Delegation of GSAUCSD Council Voting Rights to a Proxy


I, ____________________, a certified GSAUCSD representative from
[department or program] ____________________, in the event of my absence
at the GSAUCSD Council meeting held on [date] ____________________,
hereby delegate my voting rights to [proxy] ____________________, who is
also a certified representative from the same department or program.

I understand, as per the GSAUCSD Constitution, Article IV, Section VI,
that this form must be presented to the chair of the GSAUCSD Council,
that the chair cannot serve as a proxy, and that the delegation herein
shall be in effect for one meeting only.


          ________________________________________  ____________________
          signature                                 date