eligible children are your minor children (17 and under) for whom you have legal duties of care and financial responsibility. Legal proof may be required.

If you have more than six eligible children, please send an email to elsieqr@mail.utexas.edu with the name, age and gender of all additional children.

Please complete for eligible children:

Last Name

First Name

Age

Last Name

First Name

Age

Last Name

First Name

Age

Last Name

First Name

Age

Last Name

First Name

Age

Last Name

First Name

Age

Required Authorization

By clicking the box below, you are authorizing the release of the information on this page to the Austin Christmas Bureau, and understand that by participating in Orange Santa, you are ineligible for other Austin Christmas Bureau programs. You certify that the information included in this application is true and correct and authorize the verification of your work or student status through official UT records.

I authorize this application.

If you require accommodations, please call Equal Opportunity Services, Monday through Friday, 8:00 a.m. to 5:00 p.m. at 471-1849. Please call at least 5 days prior to your shopping time.

This document is covered by the University of Texas at Austin’s Privacy Policy, found at www.utexas.edu/policies/privacy .