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  • Texas Department of Agriculture

    Application for Texas Shrimp Marketing Assistance Program Advisory Board
  • NOTE: Applications must be received by 5 p.m. on Jan. 22, 2016.
    Click here for instructions on filling out this application.

  • SECTION A: APPLICANT INFORMATION

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  • MAILING ADDRESS

  • SECTION B: CATEGORY OF APPLICANT

  • SECTION C: SUPPORTING DOCUMENTATION

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  • Applicant for Categories 1-4: Provide information or documentation establishing that you have experience as a commercial bay shrimp boat owner, commercial Gulf shrimp boat owner, retail wild caught shrimp dealer or wholesale wild caught shrimp dealer.

     

    Applicant for Category 5: Provide documentation of current employment at a higher education institution or a government agency as either a researcher or instructor who specializes in the area of food science, particularly seafood.

     

    Applicant for Category 6: Provide information or documentation establishing that you have experience in the seafood restaurant industry.

     

    Applicant for Category 7: Indicate that you are a member of the general public with interest in serving on the Texas Shrimp Advisory Committee.

  • SECTION D: CERTIFICATION STATEMENT

  • I hereby certify that:

    • All information provided in connection with this application at any time is true and correct to the best of my knowledge and agree that any misrepresentation or false statement made in connection with this application will be grounds for disqualification to serve on the Texas Shrimp Marketing Assistance Program Advisory Board.
    • I am not required to register as a lobbyist under Chapter 305 of the Government Code because of my activities for compensation on behalf of a profession related to the operation of the Department.

     

    If applying as a “Representative of the general public,” I certify that neither I, nor my spouse:

    • Is certified or licensed by a regulatory agency in the field of seafood;
    • Is employed or participating in the management of a business entity or other organization regulated by or receiving funds from the Texas Department of Agriculture (TDA);
    • Own or control, directly or indirectly, more than a 10 percent interest in a business entity or other organization regulated by or receiving funds from TDA; or
    • Use or receive a substantial amount of tangible goods, services or funds from TDA.

     

    Further, as an applicant for “representative of the general public,” I certify that I am not an officer, employee, manager or paid consultant of a Texas trade association in the field of seafood.

     

    I authorize the Texas Department of Agriculture to conduct a background investigation in relation to this application, and understand that I will be required to provide my date of birth to facilitate this process. Failure to consent will result in rejection of this application.

  • SIGNATURE

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  • INSERT: This document becomes public record and is subject to disclosure. With few exceptions, you have the right to request and be informed about the information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. (Reference: Government Code, Sections 552.021, 552.023, and 559.004.)

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